30 INTERNATIONAL THERAPIST WINTER 2019

BEAUTY | Skincare

PEEL POWER

Chemical peel services are in growing demand, largely because the results speak for themselves. I know fi rst-hand the difference a skin service that gets results can have – not just on the skin, but on an individual’s self-confi dence.

I started working with peels more than 20 years ago; one of my early experiences was doing

a series of glycolic acid peels for my best friend. She had quite severe acne scarring and oily, open-pored skin, and the treatments made a profound difference. She had struggled with her skin all the way through school and was extremely self-conscious. Without doubt, the peels were a turning point for her.

PEELS IN PRACTICEChemical peels work by removing layers of the skin, stimulating cell renewal and turnover, improving the skin’s texture and appearance, and promoting more evenly distributed melanin. This makes them a popular, relatively inexpensive treatment choice for a wide range of skin concerns, from acne and hyperpigmentation to advanced signs of ageing.

Peel formulas have become more sophisticated over the last 20 to 25 years, and we have moved beyond grading the effectiveness of a peel purely on acid selection and concentration. Today, we have advanced our understanding of the skin’s physiological changes, refi ned our technique and boosted formulations with additional agents that

CANDICE GARDNER FROM DERMALOGICA

TALKS ABOUT THE BENEFITS OF SKIN PEELS

AND THE IMPORTANCE OF BEST PRACTICE

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Skincare | BEAUTY

WINTER 2019 INTERNATIONAL THERAPIST

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after treatment, the implications of not following the skin management directives, and how long recovery should take.

This is followed by coaching clients effectively on how to modify their skincare regimen in preparation for the peel. Having skin in the best possible condition can improve tolerance to the peel and facilitate recovery.

Priming the skin prepares it for application of the highly active chemical agents. This is particularly benefi cial if a client is new to peels. At-home exfoliants containing retinol or hydroxy acids can acclimate the skin and improve the tolerance of professional-grade peeling agents. Any treatment product that reduces build-up of the stratum corneum increases the permeability of the epidermis and thus the penetration of hydroxy acids. Be sure that the clients observe the rules in relation to exfoliant-free days pre-peel so that the skin tolerates well. This varies according to the type of exfoliant and product.

Generally speaking, healthy skin is less likely to experience adverse reactions to a chemical peel. Cracked or dehydrated skin allows chemical peel agents to penetrate quicker and further. This can intensify stinging and burning sensations during the procedure, which necessitates reducing the length of application or number of peel layers and potentially compromises the result due to client discomfort. Rapid penetration also increases the risk of irritant responses and over-peeling vulnerable areas. Prescribing the relevant products to repair barrier function and increase hydration in advance of having a peel will contribute to the right skin outcome.

Covering all this essential information ensures that the client can make an informed decision about whether to proceed with the service, so scheduling enough time for this consultation appointment is vital.

As chemical peels could present a problem in some skins, it is important to carry out a patch test. This is a simple strategy that reassures both you and the client that it is safe to proceed. A minimum of a 24-hour patch test protocol is recommended. However, you could patch-test several weeks in advance of the peel as it is preferable that you have at least two weeks to prime the skin to maximise the peel outcome.

As an aside, if you have not read the small print on your liability insurance, make this a priority. Insurers are usually very clear about the procedures that should be followed for your cover to be valid, and patch testing generally features. If the policy stipulates that you should follow manufacturer’s protocols, then be aware that reputable peel companies will have patch testing as part of the standard procedure.

enhance or complement the lead acid for faster results in fewer peel treatments. We have also transformed the client experience as formula advancements have made peels better tolerated with less downtime.

While there are risks attached to chemical peels, the vast majority of these can be mitigated by maintaining high standards of practice and prioritising client safety, both of which are reliant on effective training.

In this article, I’ll be exploring some areas of best practice, so if you are already offering peels, you can compare your existing procedures and protocols. If you are new to peels, this may assist you in developing your service procedures.

THE CONSULTATIONDetermining whether a peel, and perhaps which peel, might be appropriate for a client starts with an in-depth consultation. Thorough discussion with the client will rule out contraindications – such as use of isotretinoin in the last six months, skin infection, contagious disease or pregnancy – and identify the desired outcomes, but the consultation process must do more than this.

It should help the practitioner to identify client skincare behaviours and lifestyle choices that could infl uence the peel results. As an example, it is recommended that a client reduce direct UV exposure – both natural and artifi cial – and apply daily SPF sunscreen in the two weeks leading up to a peel to ensure melanin production is at baseline according to their skin type. This helps reduce the risk of hyperpigmentation developing post-peel. Clear advice and modifi cations can be presented on everything from retinoid use to scheduling correctly around other cosmetic procedures and treatments.

The practitioner has a responsibility to brief the client on what to expect during the peel procedure, the skin changes that occur

“The high success rate with peels, on a broad range of skins, makes

these treatments very rewarding

to deliver”

Skin peels are a relatively inexpensive treatment

for a wide range of skin concerns, including acne

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FHT.ORG.UK32 INTERNATIONAL THERAPIST WINTER 2019

BEAUTY | Skincare

Candice Gardner has been a professional skin therapist for more than 25 years and regularly contributes to trade and consumer press. She is education manager – content for Dermalogica and the

International Dermal Institute (UK and Ireland) and a member of the City & Guilds Industry Advisory Board for Beauty. dermalogica.com

LEARN MORE AT THE 2019 FHT TRAINING CONGRESSCandice will be giving a seminar – ‘Achieving results with peels’ – at the 2019 FHT Training Congress at Holistic Health on Monday 20 May. For more information, visit fht.org.uk/congress

THE PROCEDUREActively address safety for the client – and for yourself, as practitioner – in every service. Never become complacent.

Gloves and safety glasses should be worn when performing peels, as set out in the national occupational standard.

Of key importance is protecting the client’s eyes. If not using a treatment chair, the head of the treatment couch or plinth should be elevated rather than fl at during the procedure, to avoid peel solutions running into the eyes. Protect the eyes with eye pads and make sure there is an eye wash station on standby for emergencies. Practitioners must be trained to perform an eye fl ush to ensure they can confi dently handle the situation if the need arises.

Keep the lights up so you can observe skin changes effectively and use a sensation scale to monitor the client’s discomfort level while the chemical agent is in contact with the skin. By getting the customer to actively grade their discomfort the practitioner can maintain conscious engagement in the client experience, and can take action to allay concerns or stop the peel if necessary. This information can also be recorded and agreed with the client post-service for accurate record-keeping in the event of liability claims.

The depth of peeling should be controlled by neutralising at the appropriate point. This will be determined by both the manufacturer’s protocols and the skin response. Close monitoring will ensure that you don’t push the skin beyond your remit, or compromise the outcome by over-peeling and causing long-term damage.

Skin may feel as if it is sunburned. This can range in terms of severity of erythema and sensation. If done correctly, however, the depth of a superfi cial peel would not usually cause undue swelling or blistering. Some spot blanching on small areas that have been overprocessed should be an exception rather than an expectation in the case of hydroxy acid peels. Of course, this will be different in the case of trichloroacetic acid, which is a keratocoagulant. Keratocoagulant agents contribute to exfoliation by coagulating the skin’s proteins, contributing to stimulation of cell renewal rates and cell turnover. In this reaction, the protein is denatured, similar to an egg white turning white as it cooks. This can produce the skin-whitening effect known as ‘blanching’, particularly in areas of breakout or dehydration.

Practitioners should be very conscious of the increased sensitivity when removing neutralisers or applying moisturisers. Lightening the application or working pressure to minimise friction and

manipulation of the skin is recommended. Never massage these peeled areas. Experienced therapists can be habitual and don’t always consider how much effl eurage they use or what the pressure of the strokes may be. Techniques can easily be adapted to lessen the aggravation.

THE RECOVERYObservation of the post-care instructions prevents delay in recovery and reduces the risk of undesirable side effects.

The initial priority after a peel is to protect the vulnerable skin. Having removed a large proportion of the protective epidermis, the skin requires a moisturising barrier product and daylight protection with a minimum of SPF 30. You may wish to select a physical sunscreen agent as the sensitivity potential is lowered and will feel more comfortable for the client.

The peeling process usually begins one to fi ve days after treatment and the skin may appear darker, dry and fl aky. The acids dehydrate the keratinocytes, which contributes to the pigmentation looking darker. This is not a pigmentary change due to increased melanin production. It is the result of the lost refl ective moisture in the epidermal cells and subsequent compounding of pigmented cells as cell turnover accelerates.

Skin will feel tight due to this dehydration and will start to peel. It is essential that the client does not scratch loose skin or scabs, as

increasing irritation or infl ammation could lead to scarring. Clients should focus on hydrating the skin as much as possible.

For superfi cial peels, this process is usually completed in fi ve to 10 days, at which time you will see the result. Series applications usually schedule subsequent peels at two- to four-weekly intervals to compound the result.

Provide clients with clear guidance on how to manage their skin after the peel. A written reference piece provided in print or digitally will ensure there is no confusion or misunderstanding of how they should take care of their skin.

ESSENTIAL POST-CARE ADVICE1 Apply sunscreen protection (minimum

SPF 30) daily following treatment.2 Avoid direct sunlight and sunbeds for two

to three weeks.3 Do not wax or use any type of exfoliating

product for 72 hours, or until the skin shows no signs of sensitivity on the treated area.

4 Do not peel loose skin or pick at scabs or blisters, as scarring may occur.

5 Avoid excessive heat sources, such as sun exposure or dry saunas and steam rooms.

6 Avoid strenuous exercise or any activity that could lead to increased blood circulation to the face for 24 hours following treatment. This can cause an increased warming effect, which could result in discomfort, redness, infl ammation, swelling or other side effects.

GETTING RESULTS The high success rate with peels, on a broad range of skins, makes these treatments very rewarding to deliver. Set up for results by putting the right procedures in place and you will reap the benefi ts, not only in results but in a loyal client following that bolsters service profi tability.

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