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Medi-Spa > Chapter 10: Chemical Peelings > Flashcards

Chapter 10: Chemical Peelings Flashcards

1
Q

What are the benefits of offering chemical peels at your spa?

A

Offering chemical peels in your skin care practice will be one of the most exciting and financially rewarding areas of your treatment “bag of tricks”

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2
Q

How do we define the process of removing excess accumulations of dead cells?

A

We define the process of removing excess accumulations of dead cells from the corneum layers of the epidermis as superficial peelings, exfoliation, keratolysis and desquamation (all interchangeable terms)

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3
Q

How do we accomplish exfoliation?

A
  • mechanically: microdermabrasion, manually (scrubs)

- chemically: use of specific products (glycolic acid) formulated to achieve results

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4
Q

What are the difference of chemical peels provided by a physician and a skin care therapist?

A

-physician will provide medium to deep peels with procedures designed to penetrate deeper into the dermal layer
-skin care therapists use procedures designed only to penetrate the epidermis (light peels)
—>light peels are non invasive and non aggressive in nature and are designed to treat only the epidermis not the dermis (not living tissue)

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5
Q

Chemical Peel History:

A

-more than 5000 years ago, the Egyptians used a form of chemical peeling (they understood the value of lactic acid from milk and the various fruit acids from skin conditioning) Thus when cleopatra relaxed in her milk baths she was undergoing a chemical peel
-physicians began using deeper peels in 1882, employing RESORCINOL, TRICHLOROACETIC ACID (TCA), SALICYLIC ACID, and PHENOL
—these procedures became very popular in the 1930s and 40s, when Antoinette la Gasse brought the procedures from France to the United States
-In the 1980s, the practice of superficially peeling clients by aestheticians was just beginning
—ALPHA HYDROXY ACID (AHA) peels were the buzzword of the 1990s, and they are even more popular today.

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6
Q

Caution when using chemical peels:

A
  • peels can result in burns that’s may require medical attention and they can scar a client
  • it is important to obtain as much training as possible in working with chemical peels
  • make certain that you consult with the client before applying a peel, follow the manufacturers instructions, and always patch test (inside or behind ear) 24 to 48 hours before giving a peel to watch for adverse reactions to the product
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7
Q

What is the cell renewal factor (CRF)?

A
  • cell renewal factor (CRF), or cell turnover rate, is the rate of cell mitosis and migration through all the layers of the epidermis
  • this process slows down with age
The average cell turnover rate for:
Babies- 14 days
Teens- 21-28 days
Adults- 28-42 days
50+ 42-84 days

-therefore keeping cell mitosis going is one of the goals for skin preservation

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8
Q

Factors influencing CRF:

A
  1. Genetics
  2. The natural environment
  3. Ones medical history
  4. Lifestyle
  5. Personal care
  6. Exfoliation methods
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9
Q

How many layers is the keratinized corneum layer composed of?

A

15-20 layers

-it varies in thickness in different body areas

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10
Q

What is important to maintain in the skin during chemical peeling?

A
  • while peeling is great for the skin it is important to maintain hydrolipidic balance, especially for alipidic skin types
  • over peeling is detrimental to the skin
  • REGULATORY AGENCY ALERT
  • each regulatory agency is different, so check with your local laws to see what is acceptable in performing exfoliation services under your esthetics licence
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11
Q

What are Alpha Hydroxy Acids?

A

-AHAS
-mild acids (but stronger than BHAS)
-Glycolic Acid is an AHA derived from sugar cane that’s is used in different percentages and pH factors to dissolve Desmosomes between cells to keep skin cells exfoliated
-other AHAS promote superficial peeling as well
-

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12
Q

What are Beta Hydroxy Acids?

A

-BHAS
-milder than AHAS
-used to effectively exfoliate the skin
-salicylic acid (derived from sweet birch, willow bark, and wintergreen)
—>has antiseptic and anti-inflammatory properties
—>effective keratolytic exfoliant with a different mechanism than of action of AHAs
-citric acid
-dissolve oil and are used for oily skin and acne
-Aspirin is derived from salicylates

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13
Q

How are AHAS thought to work?

A
  • AHAS are thought to penetrate the corneum via the intercellular cement and loosen the bonds between the cells
  • the intercellular cement between skin cells consists of ceramides, lipids, glycoproteins, and active enzymes
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14
Q

What does AHAs increase the production of?

A

Intercellular lipids

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15
Q

Why is Glycolic Acid the most effective AHA?

A

-glycolic acid can penetrate into the epidermis more effectively because it has the smallest molecular size of the AHAS

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16
Q

Examples of AHAS:

A
  • glycolic acid (derived from sugar cane)
  • lactic acid (derived from milk)
  • tartaric acid (derived from grapes)
  • malic acid (derived from apples)
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17
Q

Differences between AHAS and BHAS:

A
  • AHA work on clusters of the cells, BHA works on individual cells
  • AHA works from the bottom up, BHA works from the top down
  • AHA is water soluble, BHAS are fat soluble and therefore can penetrate into the follicular pore, helping exfoliate from inside the pore as well as on the skin surface
  • Easy penetration and antimicrobial effects of BHA makes it a favourable ingredient in acne treatments
  • BHA appears to be less irritating that AHA, however if used in concentration above 2%, can cause irritation, redness, itching and burning
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18
Q

What is Jessner’s solution:

A
  • A combination of three different acids: 14% salicylic acid, 14% resorcinol & 14% lactic acid- in an ethanol base
  • provides a superficial peel, focusing on exfoliation and digestion of debris associated with acne
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19
Q

What is Trichloracetic Acid (TCA)?

A
  • a common peeling agent in the medical spa
  • comes in a variety of strengths, usually increasing incrementally by 5% points: 10%, 15%, 20%, 25% and so on.
  • has many benefits: non toxic, stable, easy to use, able to create a variety of results
  • Most commonly used TCA peel is Obagi blue peel, which usually consists of 30% TCA diluted to 15 or 20% by the blue dye used with the peel. TCA penetrates the papillary dermis or the upper reticular layer of the dermis when a full frost is achieved
  • The Frost is the result of the chemical TCA coagulating the protein in the skin and is considered the end point
  • Overall, TCA is easy to use, predictable, medium peel in the hands of a properly trained professional
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20
Q

What are Deep Peels?

A
  • administered by physicians and make use of the following chemicals: resorcinol, phenol (carbolic acid, also called Bakers peel), trichloracetic acid (TCA 50% or more), glycolic acid (50% or more) and Jessner’s peel (4 to 5 coats)
  • Jessner’s peel contains lactic acid, salicylic acid and resorcinol in an ethanol solvent
  • Phenol is a highly acidic deep peel that peels down into the dermis
21
Q

What are Medium Peels?

A

-TCA (30-50%) is a medium depth peel that removes the epidermis down to the dermis

22
Q

What are Light peels?

A
  • light peels or superficial peels are administered by aesthetician.
  • These make use of glycolic acid (30 % or less), enzyme peels, and in some cases Jessner’s solution (1-3 coats)
23
Q

Describe the pH relationship to a chemical peel:

A
  • the pH is an important consideration in peel products
  • acids have a pH of 1-6, 7 is neutral, and alkaline ranges from 8-14.
  • Average pH of skin ranges from 4.5 to 5.5
  • Acids penetrate into the skin and can be a cause of irritation
  • a pH of less than 3 is not recommended for salon peels; most states do not allow using lower pH
  • a 30% glycolic acid is usually formulated to have a pH of 3 if buffered properly
  • buffering agents are ingredients added to products to help make them less irritating
  • Products with a higher percent of acid and a lower pH are more irritating
  • the acid needs to have a pH lower than the skins pH to be effective
  • AHA product formulations contain from 2% to 15% of an acid
  • the most common products sold by salons ranger from 5-10% of an acid
  • physicians carry products with higher percentages
24
Q

PH scale diagram:

A
25
Q

Peel Benefits:

A

*Everyday the human skin undergoes the normal process of sloughing older skin cells. In their place, newer cells have travelled up through the layers of skin.
-Chemical Peels speed up this process in different ways:
1) Resurfacing the stratum corneum stimulates epidermal growth. This makes the epidermis more vibrant and youthful
2) Chemical peels cause slough damaged skin. Ideally the damaged or dichromatic skin will be replaces with healthier, normalized tissue by means of the skin’s wound healing processes
3) Deeper peels induce the production of new collagen and ground substance within the dermis
—> this occurs as an inflammatory response to wounding the deeper basal layer and the papillary layer of the dermis

26
Q

General Peel Benefits (results):

A

1) Improve the texture of the skin and increase the CRF; hydration, and intercellular lipids
2) Peeling improves the barrier function, moisture retention, and elastin and collagen production
3) Peels also reduces fine lines, wrinkles, and surface pigmentation. After treatments, skin looks and feels smoother and softer
4) Peels are used to control skin conditions such as acne, hyperpigmentation, clogged pored, and dry skin

27
Q

Who should be peeled?

A

Who are the best candidates for a peel? When determining whether a series of peels is appropriate for a client, consider the following factors:
1- skin type
2- sebaceous gland activity
3- skin conditions
4- the clients philosophy of sun exposure
5- the clients cosmetic and product use
6- if the client is using Retin-A or other acids/ AHAs, Accutane, or tetracycline

28
Q

Contraindications for chemical peel:

A
  1. Excessive telangiectasia
  2. Recent cosmetic surgeries, laser resurfacing, chemical peels, dermabration
  3. Allergies/ sensitivities to products or ingredients
  4. Pregnancy
  5. Herpes simplex
  6. Hyperpigmentation tendencies
  7. Use of accutane, retain A, or other medications that’s exfoliate the skin
  8. Inflamed rosacea or acne
  9. Infectious diseases
  10. Open sores or suspicious lesions
  11. Sunburn or irritates skin
29
Q

What should be explained about the contraindications and cautions that should be taken/ complications of chemical peels:

A
  • explain procedures, expected outcome, realistic goals
  • diagnostic facial or skin analysis before scheduling peels/ note skin condition, dehydration, hyperpigmentation, open lesions (or any condition on cilent intake form)
  • choose type of peel based on clients skin condition and desired result
  • peel complications are more severe, often to the detriment of the salient
  • chemical peel complications can range from minor irritation to permanent scarring
  • strength of chemicals used increases the risks of chemical peels
  • remember the % of the peel is not the only factor that determines the depth of the peel (one must also consider the pH to assure predictable results)
30
Q

Why are additional ingredients added to peel formulas?

A

Additional ingredients added to peel formulas include pigment lighteners, acne ingredients, moisturizers or hydra toes, and others

31
Q

Beneficial ingredients to add to peels diagram?

A
32
Q

How do you select the prodcedure guidelines and strength of the peel?

A
  • Your regulatory agency will determine the procedure regarding the strength of the peel
  • peel selection will include type of acid, procedure time, strength and the assisting ingredients
  • protocols vary between product lines
  • Advanced training and certification are necessary to perform glycolic peels (basic process involves applying peel and removing within a few minutes)
33
Q

How do exfoliation services differ in procedure time vs a more relaxing, in-depth facial.

A

Exfoliation services are efficient and take less time than more relaxing, in-depth facials.

34
Q

How many treatments are needed for peels and in what intervals? (Treatment different that’s maintenance)

A
  • Peels can be scheduled in a series of 4-8 peels (1/week for 4-8 weeks)
  • more than 8 weekly peels in a row are not recommended
  • a series of peels every 3-4 months is the typical recommendation
  • can also be scheduled 1/month or as needed
35
Q

Describe the maintenance schedule for chemical peels.

A

Maintenance is optimal at 1/month or every 6 weeks.

*schedule will depend on the product strength and the clients tolerance to AHA’s.

36
Q

What cautions are necessary after peels to prevent skin injury?

A

Warn client to avoid:

  • sun exposure
  • scrubs
  • waxing
  • rubbing
  • pulling dead skin
  • depilatories
  • benzoyl peroxide
  • exfoliating again
  • any glycolic acid products
  • for 24 to 48 hours)
37
Q

Explain the home care discussion with the client following a chemical peel:

A

Discussion of home care with clients includes issuing precautions and product advice.
Peel clients should avoid the sun and exfoliation outside of the recommended home care program.
-an example of a home care glycolic product would be a 5 percent cream in a moisturizer base. This product may be used approx every other day put under sunscreen or at night on DRY skin.
—water or moisture on the skin can make the cream more active and cause it to sting
Peels make the skin dryer because the top layer is sloughed off so moisture and staying hydrated is important
*make sure to communicate these points clearly to your clients

38
Q

Approx how long can it take to notice a difference in the skin after chemical peel treatments?

A

It can take approx 6 weeks to notice a difference in the skin, but sometimes improvements are noticed after only one peel or one week of using the home care product.

39
Q

What is glycolic plus and how many phases does the treatment consist of?

A

-is a professional treatment consisting of 3 phases: 2 serums and 1 mask

40
Q

What are the indications for glycolic plus treatment?

A
  • intended for people with thick, dehydrated, ageing and hyperpigmentation skin
  • also indicated for normal, oily, acne-prone skin

-particularly recommended for treating hyperkeratinization related to age, environmental aggressions or hyper secretion and also in treatment of hyperpigmentation (cholasma, brown spots), zeros is (so-called dry, rough skin), wrinkles, acne, etc

41
Q

How many treatments are needed for glycolic plus?

A
  • recommended in a cure of 4 treatments at the rate of 1 treatment per week
  • cures should take place at the beginning of each season, 4 times/year
  • can be used occasionally by people with sensitive and delicate skin
42
Q

Glycolic plus and sun exposure

A

-for the whole duration of the AHA cure, as in the case of a cure with Pro-Retinol, the esthetician will recommend a protection cream with SPF
-the use of Glycolic Plus, as with any other AHA-based product or with pro-retinol in a cure or occasionally, should not occur during the summertime.
—otherwise, it is absolutely necessary to use a sunscreen or sunblock with a high protection

43
Q

Glycolic Plus Phases Protocol Chart:

A
44
Q

What is the total concentration of AHA in Glycolic Plus?

A

10%

  • it is a concentration of non-neutralized free acids. Therefore this 10% represents the concentration in “active” acids.
  • These AHAs are only present in phase 1 and phase 2 of the treatment
45
Q

What is the pH of phase 1 and phase 2 of glycolic plus treatment?

A

Phase 1: 2.3-2.4
Phase 2: 2.7-2.8

  • in order to obtain maximum efficacy of the treatment

Phase 3: the mask does not contain any AHA. It’s pH is similar to that of the epidermis so as to compensate for the prominent acid nature of the AHA in phase 1&2.

46
Q

Directions for use diagram:

A
47
Q

Contraindications : Glycolic Plus must not be applied:

A
  • on the skin of children
  • on the skin of hypersensitive people prone to allergies
  • on any irritated skin or skin treated with medication
48
Q

Precautions for glycolic plus treatment:

A
  • avoid applying to mucous membranes and eyelids
  • avoid sun exposure during entire treatment
  • stop using if signs of irritation appear

N.B - the skin growing pink is a normal phenomenon and must not be regarded as irritation

As for all cosmetics:

  • for external use only
  • keep out of eyes and eye area
  • store in cool place, preferably away from light

**For professional use only!

Medi-Spa (12 decks)

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