THE SALON SPA TRAINING INSTITUTE

"CHEMICAL PEELS: 101" (CE# 12-1520-5)

Course Hours: 4; Course Eligibility: Cosmetologists (C), Estheticians (E), Teachers (T)/Instructors (I)

This Course is Offered to Licensed Cosmetologists, Estheticians, Teachers (CT, ET), and Students (Cosmetology and Esthetics)

Note: *Please take the allotted time for this 4 hr. course to read, reflect, and retain the information.  After you read through your course for the allotted 4 hrs., you can take and submit your end-of-course exam at the bottom.  Please include your name, license number and contact information at the beginning of your end-of-course exam. At the end of your exam, please press the "submit" button to submit your exam.  We will then email your exam results and course completion certificate within the same business day. If your exam is submitted after 9:00 p.m., we will email your results the next business day. Thank you and if you have any questions, please feel free to contact us at 919-672-4698, or email at SalonSpaTraining@aol.com (Note: Our online CE courses have  a timer/timing element; but it is presently being rebooted for our system, and will be up soon. Therefore, this is an alternative way you can take your online CE course.  Thank you for your patience, and we hope you enjoy your course!).

*NOTE: AFTER YOU REGISTER/PAY FOR YOUR COURSE, YOU MUST READ THIS COURSE FOR THE 4hr. REQUIREMENT. PLEASE DO NOT SUBMIT YOUR END-OF-COURSE EXAM UNTIL 4hs. AFTER YOUR COURSE PAYMENT. 

This Course Was Written and Created by:

Dr. Terri Rowland (CE Provider/CE Instructor)

The Salon Spa Training Institute℠

919-672-4698 (Phone);  SalonSpaTraining@gmail.com (Email); http://www.salonspatraining.com/ (Web Site)

Lesson Objective:

This course is designed as a 4-hour Online (Internet-based) course for Cosmetologists, Estheticians, and Teachers (Cosmetology and Esthetics Teachers respectively). This course gives the foundation of chemical peels with an emphasis on: ingredients, strength, how they affect the skin, and anticipated results. This course also addresses how chemical peels are administered; what precautions must be taken; and contraindications are discussed as well.

Overall, Light (AHA & BHA); Medium (Tricholoracetic Acid); and Deep Peels (Phenol/Carbolic Acid) will be discussed - but there will be greater emphasis on light peels, including Alpha Hydroxy Acid (AHA) peels and Beta Hydroxy Acid  (BHA) peels respectively. There will also be a discussion of the skin, including anatomy, physiology, and skin conditions - as well as discussion regarding antioxidants and free radicals of the skin and body; and various vitamins, extracts, and chemical peel acids that can treat the skin. 

Course Eligibility: Cosmetologists, Estheticians, and Teachers (Cosmetology & Esthetics)

Time Allotment: Course participants will have up to 30 days to complete this 4-hour Online course.

                                                                                                                            

 

 "CHEMICAL PEELS 101"  -  240 Min./4 HOURS

Module I: Introduction (20 Min.)     

Course Introduction/Chemical Peel Overview (7 min.)

The esthetics industry has seen a boom in the past decade with skin care services, and chemical peels have been a longstanding service, in which clients have seen vast results.  Known as a non-invasive treatment, chemical peels - also known as "epidermal exfoliation," "chemexfoliation," or "derma-peeling" have elevated advanced esthetics to a new level, with cost effective means of improving the overall appearance of the skin. Chemical peels are comprised of a chemical solution, oftentimes an acid solution; that is applied to the outer layer of the skin, better known as the "epidermis." There are also chemical peels that are administered that penetrate past the epidermis and into the initial layers of the "dermis" or the true skin. Ultimately, the anticipated results of the chemical peel, are to improve the overall appearance of the skin by working against "free radicals," in which overtime, promote cell damage and skin deterioration. Upon application of the chemical peel acid solution, various results occur - depending upon the type of chemical peel and the skin type of the client.

      There are various types of chemical peels that help with a multitude of skin conditions and skin imperfections (to be identified as acne scars, uneven pigmentation, and the like). Some of the visible improvements that chemical peels have been able to improve include (but are not limited to): (a) helping to reduce the appearance of facial blemishes, freckles, fine lines, wrinkles, age spots, and dark marks from pregnancy (a condition known as melasma); (b) improving uneven pigmentation, particularly with hyperpigmentation (darkening of the skin) and dyspigmentation; (c) aiding in the appearance of clients with skin conditions including acne, rosacea, and pilaris; and (d) to improve the overall skin texture and vibrancy by enhancing the appearance of dull skin.  Chemical peels also help to increase cell renewal, as they promote a "new skin", which has shed dead skin cells, and has begun a fresh "cell turnover."

            Ultimately, chemical peels have produced results which have led to a large client following of advanced esthetics services.  Depending upon the type of chemical peel administered, there are regulations and restrictions upon who can perform a chemical peel, whether it be a physician and or board-certified dermatologist; a medical professional such as a nurse; an esthetician, who in some states may solely administer chemical peels in the esthetics and cosmetology industries, or may work directly under a physician or dermatologist; or cosmetologists, whom in many U.S. States, have licenses that allow them to work in esthetics-related capacities as well. However, with all the present-day information regarding chemical peels, at one time in history: (a) the types of chemical peels administered, (b) who was licensed to administer them, and (c) how they were applied has an historical element.  

            History of Chemical Peels (4 Min.)

            The term "chemical peel" is seemingly a technical term which has an advanced esthetics overture.  However, World history documents that chemical peels and spa services were administered long before the 1980s, 1990s and the first decade of the 2000s.  Egypt has long been known as part of the "cradle of civilization," and there were rituals and grooming routines that promoted the chemical peel procedure. These rituals and routines were also adapted in Greece and Rome, as sour milk baths were used to rejuvenate the skin. Why use sour milk baths? Sure, this may seem unusual, but one ingredient that is a derivative from sour milk is lactic acid, and it was used for the chemical peeling process and promoted the overall health of the skin.

            Additionally, in the ancient times and Middle Ages, tartaric acid, which is derived from sour grapes, was also utilized for chemical peeling through the use of wine.  Of course in those times, the term "chemical peel" may not have been the first term used to define the actions of sour milk baths and the usage of wine - but the anticipated results were relevant to heath, beauty, and grooming of individuals. Tartaric acid and malic acid both derive from grapes, and the longer the grapes form and ferment - the more prevalent acid appears.  According to Pandell (1999), "TA" is an acronym for the "total acidity" of wine. Dr. Pandell also explains that tartaric and malic acids are "nonvolatile." This means that if grapes that contain tartaric and malic acids are boiled or heated - then the acids will not evaporate.  Therefore, tartaric and malic acids are very prevalent and in historical Egyptian, Roman, and Grecian times, these two acids were "paving the way" for chemical peels and non-invasive exfoliation in today's times! Lastly, from a chemical perspective, a typical pH balance of wine could range at about 3.4 on the pH scale, therefore, the potency of the pH will affect the skin and will cause a chemical reaction (pH balance will be discussed in more detail in Module IV: The Chemical Peel Procedure) that will emulate the "chemical peel." This just shows that in ancient times, some of the same grooming procedures and results are relevant to today's esthetics procedures and results as well.

            Types of Chemical Peels: An Introduction to Light, Medium, and Deep Peels (9 Min.)

            As mentioned previously, chemical peels promote various chemical reactions that aid in improving the skin such as: reducing the appearance of facial blemishes and marks; improving pigmentation; helping with skin conditions such as acne and rosacea; and improving the overall skin texture and promoting resiliency with a more "new skin." The increase of cell renewal and fighting free radicals are also important aspects of chemical peels and these topics will be discussed in greater detail throughout this online course.  However, there are certain categories of chemical peels that need to be introduced - so a greater understanding can take place.

            There are primarily three (3) types of chemical peels which include: light peels [often referred to as "superficial" or "lunchtime peels"]; medium peels [or TCA peels]; and deep peels [better known as carbolic acid or phenol peels). The classification of these three types of chemical peels are relevant for a number of reasons including [but not limited to]:  (a) peel strength and contents, (b) peel candidates, (c) peel application and administration, and (d) anticipated results of the desired chemical peel. (Note: in Module III: "Types of Chemical Peels: A More In-Depth Perspective," there will be greater discussion regarding the light, medium, and deep chemical peels respectively).

            Light peels can be administered in the esthetics and cosmetology environments - such as a full-service salon, skin care clinic or spa; and light peels can also be administered in medical environments - such as a doctor's office that may be supervised by a physician, a dermatologist, a plastic surgeon, and the like. In a full-service salon or spa environment, light peels are usually administered (applied) with up to a 30% acid solution, and any solution above 30% will have to be administered under the supervision of a medical doctor. Light peels are also associated with being either Alpha Hydroxy Acids (AHAs) or Beta Hydroxy Acids (BHAs), and further information regarding AHAs and BHAs will be discussed in Modules III and IV. Light peels are also known as a deep exfoliants and can aid in the removal of dead skin cells in a non-invasive (non-surgical) manner.

            Medium peels, which traditionally comprise of trichloroacetic acid (TCA), are usually administered in a doctor's office, surgery center, or dermatology clinic.  Medium peels also have to be administered under the supervision of a medical doctor. Depending upon the respective State Laws and Rules, licensed estheticians and/or licensed cosmetologists may be able to aid in the application of the medium chemical peel - or they may only be allowed to assist with pre-or post-operative procedures. Traditionally, the doctor or licensed medical professional administers and oversees the medium peel process, and the recovery time is not within the lunch hour or even 24 hours.  The recovery time usually takes days and there is definitely "down time" required after the medium chemical peel procedure.

            The deep chemical peel is the strongest of all chemical peel procedures and is associated with phenol or carbolic acid.  The chemical solution and potency of this peel is oftentimes considered as the "heavyweight" of peels.  This peel is performed by a medical doctor and there may be a need for anesthesia before this procedure.  This peel produces a totally "new skin" and is known to literally burn off the old skin over time.  The down time is for weeks (even months), and [again] the deep peel is the strongest of all chemical peel solutions.

Although this course strives to educate regarding light, medium, and deep chemical peels, the majority of this course will focus on the light chemical peel procedure.   Emphasis of all three (3) types of peels is important - however, for the licensed esthetician or licensed cosmetologist (to also be referred to as "beauty professionals"); this course strives to educate and inform regarding more advanced esthetics topics.  Although the term "light" is mentioned throughout this course, please note that it does not imply that the content is "light" in nature.  Chemical peels knowledge is important and the beauty professional has to serve as decision-maker in regard to what type of light chemical peel to use and how to administer it. There are several contraindications (i.e., various conditions, or allergic reactions) that are involved with the light chemical peel process and ultimately, advanced education is key to the betterment of your light chemical peel service. For those that are working with a medical doctor, this course may also shed light on the overall chemical peel process and ultimately, this course strives to help all beauty professionals from an advanced education perspective.

 

Module II: The Skin - An Overview (33 Min.)

Anatomy & Physiology (6 Min.)

Cells are "the basic units of all living things" and the human body is made of cells which in turn produce tissues; tissues produce organs; and organs produce various systems in which the body functions. Cells can grow and even reproduce and replace cells during their appropriate life cycle.  However, if the body is not functioning properly, toxins in the body can impair the overall health of the cells. When the overall health of the cells are affected, cell damage can occur. This damage can result from various things such as: sun damage and over exposure; life style factors (such as rest, daily schedule, and stress); diet, exercise and food/nutritional intake; smoke exposure; environmental influences (such as pollution); or aging. Ultimately, there are internal, external, and environmental factors that can contribute to the overall health of the skin and skin conditions.

Tissues are also an important part of the body's function, and epithelial tissue is a vital part of the skin and its body function.  Epithelial tissue is located all over the body as it usually represents a covering of various internal and external parts of the body such as: the skin, digestive organs, and various systems including the respiratory system.   Cells of the epithelial tissue are also packed very closely together. Below is a model of human connective tissues of the body:

Skin.Image.1.jpg

 

The skin is known as the "largest organ of the body." Oftentimes, persons don't see the skin as an organ, but the skin is one of the primary organs, along with the brain, heart, lungs, liver, kidneys, stomach, and intestines. The skin is also part of the body's ten (10) systems, which combine to make our body function on a day-to-day basis. The ten body systems include the: Integumentary System; Skeletal System, Muscular System, Nervous System, Circulatory System, Endocrine System, Excretory System, Respiratory System, Digestive System, and the Reproductive System respectively. The Integumentary System - is comprised of the dermis and epidermis skin layers. These layers of the skin are very important regarding not only anatomy, but the chemical peel process.  This system [again] is part of the largest organ of the body, the skin. It also has "sensory receptors" that aid us with the feeling and touching senses. Regarding our body temperature, this system regulates our body temperature - therefore, allowing us to feel hot, cold, warm, etc.  Below is a model of the skin, and the various layers of the skin which include the epidermis and the dermis (the epidermis and dermis represent the actual skin layers).

Skin.Image.2.jpg
Cited from: www.nlm.nih.gov

 

The Epidermis & Dermis (14 Min.)

            The skin is comprised of two layers: the epidermis and the dermis. These two layers help to protect the body from germs, toxic elements, and [again], these layers help the body to function.  Connected together, these two skin layers adjoin and connect capillaries and ducts, which produce feelings and sensation through our skin. Therefore, the dermis and epidermis are vital parts of our body.

            The epidermis is the layer in which beauty professionals can work with - without the direction of a physician. As mentioned previously, if chemical peels are administered that will affect the dermis, then a medical professional such as a physician or dermatologists will have to provide supervision and will only be able to administer the chemical peel from their respective clinics/medical practices.

The epidermis is known as the "outermost layer of the skin," and is also a very thin layer of the skin. [Again] the epidermis has "sensory receptors" that aid us with the feeling and touching senses. Even our body temperature is regulated through the epidermis - therefore, allowing us to feel hot, cold, and warm senses. The epidermis has four layers, including the Stratum Germinativum, Stratum Granulosum, Stratum Licidum, and the Stratum Corneum (an additional layer, the Stratum Spinosum will be mentioned as well).  The term stratum means a "layer of tissue," and again, cells help to create tissues, tissues help to create organs, and organs help to create our bodily systems.

  • The first layer of the epidermis, the Stratum Germinativum, contains only a single layer of cells.  Melanin, which is responsible for pigmentation in the skin, is located in the stratum germinativum.
  • The next layer of the epidermis is the Stratum Granulosum, in which "cells represent granules." Included in the stratum granulosum are keratin and intercellular lipids (which will be discussed further with the Stratum Corneum).
  • The next layer of the epidermis is the Stratum Lucidum, which represents transparency and lucidness. This unique layer is evident in the palms of the hands, as well as the soles of the feet.
  • The Stratum Corneum represents the top layer of the epidermis, and this layer is most exposed to the elements such as the sun, pollution, smoke, topical products, etc.  This layer of the epidermis is also known as "the horny layer." Beauty professionals will work mostly with the stratum corneum, as dead skin cells will begin to shed - as well as the goal of using various products and services, such as the chemical peel; which will accelerate the shedding process and will promote cell turnover/renewal. In the stratum corneum there is: soft keratin and keratinocytes, and these cells and proteins aid the cell renewal process. According to the National Institutes of Health Medline Dictionary (2009), keratin is a . . . "fibrous protein that forms the chemical basis of horny epidermal tissues [such as] hair and nails . . . ." Additionally, keratin is located in all the layers of the epidermis. Soft keratin produces keratinocytes, which is in turn, is a cell that produces keratin. Therefore, keratin and keratinocytes play an important role in cell renewal and the shedding of dead skin cells.  Hard keratin is a protein that is represented in the hair and nails.  
  • The Stratum Spinosum is not an "official layer" of the epidermis; however, it is located in between the Stratum Germinativum and the Stratum Granulosum. This layer has a "spine" prefix in its title, because is resembles a thorn-like or "prickly spine."

                        The dermis is oftentimes called the "true skin." The dermis is beneath the epidermis, and although it does not have direct exposure to the sun, such as the stratum corneum, the dermis is still a very important part of the skin, the integumentary system, and the body as a whole.  The dermis layer is composed of connective tissues that are considered live.  These living tissue layers of the dermis are 25 times thicker than the epidermis, and the two layers of the dermis are: the Papillary Layer and the Reticular Layer (Gershon, 2004).

            The papillary layer provides connectivity between the dermis and the epidermis.  This layer receives its "papi" prefix from the "papillae" - a group of connective tissues that provide nourishment in the hair follicle (dermal papillae). Within the papillae, there are looped capillaries and tactile corpuscles. The looped capillaries provide nourishment from the dermis to the epidermis; and the tactile corpuscles contain nerve endings that allow us to feel sensations and temperatures (heat, cold, etc.). The reticular layer is known as the "deeper layer of the dermis." This layer boasts protein fibers that affect the elasticity of the skin. The reticular layer produces collagen and elastin, and both work together, to improve the overall elasticity of the skin.  Collagen contains fibroblasts, better known as fibrous proteins; and collagen also represents 70% of the dermis.  Elastin contains elastic fibers and proteins, and does not have as much mass as collagen within the dermis - but nonetheless is still an important part of the natural health of the skin.  Ultimately, within the dermis and reticular layer of the dermis; as cells, fibers and proteins began to deteriorate - the aging (or pre-aging) process begins.  Therefore, wrinkles, fine lines, and lack of elasticity start to take place and the skin and the overall health of the skin starts changing.

            The papillary layer of the dermis also contains subcutaneous tissue which is also known as adipose or "fat tissue." This tissues is located at the bottom of the papillary layer of the dermis and it assist with the skin and body's shape. This will reveal how elastic is the skin and the dermis has a lot to do with how the skin holds with the body (i.e., does a person's skin sag or does it hold in its place).

            Below the dermis is the hypodermis, which is also called the "superficial fascia." The hypodermis represents fatty tissue that is connective, and this tissue helps to bind or connect between the dermis and the rest of the body. This layer of connective tissue is also loose in nature. Ultimately, the explanation of the epidermis and dermis are imperative for the overall understanding of chemical peels, their strengths, and what layers of the skin they affect.  Next will be a discussion regarding what the chemical peels have to combat, in order to produce results.

Free Radicals & Antioxidants (6 Min.)

            As mentioned previously, there are certain internal and external causes that can enhance skin damage and promote slower cell renewal turnover rates. From an internal perspective, a person's aging process may have begun, and elastin and collagen proteins and fibers may not be as prevalent.  From an external perspective, various environmental causes can affect the overall health and appearance of the skin, such as: the rays from the Sun and sun damage; pollution; smoke; weather; and the like.  Also, a person's diet, health, nutrition, and skin care regimen can affect the overall health of one's skin.

            Ultimately, when one's skin does begin to deteriorate, it can be associated with a term entitled "free radicals." Free radicals represent damaged molecules that in turn damage cells.  From a more microscopic perspective, if an atom, or group of atoms have a damaged electron; then the atom(s) would be affected - this is also an example of a free radical. Free radicals cause aging, and cell damage is prevalent within free radicals. Therefore, something has to defend the skin against free radicals, and in the esthetics industry - there are preventative measures and corrective measures that can aid in this defense (such as light, medium, and deep chemical peels).  Nonetheless, various chemical peels aid in the reduction of free radicals, and antioxidants are an important part of fighting free radicals. 

            Antioxidants can be taken orally or topically (Dermatology Times, 2006), and they represent various vitamins, extracts, acids, and natural substances.  Antioxidants are known to be good for your health and they can also help fight against chronic diseases. Some antioxidants include (but are not limited to): Vitamin C, Vitamin E, Vitamin A, beta-carotene, Amino Acids, Minerals, and Green Tea. There is greater discussion regarding antioxidants in the Vitamins, Extracts, and Acids section below; but first, a description of cell renewal and turnover rates needs to be examined - which in turn gives a greater understanding of the need of antioxidants.

            Cell renewal (also identified as turnover) can change over time, and be affected internally, as well as externally and environmentally. Babies' cells may naturally renew every 14 days, whereas teenagers' cell renewal may take place every 21-28 days.  As persons grow into their twenties to their 40s, the cell turnover rate may range anywhere from 21 to 42 days.  As persons turn 50 or older, their cell renewal may range from 42 to 84 days.  What does this mean? This means that at infancy, the body's ability to grow new cells and to shed old skin takes only up to two weeks - in comparison to new skin developing two-three months for older individuals.  Ultimately, the resiliency of the skin, the glow, elasticity and overall health and appearance of the skin will be affected if there is a slow cell renewal (Gershon, 2004).

Vitamins, Extracts, and Acids (7 Min.)

            There are various vitamins, extracts, and acids that are prevalent within the beauty industry.  These elements assist within the chemical peel process, and overall skincare as a whole.  There would be too many to mention in this 4 hr. online course, but below includes a sample (to better educate and inform). Some of the vitamins that help to fight free radicals include the following:

  • Vitamin C - also known as "ascorbic acid," is found naturally in fruits (such as oranges, strawberries, and grapefruits); plants; and vegetables (such as broccoli, brussels sprouts, and collard greens).  Although Vitamin C is natural, it can also be made synthetically as well.  Traditional Vitamin C is water soluble, and helps to strengthen the immune system.
  • Vitamin C Esther - There are various "chemical esther bonds" that can be applied to Vitamin C, such as fatty acids that contain palm oil. This would make the Vitamin C product "oil soluble," and would create a "chemical esther bond."
  • Vitamin A - Vitamin A is fat soluble, which means that it is dissolved through the intestinal tract and it also assists the cell membrane. Vitamin A also has a strong presence in cod liver oil.
  • Vitamin E - is also fat soluble, and has a strong presence in wheat germ oil, dry roasted almonds, and sun flower seeds.

There are also various extracts that can aid in fighting free radicals, and grapeseed, licorice and willow herb extracts are well known extracts (just to name a few). Grapeseed extract is a prevalent antioxidant that is known to combat free radicals.  This extract fights against oxidation (when atoms loose electrons), and is suggested to be quite powerful in potency (in comparison to other vitamins). Willow herb extract helps to calm the skin and give it a more soothing feeling. This extract is ideal for use with a salicylic acid peed (to be addressed in Modules III and IV).  Licorice extract is excellent for sensitive skin and works well with melanin and pigmentation.

Acids play a large role in the chemical peel process as well.  In Modules III and IV, there is greater discussion regarding Alpha Hydroxy and Beta Hydroxy Acids.  However, Hyaluronic acid, a natural acid within the body, plays a major part in the esthetics field.  Hyaluronic acid assists with hydration, and produces fluids that are between various proteins and fibers. As mentioned previously, the prevalence of proteins and fibers are important for the overall health and function of the body. [Again] beauty industry products can be natural or synthetic, and there are many products on the market that strive to replicate the composition and effects of hayluronic acid.

There are several other extracts and acids that can be mentioned in this course, however, this is merely a sample - and the course is more designed toward chemical peels and the chemical peel process.  Nonetheless, it is important to acknowledge various vitamins, acids and extracts, and their importance in chemical peels, skin care, and the function of the body.

           

MODULE III: TYPES OF CHEMICAL PEELS (40 Min.)

            Light Chemical Peels: AHA and BHA Chemical Peels (25 Min.)

            Alpha Hydroxy Acids (14 Min.)

            Alpha Hydroxy Acid (AHA) is also known as "Carbolic Acid" and it derives from the "Hydroxyl Group" of acids. AHAs occur in natural ingredients, such as sugarcane, milk and fruits; and are known as exfoliating agents that aid in exfoliating the epidermis - the outermost layer of the skin.  Within exfoliating the epidermis skin area, AHAs are considered a "deep exfoliant" and they are known to accelerate the cell turnover (renewal) rate.  AHA chemical peels have oftentimes been called the "lunch hour peel," and superficial peel - because after the chemical peel procedure, the down time is usually between an hour; and within hours, the skin pH balance should be back to normal. Ultimately, within no more than 24 hours, the client should feel "back to normal" and should not have many side effects.  AHA peels can be applied every 3-4 weeks to maximize results (10-14 days minimum time period at least). Depending upon the client's skin condition, s/he may have a series of AHA peels (such as 4-6 peel sessions) within a few months to achieve desired results.

            Alpha Hydroxy Acids are water soluble, which is different from Beta Hydroxy Acids - because BHAs are oil (lipid/fat soluble).  The water soluble effect simply means that when AHAs are applied to the skin during a chemical peel procedure - the product cannot permeate into skin that has sebum (oil) and build up. However, AHAs and BHAs are still known to help with several skin conditions and imperfections, which include (but are not limited to):

  • Helping smooth out fine lines and wrinkles;
  • Making  the skin seem smoother - which is often felt immediately after the AHA chemical peel procedure;
  • Smoothing out rough skin;
  • Combating hyperkeratosis (thickening of the skin);
  • Promoting desquamation (shedding of the skin);
  • Helping to reduce the appearance of acne scars and scaring overall;
  • Fighting against photodamaged skin (sun damage);
  • Helping to improve the overall skin complexion;
  • Aiding in the pigmentation and coloration of the skin;
  • Unclogging pores;
  • Helping the skin to build elastin and collagen via skin cell renewal and skin resurfacing;
  • Helping to unclog pores;
  • Reducing the appearance of blemishes and age spots; and
  • Making the skin to appear more youthful overall.

Besides chemical peels, AHAs and BHAs are also utilized in other skin care products, such as: facial cleansers, toners, masks; and depending upon the percentage solution, various products are designated for different skin types and skincare needs.

      The most common AHA chemical peel is the Glycolic Peel, which is also known as a glycolic acid peel.  Glycolic acid derives from sugar cane, and is one of the most widely used chemical peels. A glycolic peel overseen and administered (applied) by an esthetician or cosmetologist may range from 10% - 30%; and any other glycolic peel over 30% will have to be administered under the direction of a physician. Glycolic acid is water soluble, and it [again] does not penetrate deeply into sebum oriented skin.

      There are also other AHA peels that are used for various purposes, depending upon a person's skin type and skin care needs.  The primary Alphy Hydroxy Acid Peels include:

  • Glycolic Acid Peel (described above)
  • Lactic Acid Peel
  • Citric Acid Peel
  • Malic Acid Peel
  • Tartaric Acid Peel

Lactic acid, mentioned previously in this course, derives from sour milk and has been used for centuries in Ancient Egyptian, Greek, and Roman times. There were milk baths, rituals and grooming routines that promoted the chemical peel procedure. Cleopatra used sour milk to enhance her skin as well. These rituals and routines were also adapted as sour milk baths were used to rejuvenate the skin.  The lactic acid peel does not have as many side effects, and has even been popular with clients with Melasma. This peel loosens the stratum corneum and helps to "reduce corneocyte cohesion" - i.e., the thickening of the stratum corneum.

Citric acid peels, also known as "fruit acid peels," come from various citrus fruits, such as oranges and lemons. Tomatoes are also considered a fruit and they have a certain acidic level that can affect the skin as well.

Malic acid peels, originate from fruits such as apples and pears.  Malic acid is also prevalent in grapes and wine as well, along with Tartaric acid.  As mentioned previously in the ancient times and Middle Ages, tartaric acid, which is derived from sour grapes, was also utilized for chemical peeling through the use of wine.  Of course in those times, the term "chemical peel" may not have been the first term used to define the actions of sour milk baths and the usage of wine - but the anticipated results were relevant to heath, beauty, and grooming of individuals. Tartaric acid and malic acid both derive from grapes, and the longer the grapes form and ferment - the more prevalent acid appears.  Additionally, tartaric and malic acids are "nonvolatile." This means that if grapes that contain tartaric and malic acids are boiled or heated - then the acids will not evaporate. 

It is also important to note that AHAs and BHAs can be natural or synthetic, therefore - products can be naturally compounded for chemical peels; or they can be synthetically compounded, to emulate the natural products. This is commonplace in the beauty industry, and product developers, chemists, and research companies are always finding ways to better improve the viability of esthetics products - whether natural or synthetic.  Some companies promote that they supply organic products; while other companies might promote that their products are not animal tested. Therefore, there is a wide variety of choices that estheticians and cosmetologists can use in regard to chemical peels, their anticipated delivery, and the client needs and preferences.

Beta Hydroxy Acids (11 Min.)

Beta Hydroxy Acids are also known as salicylic acid, and this acid is the lone representative of BHA peels. Salicylic acid is anti-inflammatory and it derives from the bark of a willow tree (willowbark). Salicylic acid is well known for working with oily skin, as it is lipid soluble and can penetrate fat/lipid cells. Salicylic acid is also popular with use on people of color, and helps persons with rosacea (this is key because again, it's anti-inflammatory.) BHA/Salicylic acid can also penetrate the follicular ostia, which is located at the hair follicle opening - where the hair follicles originate.  This location in closer to the dermis (although BHAs still only penetrate the epidermis). Therefore, BHAs can penetrate deeper into the epidermis (in comparison to AHAs), and they can still have an anti-inflammatory effect, in which the skin does not have to be as irritated. BHA chemical peels, along with AHA peels can be administered between 3-4 weeks (10-14 day minimum); and they can be administered in multiple sessions over time to achieve desired results.         

According to Zoe Draelos, M.D., salicylic acid "offers a true epidermal peel," and it is good for patients with sensitive skin and people of color. However, because of the BHA complexity - it can still affect people of color with scaring and pigmentation. Therefore, there should still be caution in regard to the type and strength of chemical peel that is being applied. BHAs again help to reduce the demodex colonization, and BHAs are lipid soluble. BHAs are also good for clients with periocular dermatitis, in which red papules are prevalent around the nostrils, around the eyes (periocular area), or the mouth (the perioral area). This traditionally occurs between women ages 20-45 and is also known to reoccur as well. BHAs also help in the reduction of acne, which is wide spread among chemical peel clients.

BHAs are known to help with wrinkling and photoaging - however, they can also affect a person's skin sensitivity, and have potential to make the skin vulnerable to photoaging (sun damage). This is ironic because although BHAs are seemingly less irritating than AHAs, they still penetrate the skin deeper and can make the skin more exposed. However, BHAs are still known not to cause as much irritation in comparison to AHAs, and BHAs are also known to be "self-neutralizing" (to be explained further in Module IV).

Irritation is also a common effect of all chemical peels, and regarding AHA and BHA peels, the term erythema , is a more esthetics-related term for irritation. Erythema can cause stinging, burning, and itching, and this term is commonplace in the chemical peel process. "Down time" represents the healing process when the stinging and burning stops. There are different levels of "down times" associated with erythema in light, medium, and deep peels.  It's also important to note that the esthetician or cosmetologist needs to be familiar with the peeling product used in order to determine the strength of the peel, and the down time afterward (this will be discussed in Module IV).

Another fact about BHAs is that salicylic acid derives from acetylsalicylic acid, which derives from aspirin . Therefore, some of the same chemical properties that are topically involved with BHAs are related to the oral product of aspirin.  Aspirin is also known to be anti-inflammatory, and BHAs are anti-inflammatory as well. Acetylsalicylic acid is known to be used in cosmetics, as well.   

There are overall differences between AHAs and BHAs, and to review again, the primary differences between the two include:

  • AHAs are water soluble and BHAs are lipid soluble;
  • Although AHAs and BHAs only penetrate the epidermis, BHAs have a greater penetration potential (again, they are lipid soluble);
  • There are several different types of AHAs, including glycolic, lactic, tartaric, malic and citric acids . . . BHAs have only one acid and that is salicylic acid;
  • BHAs are more anti-inflammatory in comparison to AHAs;
  • Although AHAs and BHAs can treat some of the same skin conditions and imperfections, BHAs work better with sensitive skin.

Medium Chemical Peels (11 Min.)

Medium chemical peels are also known as "TCA" peels, which stands for - trichloroacetic

acid,  also known as  trichloroethanoic acid. Medium chemical peels have similar results in comparison to light chemical peels, however, the power and potency of medium chemical peels is much greater than light AHA and BHA peels.

            Medium TCA peels are known to penetrate into the dermis, or the "true skin." Unlike light AHA and BHA peels - which only penetrate the epidermis, or the top layer of the skin (outermost layer).  Medium chemical peels aid in improving moderate sun damage (photoaging), wrinkles, and uneven skin tone and pigmentation imperfections. TCA peels are also known to work well with darker, olive toned skin and people of color.  They also don't have to be administered as often as light chemical peels, whereas depending upon the client, a medium peel may only need to be administered once or twice a year - up to once every couple of years.           Medium chemical peels should be administered and overseen by a physician, medical doctor, or dermatologist, which is different from light chemical peels - which can be administered and overseen by an esthetician or cosmetologist. 

There are many advertisements online about the purchasing of medium chemical peels - which may allow persons licensed (in the beauty industry) or unlicensed to acquire this TCA product.  Additionally the medium TCA peel acid base may range from 20% - 50% (for example), but just because you see a 20%, please be mindful that the product is much more important than the percentage. For instance, estheticians and cosmetologists can use light AHA and BHA peels, and the acidic percentage may range from 10% - 30%; but AHAs and BHAs are the products that you are working with.  If you see a 20% percentage for a TCA peel, the percentage may be 20% - but the product is Trichloroacetic acid. Therefore, be mindful of your State laws, rules & regulations, and legislation.  Also make sure you contact your State Board of Cosmetology, to make certain that you are in compliance with which type of chemical peels you can administer, and what strength or product of chemical peels you can use.  Also, make sure that within your respective State that you are allowed to administer chemical peels.  In some States, Microdermabrasion (another form of peeling known as a mechanical or "derma" peel) are not allowed to be administered by estheticians or cosmetologists.  Therefore, it is important to make sure you are compliant, because this could be a liability for you and your client, and your business.

            The recovery time for medium/TCA peels is much longer than the light AHA peels, in which TCA peel recovery time is between 5-7 days ( in comparison to a few hours to one day for light AHA and BHA chemical peels). Therefore, the client will have to protect her or his skin from sun exposure, and in Module IV, there will be additional discussion regarding contraindications, side effects, and recovery time for medium TCA peels.

            Two other types of TCA peels to mention are: the Jessner's Peel and the Obagi Blue Peel, which are also two well-known TCA peel procedures. Although the Jessner's Peel has medium chemical peel strength, it has AHA, BHA, and TCA components. The Jessner's Peel contains salicylic acid (BHA component), lactic acid (AHA component) and resorcinol - which according to The Mayo Clinic is ". . . is used to treat acne, seborrheic dermatitis, eczema, psoriasis, and other skin disorders. It is also used to treat corns, calluses, and warts." The Obagi Blue Peel is a TCA peel that helps to minimize fine lines, scars, and dyspigmentation as well. This peel is unique because after application, it turns a blue tint, which allows the medical profession to determine when it is completed. The Obagi Blue peel does color the skin somewhat after the peeling process, and it can take in excess of ten (10) days for the skin to resume its natural pigmentation. The term "frosting" is also associated with the medium/TCA peel, and can occur during the chemical peel process (the skin turns a white, frosting color).

            With the Jessner's and Obagi Blue medium peels, the client may receive a light fan of air blowing on them during the peeling procedure.  This helps to relieve the client from a burning or stinging sensation (erythema).

Deep Chemical Peels (4 Min.)

            Deep chemical peels are the very strongest of chemical peels and they are the most powerful.  Deep chemical peels are associated with phenol or carbolic acid, and they have been called the "heavy weight" of chemical peels. Phenol is also known as carbolic acid, and it is so potent, that is requires up to two (2) months recovery time after the deep peel process. Deep peels are administered and overseen by a doctor, physician, dermatologist, or plastic surgeon - and persons licensed in the beauty industry may assist the doctor with pre-operative and post-operative care. Additionally, other medical professionals such as RN and LPN nurses may assist the physician with phenol or carbolic peel process (and medium TCA peels as well). Deep peels can provide results such as skin resurfacing , the removal age spots, course wrinkles, and crow's feet; and skin blotchiness. Deep peels can also treat patients with pre-cancerous growths. They have been known to be administered in the United States since the 1960s.

            Deep peels are recommended to only be applied once (even in a lifetime); whereas light chemical peels can be applied every other week; and medium chemical peels can be applied a few times a year, to every two years. There is also sedation required for deep chemical peels, and the deep phenol peel process is considered an operative procedure.  Ultimately, there are similarities and differences among light, medium, and deep chemical peels, and how they are applied and administered.  The next Module (Module IV) will give a description of the chemical peel process - mostly from a light AHA and BHA peel perspectives.

MODULE IV: THE CHEMICAL PEEL PROCEDURE (132 Min.)

Light Chemical Peels (125 Min. Total)

            Light Peels: Candidates, Contraindications, Consultation (20 Min. Total)

                        Candidates (5 Min.)

Esthetics and chemical peels go "hand in hand" in offering a quality service that can produce maximum results.  However, you as the licensed esthetician or cosmetologist will have to educate and inform your clients about various types of chemical peels; and whether or not your clients are candidates for chemical peels. This course has described light (AHA and BHA), medium (TCA), and deep (phenol/carbolic) peels and their properties; and as you know - as licensed estheticians and cosmetologists, if administering a light chemical peel, you will have to determine what type of chemical peel (AHA or BHA) and what product line you would like to use as well.  All of this is said to remind you that there is a lot of responsibility involved, and your client consultation will help you to determine whether or not your clients are candidates for chemical peels, and what type of chemical peel product line you would like to use for your client (there is further discussion about your chemical peel services and your skin service business in Module V).

            Therefore, it is important to note that there are various candidates for light chemical peels that may have natural/genetic factors that will determine what type of chemical peel they can have administered; or there may be skin conditions and imperfections that might also determine what type of chemical peel they need. 

Lighter skinned clients with lighter hair are known to be well suited for the AHA peel; and darker skinned clients are known to be well suited for the BHA/salicylic acid peels.  However, you may have lighter skinned clients who have oily skin, and the BHA peels may be better because they are lipid soluble. Or, you may have a lighter skinned client that may have rosacea that may be better suited for BHA peels as well, because BHAs work well with sensitive skin.  Also, for persons who may have more minor skin imperfections - they would be good clients for the light chemical peels. Additionally anyone who wants to improve the appearance of their skin - whether they have acne, fine lines, age spots, rosacea and minor dyspigmentation are good candidates as well.  Ultimately, upon talking with your client during the client consultation, it can help you to better determine which type of peel to use. 

Contraindications of Chemical Peels (7 Min.)

The term "contraindication" means that there is a symptom or condition that a person may have, or a risk that might be taken - in which a particular service will have an adverse effect.  Contraindications are widely identified in the beauty industry as a whole, and for esthetic services and chemical peels - they are important to note. Cosmetic Surgery Times recommends various "risks" that are involved with chemical peels (light, medium and deep) which include (but are not limited to): scarring, infections, changes in skin tone, cold sore breakouts, heart disease, and swelling.  Additional contraindications include erythema, and intense skin sensitivity from the sun.

  • Scarring - Chemical peels can have such a potency, that they can cause scarring on the skin. Particularly in medium (TCA) and deep (phenol/carbolic acid) peels, scarring does have the potential to occur. There is less potential of scarring in light (AHA and BHA peels).
  • Infections -Infections can occur because the epidermis (AHAs & BHAs) or the dermis (TCA & Phenol/carbolic) is being exposed.  The skin is a part of the Integumentary system, and it is the largest organ of the body. Therefore, when various chemical compounds (whether natural or synthetic) are being applied to the body, there is a change in the chemical balance of the skin, as well as exposure to the skin.  This leaves the skin to potential infection. 
  • Changes in Skin Tone - Depending upon the type of chemical peel, there could be a change in skin tone that could be temporary or permanent. This is more prevalent in medium and deep chemical peels, and not as prevalent in light chemical peels.  However, there may be a temporary hypopigmentation (lightening of the skin) that can occur with light chemical peels, and usually, it will take a few days for the skin to resume its natural skin tone. However, it is better to improve hpyerpigmentation (darkening of the skin) as opposed to hyperpigmentation.
  • Cold Sore Breakouts - If patients have a history or cold sores, than cold sore breakouts could occur.  Also, if patients have recurring herpetic sores, they can breakout as well.
  • Heart Disease - Particularly in deep chemical peels, heart disease may be a contraindication. With deep peels, the client/patient will have to go into sedation, and this can be of harm to the client.
  • Swelling - Depending upon the client's physical and genetic makeup, swelling can occur.
  • Erythema - As mentioned previously, light, medium, and deep peels can cause erythema - in which burning, stinging, or itching could occur.  There are different recovery times with erythema, which will be discussed later in this module.
  • Skin sensitivity is important to note as well for light, medium and deep peels. It is one of the most important contraindications that can occur with all chemical peel clients. There will be further discussion regarding skin sensitivity later in this module.

Client Consultation (8 Min.)

            Client consultation is one of the more important components of the beauty industry as a whole.  It is important to talk with your client to understand various medical, lifestyle, and environmental aspects of her or his everyday life. Although licensed beauty professionals are not medical professionals; [in comparison] in the medical profession, your doctor or nurse would ask you questions about your health. And in the beauty profession, as you use different chemicals and compounds, and you too should ask your clients about their health as well. This is for the betterment of the clients experience, and it also helps you to be a responsible beauty industry professional in using your best judgment regarding a particular client.

            From a medical perspective, various questions should include (but are not limited to):

  • 1. Are there any present medical conditions that your client may have - such as diabetes, high blood pressure, seizures, etc.?
  • 2. Are there any past medical conditions that your client would like to make you aware of - such as skin cancer, previous surgeries, shingles, etc.?
  • 3. Are there any medications that your client is taking - such as skin care medications including accutane or retinol products; heart medication, birth control, and other medications?
  • 4. Is your client pregnant?
  • 5. Does your client have any allergies?
  • 6. Has your client had any previous chemical peels? - If so, what type of chemical peel (AHA, BHA, TCA, Phenol/Carbolic, etc.) and how many sessions?
  • 7. What type of skincare products does your client use and what type of regimen do they have (such as daily use of cleansers, moisturizers, and toners; weekly use of masks; bi-weekly use of exfoliants, etc.)?

From a lifestyle perspective, you may want to ask some of the following questions:

  • 1. Does your client smoke?
  • 2. What type of diet does your client have (beverages, foods, and dietary supplements)?
  • 3. Does your client exercise?
  • 4. Does your client experience fatigue?

Various environmental questions can include:

  • 1. Does your client's work environment affect her or his skin? - such as in a manufacturing plant where there may be dust particles in the air;
  • 2. Does your client live where there may be a high density of smog?
  • 3. Is your client exposed to second-hand smoke at home or on the job?

It is also important to ask you client what are her or his overall goals for the health and betterment of their skin?  - It's always good to know what your clients wants to do to improve the overall appearance of their skin.  Communicating these goals are key during the client consultation process.

Some of the aforementioned questions may affect the chemical peel process directly or

in-directly; and some of these questions might not affect the chemical peel process at all.  However, it is important to know as many factors as you can, that might better your knowledge of your clients, and their overall health and lifestyle. It could also help your client as well - because you will have to make choices upon which type of chemical peel to use; and you want the best results possible.

            Anticipated Results of Light Chemical Peels (3 Min.)

            As mentioned previously, light chemical peels help with the following:

  • Helping smooth out fine lines and wrinkles;
  • Making  the skin seem smoother - which is often felt immediately after the AHA chemical peel procedure;
  • Smoothing out rough skin;
  • Combating hyperkeratosis (thickening of the skin);
  • Promoting desquamation (shedding of the skin);
  • Helping to reduce the appearance of acne scars and scaring overall;
  • Fighting against photodamaged skin (sun damaged);
  • Helping to improve the overall skin complexion;
  • Aiding in the pigmentation and coloration of the skin;
  • Unclogging pores;
  • Helping the skin to build elastin and collagen via skin cell renewal and skin resurfacing;
  • Helping to unclog pores;
  • Reducing the appearance of blemishes and age spots; and
  • Making the skin to appear more youthful overall.

All of the aforementioned anticipated results can prove valuable to your client, as your client can

have a better overall appearance and feeling about her or his skin.  Some of your clients may receive multiple results during their chemical peel process, and as you work more with your client's skin, you will learn more about her or his skin as well. 

            Pre-Service Preparations (8 Min.)

Pre-service preparations for chemical peels are important, because the client's skin needs to be in the best of condition before the chemical peel treatment(s). There are different types of pre-service preparations that can occur, and three to note include (but are not limited to): (1) client consultation & skin test; (2) acne product application and/or non-application, and (3) sun exposure.

The client consultation and skin test involves the initial meeting with the client and talking with your client about various things about their skin and their overall skin care goals.  As mentioned in the previous Client Consultation section, there are questions regarding medical lifestyle, and environmental aspects that should be addressed.  After the client consultation, the esthetician or cosmetologists can then make a recommendation regarding the chemical peel type (AHA or BHA) or whether or not a chemical peel is recommended at that time.

If a chemical peel is recommended, a skin test can then be conducted to observe how the skin reacts. The skin test can be performed as a "mini peel," in which the chemical peel procedure could be utilized on a small part of the skin - such as under the jaw line. The area of testing does not have to be larger than a quarter, and the same steps with the chemical peel procedure can take place (these steps will be explained shortly).  After the skin test in the treatment room, you can immediately view the skin to see how it reacts, and you can also as your client how s/he feels. Then recommend to your client to see how s/he feels within the next 24 hours, and then you can make your final assessment.

Acne product application or non-application  is something that you should make sure you recommend to your client.  Although you are not a medical professional, it is still important to know what acne medications would serve as contraindications for your chemical peel procedure. Therefore, you should be knowledgeable about your product manufacture's recommendations regarding contraindications that may affect your client's skin.  Some chemical peels and esthetic treatments may not recommend your client taking accutane or retinol-based products.

On the other hand, there are some medium (TCA) and deep (Phenol/Carbolic) chemical peel procedures that require your client to take "pre-conditioning medications" such as Retin-A, Renova, or Glycolic Acid.  However, various pre-conditioning medications are prescribed by a medical professional and this would not be your area of expertise. But, for this course, this is mentioned for you to be aware that some pre-conditioning medications can be prescribed (by medical professionals), if a medium or deep peel is administered.  

Sun exposure is also important to note, because your client should not over exposure her or his skin after the chemical peel process - or even before the chemical peel process. Therefore, your client should be mindful about her or his activities before the light chemical peel - and please remind them that outdoor activities in the sun makes the skin more vulnerable to increased erythema (burning, itching, and stinging). A good cleansing routine of twice a day, along with applying a moisturizer and sunscreen daily, can also help prepare the skin for the chemical peel procedure.

Pre-Service Set Up & Sanitation (15 Min.)

            The pre-service set up for the chemical peel service is similar to a facial service set up -as the  treatment room will need either a spa chair or spa table for the client to lie down or to sit while leaned back. There are also supplies, equipment, product, and disposable items that will be needed, and sanitation is also very important for your treatment room setting. Therefore, the following will be addressed for the pre-service set up which include: (1) sanitation, (2) treatment room set up and equipment, and (3) chemical peel product.

                        Sanitation

Sanitation is very important in a salon setting.  State Boards and regulatory agencies are very stringent on making certain that professionals in the beauty industry use precaution in regard to cleanliness and sanitary salon and spa environments. It is an overall goal of making sure that there is control of contamination upon all levels in the salon setting.  Ultimately, if something is soiled, tainted, or infected - it can be considered contaminated. Therefore, decontamination is imperative for a safe, healthy salon and concerning chemical peels - it is important to make certain that the treatment room is decontaminated.

Pathogens - are disease-causing microorganisms that cause contamination.  In order to control pathogens, surfaces (living or non-living) and implements must be decontaminated.

There are three (3) types of decontamination which include sterilization, disinfection, and sanitation.

  • Sterilization - This is the very highest level of decontamination, and it is mostly associated with hospital-grade decontamination. The sterilization process destroys all living organisms related to a surface or an object. However, the chemicals, products, and processes utilized in sterilization are not appropriate for salon settings. They are not appropriate because there are dangers involved and the chemicals could damage skin and cause harm to your eyes, and the like. Therefore, sterilization is [again] not appropriate for the salon and spa settings.
  • Disinfection - This process is the second highest level of decontamination, because it controls microorganisms that grow on various implements used in the salon setting such as metal extractors - which are known as "non-living surfaces." The chemical products used in disinfection often have strong chemical properties and need to be used safely. Therefore, you must follow safety rules documented by the manufacturer of the disinfectant product. Safety rules are published on the Material Safety Data Sheet, or the - "MSDS."
  • In the salon setting, the disinfection: of bacteria, viruses, and fungus are crucial. Therefore, EPA registered, hospital-level disinfection is used to disinfect by killing bactericides, viricides, and fungicides. The EPA stands for the United States Environmental Protection Agency, and their primary mission is to: ". . . protect human health and the environment . . ." and to ". . . lead the nation's environmental science, research, education and assessment efforts." Concerning the chemical peel procedure, disinfection is key for the overall health and safety of client, the esthetician or cosmetologists, the salon equipment and tools, and the salon or spa overall.
  • Sanitation is the lowest level of decontamination in the salon setting, however, it is still very important. Sanitation can help to reduce pathogens on living and non-living surfaces such as your hands (living) and your salon floor (non-living). If you are using an antiseptic on your hands, that is an example of sanitation. If you are washing your towels and linens, that is a form of sanitation (as long as the water temperature is appropriate according to State Board regulatory standards). If you are sweeping the floor, that is a form of sanitation. Therefore, sanitation is important as well and can oftentimes be associated with the daily cleaning routine of a salon. Please make sure that you follow sanitation rules and guidelines, according to your State Board rules, regulations, and standards.

Treatment Room Set Up & Equipment

The chemical peel treatment room should be prepared similar to that of a facial set up, whereas equipment & supplies; disposables; and products should be at the beauty professional's disposal.  Regarding equipment & supplies, the following items are needed:

  • spa table or spa chair (which leans back) for client
  • esthetician's or cosmetologist's stool with rolling wheels (to allow the beauty professional to move around and behind the spa table if necessary). This chair to be housed behind the spa table/spa chair  (the beauty professional may choose to stand throughout this procedure, but a chair is recommended for treatment room set up protocol)
  • supply tray or cart to place products, supplies and disposables
  • fan brush
  • magnifying lamp
  • hand towels
  • paper towels
  • UV sanitizer
  • hand sanitizer
  • mask brushes,
  • bowls
  • spatulas
  • head band
  • client gown or wrap
  • clean linens (or disposable linens),
  • blanket
  • bolster

Disposables are items that you will use during the chemical peel procedure, that will have to be discarded afterward.  When working with chemical peels, it is important to have plenty of disposables available, and it's better to have more than enough available, instead of interrupting the chemical peel process to replenish your disposables.

The following disposables are recommended:

  • cotton pads
  • cotton rounds
  • cleansing sponges
  • tissues
  • vinyl gloves (or preferred type of disposable gloves)
  • cotton swabs - cotton swabs are very important during the chemical peel process (you'll use the swabs to apply the chemical peel products). It is recommended that you use a large cotton swab with a six-inch long handle. These large swabs are known as "large round" swabs, where the cotton tip is extra large. The handle, whether wood or paper, is twice as long as the traditional 3 inch handle.  

Although the chemical peel is an advanced esthetics process, there are not dozens of products that are needed for the chemical peel. Traditionally, the following chemical peel products include:

  • chemical peel cleanser
  • chemical peel solution
  • chemical peel neutralizer
  • chemical peel moisturizer       

Chemical peels are usually made and manufactured as a "chemical peel system," in which all products required are made by the same manufacturer. It is not recommended to mix other products with the chemical peel procedure.  However, in the traditional esthetics set up room the following products are also utilized which include: cleanser, toner, exfoliants, mask(s) applicable to skin type, massage lotion, sunscreen; and serums, eye creams, aromatherapy oils if applicable. Again, these items are mentioned for informational purposes regarding "products," and please note to use only the manufacturer-recommended products within the chemical peel process.

In regard to your client, please make sure that s/he is in a laid back position on the spa table or spa chair, and that their hair is removed from the face with a headband or spa towel wrap. Also make sure that your client's jewelry has been removed - including earrings, facial body piercings, and necklaces. Your client can wear a client gown or wrap, and make sure they have a covering [at least] over their shoulders. This covering can be a clean, sanitized towel, sheet or blanket (preferably a sheet or blanket). You may also use a bolster under the clients back, lower back, or under their legs for comfort.

The Light Chemical Peel Procedure (75 Min. Total)

The Cleanse (6 Min.)

            There are four primary steps within the light (AHA of BHA) chemical peel procedure, and those steps include: cleansing, peeling, neutralizing and rebalancing the skin. Depending upon the manufacturer's recommendation, there may be additional steps involved.  But traditionally, these are the four main steps that the skin must go through, for the light chemical peel experience to be effective. The overall light chemical peel process may take about 15 minutes, because the actual chemical peel solution does not rest on the skin for long lengths of time. If you add time for client set up and preparation, you can block off at least 30 minutes for your chemical peel appointment (longer if you have an additional consultation). Ultimately, each step is important to be aware of - and after proper room sanitation, set up, and client preparation/draping, it is time for your client's chemical peel!

The cleanse is the first step, in which the skin will have to be cleaned appropriately before the application of the chemical peel solution. The cleanse is needed because various oils, particles, and elements need to be removed from the skin - so the light chemical peel will have better penetration into the skin. If the skin is not properly cleansed, then the light chemical peel product may not be allowed to provide ample exfoliation - which will affect the overall skin cell renewal.  Before you begin, remember to put on your gloves. You need to cleanse the skin according to the manufacturer's recommendations, and the light chemical peel cleanse may be different from the traditional facial cleanse. Within the traditional facial cleanse, in a sweeping movement, you use a facial cleanser to cleanse with both hands or facial sponges - in upward and outward motions among the face, chin, neck and décolleté (collar bone and upper shoulder area).

However, the AHA or BHA cleanse involves a different cleansing solution that

should be applied to the face and neck with either cotton rounds or large cotton swabs (cotton rounds give you more stability with your hands, and the weight of the hands can be stronger during the cleanse than with the chemical peel application). This cleanser should be applied by using upward and outward motions, and the cleanse should take no more than 60-90 seconds (this time may vary).  After the cleansing solution, the next step is to apply the chemical peeling solution.

            The Peel (20 Min. Total)

            Applying the Chemical Peel Solution (5 Min.)

Applying the AHA or BHA chemical peel should take between 3-6 minutes and the light chemical peel solution never has to stay on the face for too much time. During this process, make sure you cover the client's eyes with cotton rounds, for your client's safety. You can then take a disposable portion cup or bowl to put the chemical peel solution in - it's  good not to have the product exposed too long, and that's why it is recommended to prepare it for use right before you apply the chemical peel solution.  

You then take your large cotton round swab or a fan brush, and dip into the light chemical peel solution, and apply to your client's face in circular, upward, and outward motions (if you use the fan brush, you will use upward and outward motions only). You don't have to press too hard toward the face, and make sure you cover the entire facial working area. Additionally, the chemical peel may be applied to the face, neck, and décolleté.  Note - it is acceptable to customize what parts of the face you want to work with, such as just the forehead, chin, etc. However, this course explains the light chemical peel while working with the entire face.  Also to note, light chemical peels can be applied to other parts of the body such as the hands, back, etc.  But again, the scope of this course addresses the face and neck primarily. 

Usually, 1-2 coats of the chemical peel solution is sufficient, and after applying, you can let the solution set from 3-6 minutes. Ironically, it can take less than 5 minutes for the light chemical peel to help the skin transform. As the solution sets on your client's face, your client may feel some tingling and slight burning (erythema), and parts of your client's skin may turn pink.  This is normal, but this shows that the chemical peel is actually working.  However, make sure you keep in close communication with your client to make sure s/he is comfortable. If your client is too uncomfortable, you can apply a cold compress to the skin after removing the chemical peel solution.

            Light Peel Penetration (15 Min.)

While the AHA or BHA solution is absorbing into the epidermis, there is a certain level of penetration that the chemical peel solution will have.  Depending upon the type of peel, and the client's skin type and skin conditions, the skin will have different effects. The next discussion will involve four (4) factors which will affect the light peel penetration. These factors are: epidermolysis; hydroquinone penetration (BHA peels); vasodilatation (AHA peels); and adjuvants/boosters.

            Epidermolysis

As you know, AHA and BHA peels are known to only penetrate into the outermost layer of the skin - the epidermis.  The dermis, or "true skin" is penetrated only if the chemical peel procedure can penetrate the epidermis first.  Epidermolysis involves the chemical peel solution "loosening the epidermis," which in turn, allows the chemical peel solution to penetrate into the dermis.  Epidermolysis may be feasible for medium and deep chemical peels, but it is not usually associated with light chemical peels. Therefore, during light chemical peels, epidermolysis traditionally does not take place, however, it is important to note that depending upon how potent the chemical peel percentage is, and how long it is left on the skin - there could be a possibility that epidermolysis could take place. Therefore, it is important to take precaution with your chemical peel procedure by adhering to the manufacturer's recommendations; communication with your client throughout the chemical peel process; and using your overall judgment as well (such as using a cold compress if your client says that s/he is too uncomfortable).

Hydroquinone Penetration    

            There are other types of penetration that will provide not only cell turnover rate, but will help with other skin conditions as well.  Hydroquinone penetration helps with the treatment of dyspigmentation and hyperpigmentation. Hydroquinone is a bleaching agent that helps clients with hpyerpigmentation symptoms - such as melaysma (oftentimes referred to as the "pregnancy mask"). Hydroquinone penetration occurs within BHA/salicylic acid peels and again, BHA peels can offer a deeper penetration because they are lipid/fat soluble. Other bleaching agents that are known to work with dyspigmentation include kojic and arbutin. Kojic is an antibacterial substance that helps to lighten the skin and has been compared to hydroquinone.  In Europe, hydroquinone is actually banned from use and kojic is one of the alternatives that are recommended for use in Europe.

            Vasodilation

            As mentioned throughout this course, BHA chemical peels are suitable for persons with Rosacea and sensitive skin. The salicylic acid properties in BHA peels have the ability to penetrate into the epidermis (even more compared to AHA peels), but they are known to work better with sensitive skin clients and clients with Rosacea - in comparison to AHA chemical peels.

In America today, over 14 million people have Rosacea, and ironically, nearly 70% of persons with Rosacea don't even know that they have it.  It is assumed that Rosacea occurs mostly in mature populations (age 65 or older), but Rosacea can affect persons of all ages. Some of the most common symptoms of Rosacea include redness on the face - particularly in the cheeks area.  Other parts of the face that acquired redness include the chin, nose, and forehead - and even eyes can be irritated from Rosacea as well. Some of the common causes or Rosacea involve the dilation of the blood vessels near the skin's surface - which in turn, gives a reddening color to the skin. This can also be identified as "Vasodilation."

Vasodilation means that the blood can dilate and can cause increased redness.  Vasodilation can occur with glycolic peels if used on sensitive skin or with clients with Rosacea. Glycolic AHA Acid, slightly less potent then Salicylic BHA Acid, still has properties that are contradictive to sensitive skin. Therefore, vasodilation can be a contraindication within the AHA chemical peel process - if a glycolic AHA peel is applied to sensitive skin. As a beauty professional, it is good to know that not all chemical peel penetrations work for everyone and again, you have to make a decision in which you believe is the best for your client.

Adjuvants/Boosters

There are also means in which you can increase light peel penetration for maximized results. There are different additives (manufacturer recommended) that you can use with the light chemical peel, that can present a better intended outcome for your client's skin. Adjuvants - better known as boosters, are widely used during the chemical process. Boosters usually come with your chemical peel system, and are recommend if you want increased results.  A booster may be applied to the skin just before the chemical peel solution is applied, and ultimately, they serve as a "vehicle" that will aid in the light chemical peel penetration. Ultimately, boosters help in the loosening of the epidermis, in order to allow the chemical peel solution to penetrate the skin and in turn - to help with the overall cell turnover and renewal rate. Boosters are commonplace in use with skin care services, and are often used with various types of facials.

Neutralization of the Skin (15 Min.)

After the light chemical peel penetration, the chemical peel then needs to be removed and the skin has to be neutralized. Remember, this AHA or BHA solution is seeping into the dermis, and it now needs to stop reacting and the skin has to be routed back to normal. By this time, your client  may also be experiencing some erythema, and the neutralization procedure will help to relieve your client, by returning the skin's pH balance back to normal.

            pH Balance of the Skin

pH stands for "potential hydrogen," and it has a lot to do with our bodies and our skin. In esthetics, skin care, and the beauty industry as a whole, there are several types of services conducted that can affect a person's pH level. Therefore, it is important within the chemical peel procedure, to understand the need to neutralize your client's skin.

pH is measured on a scale from 0 to 14 - which includes two elements: acids and alkalis (alkalinity). Acids have a pH from 0 to below 7 and alkalis have a pH from above 7 to 14. In the middle, the pH of 7 is a neutral level (this level can vary from 6.5 to 7.5). The skin's pH is normally at 5.5, and although it is not in the "middle" of the pH scale, this is the skin's pH level. An example of pH on the "acid side" of the scale is vinegar; and an example of the "alkalis side" of the pH scale is lye. Therefore, there is a great range of pH properties, and please note that either side of the pH scale can promote harm to the skin. Below is an example of a pH scale:

SkinPic4.jpg
Cited from: www.rrcc.nsw.gov.au

 

Additionally, within each pH number change, there is a change ten times greater in the pH level; for instance - a pH7 (neutral) to a pH6 change would be ten times greater the pH level; but from pH6 to pH5, there would be a 100 times greater pH level [10x10 = 100] (this example is in the diagram above).

For chemical peels to be effective, the chemical peeling solution must have a lower pH acid than the skin's pH acid balance - which is 5.5 However, chemical peel acid should not fall under 3 on the pH scale, because this level would promote harm to the skin. Remember, acids penetrate the skin, so you want to make sure you take precautions in the application of the chemical peel. As mentioned previously in Module I regarding malic and tartaric acids, a typical pH balance of wine could range at about 3.4 on the pH scale, therefore, the potency of the pH will affect the skin and will cause a chemical reaction. 

            Erythema

Erythema has been mentioned throughout this course, and please note the following:

  • Your client will more than likely experience erythema - in which burning, stinging and itching could occur.
  • Your client's skin may also have a redness tone, and this is normal after the light chemical peeling procedure.
  • Erythema is something that you need to discuss with your client ahead of time, along with other side effects of the chemical peel process.
  • A cold compress can always give your client some temporary relief from erythema.

Rebalancing of the Skin

When the light chemical peel solution is ready to be removed, the skin has to be

rebalanced (same as neutralized), and the pH level has to be brought back to normal.  Therefore, there is usually a solution that is included from the manufacturer that "rebalances the skin." This solution should stop the penetration of the chemical peel solution, and this step is usually conducted with cotton rounds. The solution should seep into the cotton rounds, and then you would wipe your client's face - by using upward and outward motions for approximately 60-90 seconds (similar to the chemical peel cleanse process). Salicylic acid is also known to be "self-neutralizing," and has "neutralizing properties."  However, still make sure that when you're using your BHA/salicylic acid peel, that you follow the manufacturer's instructions regarding neutralizing.  Water is also known to have neutralizing properties, and some beauty professionals have used distilled water as an after peel neutralizer, but again, please follow the manufacturer's instructions for chemical peel neutralizing.  

Moisturization (8 Min.)

The final step of the light chemical peel procedure is moisturization, in which the

skin has to be replenished and protected from the sun. After the cleanse; peel and neutralization of the skin; there several stages that the skin has been through. The pH balance has been changed and then brought back to normal, and the skin will definitely need protection. Although dead skin, sebum, and other elements have been exfoliated, the newer, fresher skin will need to be protected; by building a moisture barrier as well.  The skin renewal process is important, but if the new cells and skin are not protected, then it could harm the skin and cause greater damage - particularly from the sun.

Moisturization helps to retain hydration in the skin, and it also helps to create a barrier for the skin. [Again], the skin is the largest organ of the body, and it has to have hydration and protection to not only properly function - but to protect the body from harmful bacteria. Therefore, when moisturizing, humectants are one way to provide moisture to the skin, because they help to hydrate the skin with the replenishment of natural molecules. Humectants also help to draw moisture to the skin, and are known to aid dry skin. Additionally, oily-based moisturizers, also known as emollients, aid in the protection of the skin as well.  Emollients serve as a water barrier; that helps to hold moisture into the skin.

After the neutralizing and rebalancing of the skin, it is time to provide a moisturizer. Please review the chemical peel manufacturer's instructions first - and if the chemical peel system has a designated moisturizer, please use it to complete the light chemical peel process.  If the manufacturer's instructions recommend that you can use your own moisturizer, than do so. However, it is important that the moisturizer has a quality level of SPF - or sun protection factor to protect the skin (SPF will be discussed later in this Module). 

When applying the moisturizer, please continue to use your protective gloves, so your client's skin will be well protected (some may prefer not to use gloves during the moisturizing portion of the chemical peel, but for the scope of this course - gloves are recommended). You can apply the moisturizer with your hands (glove protected), and apply to the skin in circular, upward, and outward motions.  The moisturization portion should not take more than 60 seconds (you do not want to moisturize too intensely with your hands, because remember - the skin is still very sensitive).             Also make sure during the client consultation, that you confirm with your client how many sessions you would like for your client to have.  You can also monitor the peel sessions and make adjustments when needed (such as needing more sessions or reducing sessions). Some clients like to receive a light chemical peel once a month to maintain their cell renewal factor. Therefore, light chemical peels can be performed on a bi-weekly, monthly, or quarterly (every three months) schedule, depending upon your client's skin care needs. Just make sure that you monitor your client's skin during their chemical peel regimen. 

Chemical Peel Solutions and Percentages (7 Min.)

            As mentioned previously in this course, there are various levels of chemical peel solutions and percentages.  As a beauty professional, you have to make the wisest decision (to the best of your ability) for your client regarding what type of chemical peel solution you would like to use. Most importantly, please follow the rules and regulations within your State, according to your respective State Board of Cosmetology, regarding chemical peels.

[Again] some States may not allow estheticians or cosmetologists to solely administer light AHA and BHA chemical peels. Additionally, medium (TCA) and deep (Phenol/Carbolic) peels are not allowed to be administered solely by a beauty professional. However, an esthetician or cosmetologist can work alongside/under the direction of a physician, dermatologist, or plastic surgeon in the administering of a chemical peel, and/or during pre and post operative care (this does not mean that the beauty professional is actually administering the medium or deep peel themselves, they may serve as assistants). Medium or deep chemical peels may also be accompanied by other medical professionals, such as an RN or LPN nurse, and the beauty professional may work with other medical personnel as well (but still under the direction of a physician, dermatologists, or plastic surgeon).

[Again] when using a light AHA or BHA peel, there are certain percentages that you can use for the chemical peeling solution. However, make sure that you stay at or under the 30% acid solution, because traditionally, any light chemical peel acid peel over 30% is considered "medical grade." Now, there are various State laws and rules that may fair different than the 30% acid peel limit - but please make sure that you confirm with your State Board of Cosmetology the acid limit for light chemical peel solutions.

You will also have to make a determination of which acid level you want to use for your client.  For example 10%, 20%, and 30% acids are some of the percentages used during the light chemical peel process. If you use a 10% peel, this is a very low percentage and may not have as much of an effect on the skin.  There will be a limited amount of the epidermis loosening, but the 10% peel can still make somewhat of an effect.  If you are using a 20% or 30% acid peel, there will be a greater effect - with 30% giving the maximum results.  However, depending upon the skin type, skin condition, and how many times you would like your client to receive treatments - this will help to determine what type of acid level to use. You may choose to use a 20% solution first, and then gradually use 30% solutions - to help the skin adjust to the higher potency. You may also want to reduce the solution back to 20% (or even 10%), after the skin has improved over time. That's why the initial consultation is important, and you can [again] always test your client's skin before the light chemical peel, to see how her or his skin will react. 

Side Effects,The Sun & Sunscreen (15 Min.)

            Side Effects

As mentioned throughout this course, there are various contraindications that can inhibit the chemic peel process. You as a beauty professional have already consulted with your client, and you have already made your best professional decision regarding which type of light peel your client needed.  Your client's skin has gone through a chemical peel process, and now (and even during the service), your client may experience side effects. Side effects and contraindications may seem similar in nature, but one major difference is that contraindications represent risks regarding the chemical peel and reasons not to have a chemical peel (depending upon your client's skin type and skin conditions). In contrast, side effects occur after the chemical peel, hence, there is a difference between the two. Therefore, your client needs to be very knowledgeable about side effects, the sun, post treatment and recovery.  Although their chemical peel may not be a TCA or Phenol/Carbolic peel - an acidic compound has still been applied to their face and they need to understand how to protect their skin after they leave your treatment room.

Some of the light AHA or BHA peel side effects may include [but are not limited to]: erythema (stinging, burning, itching); the skin flaking; a redness or pink tone; skin irritation; a heated sensation; and dryness. Therefore, you need to make your client well aware of the side effects during the initial consultation, the chemical peel process itself, and after the chemical peel. This will help the client feel more comfortable and knowledgeable about various side effects. You will also need to assure your client that protecting her or his skin from the sun is very important, because it will allow the cell renewal process to take place "more safely" and will have the best possible results for your client's skin.

            The Sun and Sunscreen

The sun is one of the primary causes of aging prematurely, wrinkles, skin damage, and skin cancer. The sun can also affect the hydration of the skin, as it will absorb the natural hydrants from the skin and body. The sun produces rays that are very potent and powerful towards the skin, and ultraviolet light, is very important to understand. As ultraviolet light shines through the sun, there are also ultraviolet rays that give off radiation (UV radiation). Ultraviolet radiation in turn can affect the skin; and the epidermis, the outermost layer of the skin, is one of the first parts of our bodies to feel and absorb the ultraviolet radiation.    There are three (3) types of UV radiation derived from the sun which include: UVC radiation; UVA radiation; and UVB radiation.

             UVC radiation is not known to affect the skin directly, as the Earth's ozone layer protects the UVC radiation from reaching our skin. The ozone layer actually absorbs the UVC radiation, which prevents it from damaging our skin. UVA radiation is different, because it can affect our skin and may aid in damaging our skin as well.  UVA rays are known to tan the skin and to affect the epidermis, and they are also known as "shorter rays."  UVB radiation has long been known to damage the skin, and these rays can be very potent during the daytime, especially between 10:00 a.m. - 2:00 p.m.  At this time, the sun is known to have the most exposure, and ultimately, UVB rays can cause sunburn and they greatly affect the epidermis and dermis. This can also increase the production of free radicals, which can cause the skin to age, sag, and wrinkle.

            Ultimately, when the skin is exposed to UVA and UVB rays, a person's skin phototype (SPT) will determine how their skin absorbs these rays. As you know, the skin is the largest organ of the body -and different people have different physical and genetic factors such as: skin types and melanin content; and lifestyle factors, such as: diet, exercise, smoking/not smoking, and skin care regimen that can affect their skin.  Collectively, these traits can help determine the overall health of the skin, and the absorbency and tolerance level the skin can take. 

There are six (VI) levels of SPT, which compares whether or not a person burns and/or tans from the sun, with: the lowest SPT I level representing a person that does not tan, but will burn; up to the SPT VI level representing a person that has a deep pigmentation in their skin - caused by their high level of melanin, that doesn't burn at all. (Note: It is important that a person's skin phototype [SPT] be determined by a physician or medical professional.)  The first SPT levels (I & II) are the two levels in which persons will have the highest probability of sun burn and premature aging. These persons will also experience more intense effects of sun damage and increased free radicals (Brannon, 2008).

Protecting the skin is important, and sunscreen has been a topical product that has aided in the protection from UVA and UVB rays that can damage the skin - and can [again] even cause skin cancer.  Sunscreen is a topical product that has a potency level called  "SPF" - better known as the Sun Protection Factor.  The SPF can be as low as 1, to 8, 15, 25, 45, and even greater - and the greater the SPF, the more protection the skin will receive. Primarily, sunscreens can block radiation, or they can absorb radiation.

  • Sunscreens that absorb (reflect) UVB rays include: "octyl salicylate; octyl methoxycinnamate, oxybenzone, and titanium dioxide." (Gershon, 2004).
  • Sunscreens that absorb (reflect) UVA rays include: "oxybenzone, titanium dioxide, zinc oxide, butyl methoxydibenzoylmethane, and parsol 1789." (Gershon, 2004).

It is also recommended that when a person does choose a sunscreen, that the sunscreen register at least an SPF 15, and it should contain avobenzone, titanium dioxide, or zinc oxide (Brannon, 2008).  Gershon (2004) also cites that if a sunscreen has an SPF of 15, than it can protect the skin from up to 93% of UVB rays.  Also, if a sunscreen has an SPF of at least 30, than it can protect the skin from up to 96% of UVB rays.  Therefore, it is important to have a higher level of sunscreen, for maximum protection.

     

Post Treatment & Recovery (4 Min.)

Client post treatment, recovery and care are important after the light chemical peel process. Although the light chemical peel process does not take long to perform (15 min. for the peel process and approximately 30 minutes for the entire appointment slot); ongoing protection will be needed for your client's skin. Ultimately, there are various side effects that the skin may encounter, and there are also preventative measures your client can use to protect her or his skin from the sun.

Light peels have been called "lunchtime peels," because they can be performed in a short period of time, and your clients can go about their daily routine after the light chemical peel.  They still may have some symptoms of erythema and redness, but it won't stop them from functioning. However, sun protection and skin care maintenance is still very important.  During the moisturization after the chemical peel, you should make sure the moisturizer has at least an SPF 15. Some beauty professionals prefer to have an even greater SPF, due to the overexposure of the skin directly after the AHA or BHA chemical peel.

Additionally, your client needs to apply sunscreen to her or his face during "at home care," and your client should also be reminded of protecting the overall body with sunscreen as well.  Your clients should know that sunscreen takes at least 20-30 minutes to absorb and take effect - therefore, it should be applied at least 20 minutes before going outside and being exposed to the sun. Additionally, sunscreen can be applied multiple times while you are in the sun, and usually you can reapply sunscreen at least every 2-4 hours.  You can also apply sunscreen liberally to the skin, and make sure you put enough coverage on your skin.   Clothing is also known to protect the skin from the sun, and there are various clothes that retail as "SPF protected."  Hats and can also protect your skin from the sun as well.

At A Glance:  The Medium/ TCA Chemical Peel Process (6 Min.)

As mentioned earlier, medium TCA peels are known to penetrate into the dermis, or the "true skin." Unlike light AHA and BHA peels - which only penetrate the epidermis, or the top layer of the skin (outermost layer).  Medium chemical peels aid in improving moderate sun damage (photoaging), wrinkles, and uneven skin tone and pigmentation imperfections. TCA peels are also known to work well with darker, olive toned skin and people of color.  They also don't have to be administered as often as light chemical peels, whereas depending upon the client, a medium peel may only need to be administered once or twice a year - up to once every couple of years.          Medium chemical peels should be administered and overseen by a physician, medical doctor, or dermatologist, which is different from light chemical peels - which can be administered and overseen by an esthetician or cosmetologist.  

The medium peel process is similar to the light chemical peel process, however, the primary differences are: (1) the acidic solution and percentage of the medium peel, (2) the medium peel contents can affect the dermis or "true skin," and (3) a physician or dermatologist has to oversee the medium peel process. An esthetician or cosmetologists can assist medical professionals with the medium peel, or work with pre or post care.

            Some of the medium peel side effects include erythemia (stinging, burning, itching); swelling; and millia (whiteheads). Other side effects include dyspignemtation, in which a temporary or even permanent color change could occur. If a color change occurs, it is more feasible to try to correct hyperpigmentation (darkening of the skin), as opposed to hypopigmentation (lightening of the skin).  During the medium peel process, sedatives may be administered, to make the client feel more comfortable. 

The actual recovery time for the medium chemical peels is 7-10 days, and during recovery, the client/patient needs to refrain from sun exposure, and it is recommended that the client/patient take off from work and not have the skin exposed to outside elements (air, pollution, etc.). The skin will also literally "peel" as a newer skin will emerge. Therefore, the client/patient should follow the physician's recommendations for home care and follow up treatments.

At-a-Glance - The Deep Chemical Peel Process (2 Min.)

The deep chemical peel is a more in-depth procedure in which the client/patient may need to be sedated during the procedure. This is also known as an operative procedure. [Again] this procedure is conducted by a physician, dermatologist, or plastic surgeon and is only performed in the medical setting. After the deep chemical peel is performed, the recovery time is up to two months. The skin goes though a complete transformation as a practically "new skin" emerges. The color traditionally turns red, and has scabbing and will peel off. The skin may also develop water blisters and can crust and turn a dark brown color as well.  This can happen over a period one to two weeks. The skin can also be wrapped with protective adhesives that are waterproof (so they won't harm the skin). These adhesives may be applied for up to two days or longer. 

The deep chemical peel process [again] may only be needed once ever for most clients. And during the recovery time, it is important to follow the physician's recommendations regarding medication and at home care. And as for chemical peels as a whole - using a sunscreen and having a proper cleansing routine and skincare regimen; are key to having a happier and healthier skin.

MODULE V: CONCLUSION (18Min.)

Course Recap (10 Min.)

            This course has introduced the course participant to chemical peels and various types of chemical peels - including light, medium, and deep chemical peels. Light chemical peels can be classified as AHA chemical peels or BHA chemical peels.  AHA is an acronym for "Alpha Hydroxy Acids," and various types of AHAs include - glycolic, malic, lactic, tartaric, and fruit acids. BHA chemical peels contain salicylic acid, and this is the only acid traditionally associated with BHA chemical peels. Medium chemical peels are mostly identified with trichloracetic acid, also known as "TCA." The Jessner's peel and Obaji Blue peel are also considered medium chemical peels. Deep chemical peels are associated with Phenol, which is also known as Carbolic Acid.  The deep chemical peel is known as the "heavyweight" of peels and is the strongest of all types of chemical peels.

            Chemical peels are known to aid in shedding dead skin cells and helping to remove the outer layer of skin, or the epidermis. Chemical peels are also known as "chemexfoliation" and during this exfoliation process, cell renewal, or cell turnover occurs. Cell renewal aids in fighting "free radicals," which are damaged cells that may have been damaged through internal or genetic factors; or external and environmental factors.  The aging process is an example of free radical damage, as well as a person's diet, exercise, skin care regimen, and exposure to the sun, smoke, and pollution.  Ultimately, the cell renewal rate changes over time as persons get older. Babies may have cell renewal in up to two weeks, and an elderly person over 85 years may have cell renewal once every three months. This means that babies will acquire a "newer skin" at a much quicker pace. In esthetics services, whether someone is in their 20s or their 60s - the overall appearance and health of the skin may be a goal for your client. It is also important to recognize that different clients may have different skin care needs, which will help to determine which type of chemical peel they need.  

There are various types of chemical peels that help with a multitude of skin conditions and skin imperfections (such as acne scars, uneven pigmentation, and the like). Some of the visible improvements that chemical peels have been able to improve include (but are not limited to): (a) helping to reduce the appearance of facial blemishes, freckles, fine lines, wrinkles, age spots, and dark marks from pregnancy (a condition known as melasma); (b) improving uneven pigmentation, particularly with hyperpigmentation (darkening of the skin) and dyspigmentation; (c) aiding in the appearance of clients with skin conditions including acne, rosacea, and pilaris; and (d) to improve the overall skin texture and vibrancy by enhancing the appearance of dull skin. 

            The light chemical peel can be administered and overseen by a beauty professional, such as an esthetician or a cosmetologist. Medium and deep chemical peels have to be administered and overseen by a physician, dermatologists, or a plastic surgeon.  A nurse may also work with the chemical peel process, and beauty professionals are also hired to work with pre and post operative care, during medium and deep chemical peels. Make certain that you know your State Board of Cosmetology's laws, rules and legislation regarding chemical peels; because in some states, estheticians and/or cosmetologists may not be able to administer light chemical peels at all.     

Regarding light chemical peel percentages, a 30% acid solution is usually the highest

chemical peel solution a beauty professional can administer.  [Again], make sure you are aware of your State laws and legislation - however, a 30% acid solution is the standard for the application of AHA and BHA peels by beauty professionals. And again, only licensed medical professionals are supposed to administer and/or oversee medium and deep chemical peels. 

            After the chemical peel procedure, sunscreen and protecting the skin is very important. Ultraviolet rays from the sun, including UVA and UVB rays, can penetrate the skin and cause burning, skin damage, and even skin cancer.  The SPF, or sun protection factor, is important regarding the sunscreen's ability to protect your skin. Make sure your client uses a minimum SPF of 15 for their moisturizer and/or sunscreen; and there are much higher levels of SPF (such as 25, 45, 60, etc.) that can protect your client's skin as well.

Advanced Training/Growing Your Chemical Peel Business & Conclusion (8 Min.)

It is wise to make sure you keep abreast of issues and trends regarding your beauty industry

specialty; and if you want to grow your chemical peel business or learn more about chemical peels -

advanced education, training, and gained experience are key.  Continuing education (CE) courses, workshops, and seminars can provide valuable resources for your chemical peel knowledge base.  There are various continuing education courses offered by your respective State Boards, and there are also CE courses offered by product manufacturers (that manufacture your particular chemical peel of interest). 

Also, make sure that you take the leap "from theory to practice" regarding your chemical peel knowledge and expertise.  Although reading and becoming educated regarding chemical peels is very important - you still have to gain experience by physically performing chemical peels as well.  If your skin is suitable, consider a chemical peel or even a skin test for yourself; so you can understand how a chemical peel feels and how your skin reacts. As you work with more clients with different skin types and skin conditions, you will have more "practical" knowledge, which will also help you to make professional decisions regarding your clients (such as using an AHA or BHA peel, and how many sessions your clients need).

You can also study different product lines, and try to attend beauty, cosmetology, and spa conferences that will have distributors and CE classes as well. You can talk to estheticians and cosmetologists and who work in esthetics and skin care, and get feedback on which types of light chemical peels they like to use. Ultimately, communication is key; and you can expose yourself to the advanced esthetics field and grow your business.

In conclusion, the chemical peel is one of the most sought after esthetics services in the United States. Regarding medically supervised chemical peels in the U.S., in 1996, nearly 490,000 chemical peels were performed - and in 2003, nearly 773,000 chemical peels were performed.  It would be difficult to determine all light AHA and BHA chemical peels that were performed at various salons and spas; because medium and deep peels would have to be "on record" with various medical facilities in which they were performed.  However, with light chemical peels being non-invasive, there are hundreds of thousands of persons who are candidates to receive them (and have received them). The medium chemical peels cost range may be between $250 - $1,000 (this price may vary); deep peels may cost between ($1,200 - $3,000, price may vary as well). Although your chemical peel would not be a medical service, light chemical peels can cost anywhere from $50 - $600.00, depending upon the type of service package that is offered. Therefore, the chemical peel service could help increase your business. In closing, you as a beauty professional have the license and the potential to be a chemical peel specialist and ultimately, through your knowledge and skill - you will help your clients in improving the overall appearance of their skin.

 

Citations/Bibliography

  • Brannon, M.D., Heather. Preventing Wrinkles With Sunscreen. About.com: Dermatology. July 26, 2008.
  • Brannon, M.D., Heather. UVB Radiation. About.com: Dermatology. August 27, 2006.
  • Brannon, M.D., Heather. Alpha Hydroxy Acids/Beta Hydroxy Acids. About.com: Dermatology. March 23, 2007.
  • Dermatology Times. Dermatologic Cosmetic Laboratories. P. 146. March 2006.
  • Facial Plastic Surgery.net. Chemical Peels. 2009.
  • Foltz-Gray, Dorothy. A Beginner's Guide to Facial Peels. Heatlh (Time Inc.). Vol. 11, Issue 7, p. 42. October 1997.
  • Gershon, J. Milady's Standard Fundamentals for Estheticians. Thompson-Delmar Learning. 2004.
  • Guttman, C. Citric Acid Formations Enhance Glycolic Peels. Cosmetic Dermatology/ Dermatology Times. June 1, 2005.
  • Guttman, C. Choice of Peeling Agent Depends on Patient Characteristics. Cosmetic Surgery Times. March 2003.
  • Laing, J. The Peel Deal. Women's Wear Daily/Beauty Biz. Vol. 189, Issue 51, p. 14. 2005.
  • Kotter, M.D., Robert. Peels, Lasers and Microdermabration? Which is Best? WebMD. March 25, 2008.
  • Modern Medicine/Cosmetic Surgery Times. Chemical Peel. November 12, 2008.
  • Oliveri, C. Neutraceuticals, Phytochemicals, and Antioxidants - What are They All About?. Ohio State University Extension. 2000.
  • Sharquie, K. et al. Latic Acid as a New Therapeutic Peeling Agent in Melasma. Dermatologic Surgery. Vol. 31., Issue 2. February 2005.

Web Citations

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1. Chemical peels are known to help reduce the appearance of facial blemishes, freckles, fine lines, wrinkles, and age spots.
 2. AHA is an acronym for "Alpha Hyrdoxy Acid."
3. BHA is an acronym for "Beta Hydrogen Acid."
4. Malic Acid is a known AHA acid.
5. Salicylic Acid is also an AHA acid.
6. Overall, there are three (3) main types of chemical peels, which include light, medium, and deep chemical peels.
7. Deep chemical peels are known as the "heavyweight" of all chemical peels, and they contain phenol or carbolic acid.
8. Deep chemical peels can only be administered and overseen by a physician, dermatologist, or plastic surgeon.
9. Trichloroacetic Acid is a part of the light chemical peel process.
10. Latic acid is best known for its acidic content in - limes, oranges and apples.
11. Chemical peels were performed in ancient Egyptian, Greek and Roman times, as sour milk baths were taken - which were known to soften the skin.
12. Tartaric acid is known to be an active acid in sour grapes.
13. Light chemical peels are also known as "superficial" and "lunchtime" peels.
14. Traditionally, a licensed estheticians and cosmetologists can perform a light chemical up to a 40% acid solution.
15. Cells, which are known as the "unit of all living things," produce tissues; tissues produce organs; and organs produce various systems in which the body functions.
16. Environmental influences, such as pollution and smoke do not affect the overall health of the skin.
17. Epithelial tissue covers the digestive organs, and solely helps for the body's system to digest.
18. The Integumentary System is a respiratory system that does not involve the overall health of the skin.
19. The epidermis is known as the "true skin" and lies below the dermis, which is the outermost layer of the skin.
20. The epidermis and dermis are connected together, and these two skin layers adjoin and connect capillaries and ducts, which produce feelings and sensation through our skin.
21. The epidermis is the layer of skin in which beauty professionals can work with - without the direction of a physician.
22. The first layer of the epidermis, the Stratum Germinativum, contains only a single layer of cells.  Melanin, which is responsible for pigmentation in the skin, is located in the stratum germinativum.
23. The Stratum Corneum represents the top layer of the epidermis, and this layer is most exposed to the elements such as the sun, pollution, smoke, topical products, etc.  This layer of the epidermis is also known as "the horny layer."
24. In the stratum corneum there are: soft keratin and keratinocytes, and these cells and proteins aid the cell renewal process.
25. The living tissue layers of the dermis are 25 times thicker than the epidermis.
26. The reticular layer is not the deeper layer of the dermis. This layer has no protein fibers that affect the elasticity of the skin.
27. The papillary layer of the dermis contains no subcutaneous tissue which in turn, will not produce any adipose or "fat tissue" that can help the skin and body's shape.
28. Free radicals represent damaged molecules that in turn, damage cells. Free radicals are also known to promote the pre-mature aging process.
29. Some antioxidants include (but are not limited to): Vitamin C, Vitamin E, Vitamin A, beta-carotene, Amino Acids, Minerals, and Green Tea.
30. Cell renewal can also be identified as "cell turnover."
31. As persons turn 50 or older, their cell renewal may range from 20 to 45 days.
32. Hyaluronic acid assists with hydration, and produces fluids that are located between various proteins and fibers.
33. Beta Hydroxy Acids occur in natural ingredients, such as sugarcane, milk and fruits; and are known as exfoliating agents that aid in exfoliating the epidermis - the outermost layer of the skin.
34. Beta Hydroxy Acids are water soluble, which is different from Alpha Hydroxy Acids - because AHAs are oil (lipid/fat soluble).
35. Hyperkeratosis is the thickening of the skin; whereas desquamation is the shedding of the skin.
36. Glycolic acid derives from sugar cane, and is one of the most widely used chemical peels.
37. Beta Hydroxy Acids are also known as salicylic acid, and this acid is the lone representative of BHA peels.
38. Salicylic acid is well known for working with oily skin, as it is lipid soluble and can penetrate fat/lipid cells.
39. BHA salicylic acid peels are not recommended to use with clients that have rosacea and sensitive skin.
40. Erythema represents a soothing feeling on the skin after the chemical peel process.
41. SPF, is an acronym for Sun Protection Factor, which is associated with protection of the skin by using sunscreen.
42. The Jessner's Peel and Obaji Blue Peel are associated with deep chemical peels.
43. The term "contraindication" means that there is a symptom or condition that a person may have, or a risk that might be taken - in which a particular service will have an adverse effect.
44. Some of the risks of chemical peels overall include scarring, infections, changes in skin tone, cold sore breakouts, heart disease, and swelling.
45. A skin test is recommended before you perform a light chemical peel.  The skin test can be conducted during the initial client consultation.
46. Sanitation is the lowest level of decontamination in the salon setting, however, it is still very important. Sanitation can help to reduce pathogens on living and non-living surfaces such as your hands (living) and your salon floor (non-living).
47. The traditional light chemical peel system includes the chemical peel: cleanser, solution, neutralizer and moisturizer.     
48. Epidermolysis, involves the chemical peel solution "tightening the epidermis," which in turn, will not allow the chemical peel solution to penetrate into the dermis. 
49. Hydroquinone is a bleaching agent that helps clients with hpyerpigmentation symptoms, such as melaysma - which is oftentimes referred to as the "pregnancy mask".
50. Vasodilation means that the blood can dilate and can cause increased redness.  Therefore, vasodilation can occur with glycolic peels if used on sensitive skin or with clients with rosacea.
51. Adjuvants are not associated with boosters, as adjuvants can decrease light peel penetration for minimum results.
52. pH is measured on a scale from 0 to 16 - which includes two elements: non-acids and alkalis (alkalinity).
53. The skin's pH is normally at 6.5, and although it is not in the "middle" of the pH scale, this is the skin's pH level.
54. For chemical peels to be effective, the chemical peeling solution must have a higher pH acid than the skin's pH acid balance - which is 7.5.
55. The skin renewal process is important, but if the new cells and skin are not protected, then it could harm the skin and cause greater damage - particularly from the sun.
56. Medium (TCA) and deep (Phenol/Carbolic) peels are not allowed to be applied and administered solely by a beauty professional.
57.  Some of the light AHA or BHA peel side effects may include [but are not limited to]: erythema; the skin flaking; a redness or pink tone; skin irritation; a heated sensation; and dryness.
58. UVA rays are known to tan the skin and to only affect the dermis, and they are also known as "longer rays."
59. When the skin is exposed to UVA and UVB rays, a person's skin phototype, known as "SPT" will determine how the skin will absorb their these rays.
60. During the post treatment and recovery stages after the chemical peel, it is important for your client to use sunscreen - to protect their skin from the UVA and UVB rays of the sun.

END OF EXAM.

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