• 1
  • 2
  • 3
  • 4
  • 5

Many of our clients’ skin concerns are related to excessive dead skin cell build-up, a compromised barrier function, wrinkles, acne or discolorations of the skin. To achieve skin wellness, it is necessary to offer a corrective treatment plan that will attain the results that our customer desires, such as a chemical peel.

 

Many of our clients have never experienced a chemical peel. Apprehensions are common and understandable.  Even the term “chemical peel” may be frightening to a new customer. A simple rephrasing to “professional exfoliation treatment” can calm these fears as most customers understand exfoliation. The key to a successful professional exfoliation outcome depends on selecting the appropriated treatment and gaining customer confidence and compliance with corrective homecare products.

Evolution of Exfoliation

The use of chemicals to treat the skin has evolved throughout history from poultices to modern day blended chemical peels. In our esthetic educational programs, we learned that exfoliation originated as early as 3000 AD with the ancient Egyptians bathing in sour milk (lactic acid) and wine (tartaric acid) to smooth the skin. The Greeks used limestone, mustard poultices, sulfur and urine to exfoliate while the Romans exfoliated with sour goat’s milk, alabaster and red wine. The ancient Turks were far more daring using fire to exfoliate and lighten the skin.

Today many manufactures blend multiple acids such as trichloroacetic, retinoids, lactic, glycolic, salicylic , ascorbic and kojic acids amongst many others to exfoliate the dead or compromised skin cells and uncover healthy new ones. With blended peels we can treat multiple skin conditions simultaneously, such as aging with hormonal breakouts or acne with post inflammatory hyperpigmentation. Some companies have added phenol to the blended solutions to provide antiseptic and anesthetic properties. Blended peels have the additional benefit of combining multiple acids at lower percentages that are able to produce similar results as a straight acid at a higher percentage but without a high level of inflammation and irritation.

Exfoliating Agents and Their Uses

Each exfoliating agent has a different mechanism of action accompanied by varying benefits. The more educated the practitioner is, the more effective the treatment program will be.

Alpha hydroxy acids (AHAs) are water soluble acids that dissolve the desmosomes (fibrous bonds) that hold skin cells together. This allows for easier exfoliation.

Alpha Hydroxy Acid

Source

Benefits

Glycolic

Sugarcane or synthetic

Stimulates collagen, degreaser

Lactic

Milk or sugars

Hydration, pigment suppression

Malic

Apples

Hydration, soothing, antioxidant

Tartaric

Grapes

Antioxidant

Citric

Citrus fruits

Antioxidant, hydration, brightens, regulates pH

Mandelic

Almonds

Pigment suppression, antiseptic

Beta hydroxy acids (BHAs) such as salicylic acid are keratolytic meaning that they digest surface cells. BHAs are lipid or oil soluble making salicylic acid an excellent choice to clear the cellular buildup that clogs pores.

Beta Hydroxy Acid

Source

Benefits

Salicylic

wintergreen

Anti-inflammatory, antimicrobial and antiseptic.

Beta-lipohydroxy  (LHA)

salicylic derivative

Less irritating than salicylic acid, decreases bacteria

 

  • Trichloroacetic acid (TCA) is a chemical cauterant synthesized in a lab by combining three chlorine molecules with acetic acid, a mild organic acid derived from vinegar. TCA dissolves aging cells to make room for newer healthier ones. It is an excellent ingredient in chemical peels due to its ability to stimulate the fibroblast cells to produce collagen.
  • Phenol (carbolic acid), also known as phenic acid is another chemical cauterant which dissolves cells. Additionally, phenol is an antiseptic and provides an anesthetic or mild numbing effect on the skin. Phenol is the numbing agent used in Chloraseptic® throat spray.
  • Resorcinol is a phenol derivative, often sourced from wood barks. It is commonly used as a flaking agent in chemical peels.   
  • Retinoids are a class of chemical compounds that are related chemically to Vitamin A. Retinoids increase cell turnover, inhibit pigmentation (melanogenesis), hydrate and stimulate collagen and elastin production.
  • Retinoic acid has the extra cellular action of AHAs and the ability to penetrate epidermal and dermal cells internally. Retinoic acid encourages exfoliation while repairing or replacing damaged cells. Retinoic acid acts by binding to the retinoic acid receptor  (RAR), which is bound to DNA as a macro molecule with the retinoid X receptor, enabling retinoic acid to affect cellular DNA by repairing damage and producing cellular renewal.
  • Retinol is not as strong as retinoic acid and cannot interact with the retinoic acid receptors in the skin; it converts to retinoic acid by chemical reaction. Retinol binds with an enzyme called cytoplasmic retinol binding protein that converts it to retinaldehyde. Retinaldehyde is then oxidized by retinaldehyde oxidase which converts it to retinoic acid. 
  • Retinyl Palmitate, retinol combined with palmitic acid, is the mildest form of vitamin A. It functions as an antioxidant. Retinyl palmitate must convert to retinol, then to retinaldehyde before converting to retinoic acid.
  • Pyruvic acid sourced from grapes, honey, apples, fermented fruit, and vinegar is commonly used for medium depth peeling. It provides antiseptic properties, stimulates collagen and elastin production and reduces sebum levels.
  • Poly hydroxy acids (PHAs) are similar in action to AHAs, except they are less irritating. PHAs exfoliate, moisturize, improve tone and texture and are excellent anti-oxidants. Gluconolactone and galactose are examples of PHAs.
  • Enzymes can also be used for professional exfoliation. Common enzymes include pumpkin, pineapple and papaya. Papain from papaya, bromelain from pineapple and pumpkin extract are called proteolytic or protein dissolving enzymes that dissolve the keratinized layer of skin.

Peel Penetration Factors

The following are several factors to consider when determining a client’s treatment.

  • Skin preparation: Skin prepped with a topical retinoid and degreased with acetone strips the skin of all oils allowing for optimal penetration.
  • Skin type: Dry or dehydrated skin tends to absorb a solution more than oily skin.
  • Area treated: The skin on the body is thicker than the face or neck which slows peel penetration.
  • Time of treatment: The longer the solution is left on the skin, the deeper it can penetrate (unless it is self-neutralizing).
  • Application methods: Methods range from soft cotton squares, sponges, and glycolic wands, to gauze and fan brushes. Gauze and fan brush applications produce deeper penetration.
  • Type of formula: Dependent on the formula and percentage of acid, a straight acid will usually penetrate deeper than a blended peel. A chemical peel with a lower pH will penetrate deeper than a peel with a higher pH.
  • Concentration of formula: A 100% TCA is very aggressive, penetrating deeply, while a 5% TCA is superficial.
  • Peeling agents:  AHA’s provide superficial exfoliation while a straight TCA or phenol peel incurs deeper penetration and moderate to heavy exfoliation.

 

PEEL PENETRATION *

*This chart is intended to serve as a guideline for potential peel penetration.


Very superficial

Superficial

Medium depth

Deep

Low potency AHA’s

AHA’s

30-40% TCA

Straight Phenol –high %

6-10% TCA

10% Retinols

35% TCA + Jessner

Baker- Gordon

Low % Retinol Peels

Jessner Solution

Obagi Blue Peel

 

Salicylic acid

10-20% TCA

(layer dependent)

VI Peel™

50% Pyruvic Acid

Various medium depth blends

 

Setting Realistic Expectations for Your Clients

Clinicians occasionally experience customer dissatisfaction regarding the results of their chemical peel treatments. Many clients have unrealistic expectations for chemical peels. The biggest misconception being that the skin will always flake. While there is always exfoliation, it may be at the cellular level and not visible to the naked eye.  Another issue that is often misclassified as an adverse reaction to a chemical peel is Post Inflammatory Hyperpigmentation (PIH). As clinicians, we need to educate our clients on expected outcomes from their treatments. Each person’s skin is unique. Never expect any two clients to have the exact same results. A consent form should be signed prior to each peel after reviewing realistic expectations.

 

Common Reasons Why a Client Does Not Visibly Flake

Many clinicians suffer frustration because a client expects to see flaking after a chemical peel. There are many reasons that flaking may not occur.

  • The client may have an extremely impacted stratum corneum (corneocyte cohesion). It may take two or more treatments to break down that outer shell so that the skin can begin to shed.
  • A client with oily skin must be degreased thoroughly to enable the solution to penetrate adequately. Otherwise the client may experience a sub-par treatment with little to no flaking.
  • The client may be so well exfoliated that their skin does not need to flake. They are still exfoliating at a cellular level, just not on a visual epidermal level.
  •  “Application technique failure” occurs when the clinician does not degrease the skin appropriately or apply the solution according to manufacture protocol which can affect treatment outcome.
  • The environment can play a factor. In humid environments the moisture in the air can inhibit exfoliation.
  • Recent treatments by the client can be another factor. Have they had aggressive treatments in the recent past that may account for a lack of, or lower level of exfoliation?
  • Client skin preparation prior to the peel is a large factor. Recent use of skin thinning topicals or systemic medications such as Accutane, antibiotics, recent sun exposure, and Fitzpatrick Type are examples of factors that may affect flaking.

*This list is not intended to be all inclusive; but to be used for educational purposes.

How to Avoid Treatment Complications

The most effective way to avoid complications is to be informed. Schedule a pretreatment consultation. Complete a thorough client intake form and conduct a complete skin analysis using your mag light and Woods Lamp. Apply a patch test of peel solution about the size of a dime in the area that you plan to exfoliate. As most allergic reactions will occur within 48 hours, a consultation is best held one to two weeks prior to treatment, at the very minimum 48-72 hours prior to peeling. Always review any client sensitivities to all ingredients used in the peel and post care regimen, and review any possible contraindications to your suggested treatment plan.

Brenda Linday, L.E., L.E.I.

 

 

Share this post

Submit to FacebookSubmit to LinkedIn