Customized Peels

by Elizabeth A. Cardarelli
Twenty-five years ago, peel clients had only two choices: either a 2 percent lactic or a full phenol peel. Today, there is an abundant variety of distinctions among peels with different depths and ingredient combinations (see our article “Mastering Peels: The Ins and Outs of Skin Care Peels” on page 68). As with many skin care treatments, it is essential to customize your clients’ peels to establish yourself as being in a league of your own in terms of your expertise.

The Consultation

Providing the perfect customized plan for your client requires listening carefully to them to determine their specific skin concerns. Fitzpatrick classification is another key consideration, as well as several possible contraindications. In addition to these factors and a thorough consultation based on current skin conditions and medical history (see “Before and After Peels: The Dos and Don’ts of Skin Care” on page 88), gather the following information from each client to create a treatment plan designed specifically for them:

1. Expectations

What are the client’s expectations? Are they consistent with the result of the selected treatment? For example, a glycolic peel is not going to change the skin as fast as a stronger TCA peel. Make sure the client understands what results to expect based on the treatment plan selected from the beginning.

2. Time commitment

Many clients’ lives do not permit much downtime following a peel treatment. This is a pertinent factor to consider when committing to a treatment plan. If downtime is not a problem for a client, you can present them with a different set of options.

3. Client budget

This is difficult for many practitioners to discuss with the client; however, it is essential to be upfront about the financial considerations of each treatment and overall plan. There is a wide range of treatments starting from a one-layer peel to multi-level peels combined with other modalities such as dermaplaning and microdermabrasion. The price range can be significant. If the client is treated to a case of “sticker shock” at the front desk after their treatment, you will never see them again. Integrity and ethics is always the number one consideration in any well-devised plan.

Now you are equipped to create your client’s customized treatment plan! The next factors to take into consideration are skin types and conditions.

Acne, acne prone, oily, combination

Glycolic peels are highly effective for these skin types. Glycolic is used to improve the skin’s appearance, tone and texture while addressing wrinkles, scarring and hyperpigmentation. It can also improve skin conditions such as actinic and seborrheic keratosis. The glycolic reacts with the epidermis, weakening the lipids to remove the dead skin cells, creating a clean, polished, firm complexion. The potency of the glycolic acid is determined by its solution strength (20-70 percent) and pH of the glycolic solution.

Consider the following peel options for these skin types, starting from a beginners’ treatment and working up to creating advanced, designer peels:

Level 1: Bromelain and glycolic

This signature peel is a highly effective starting point in a peel series, or for a new client. Cleanse, de-grease and apply a thin layer of bromelain to entire face and neck. Allow to stand for five to 20 minutes (depending on sensation factor and irritation level of client’s skin). Rinse off with H2O or neutralize it with a bicarbonate. Then apply two passes of 20 percent glycolic solution to face and neck (carefully avoiding eyes). The client will feel a significant sensation lasting between 30 seconds and three minutes before neutralizing.

Level 2: Glycolic and salicylic

Start out with a 20 percent glycolic solution on the forehead to ensure the client feels comfortable. It is normal to feel tingling for the first minute. Once you neutralize it they will feel the sensation again but only for a second. Work your way up the glycolic acid chain with each visit, as high as 70 percent.

Spot treat areas with salicylic acid of 10-30 percent to banish blemishes. This causes the cells of the epidermis to shed rapidly, releasing clogged pores and neutralizing bacteria. It penetrates and dehydrates the cell wall, allowing for immediate transformation of a breakout or a blemish, also calming the inflammation and constricting pore size to correct and prevent build-up and breakouts.

It is important to apply one stroke of salicylic acid and let it stand for two to three minutes before adding another. Salicylic acid is self-neutralizing and needs to stand for a few minutes before determining how strong it will be for the client. Keep layering until skin has a slightly white opacity to it. If the skin starts to frost or crystallize, stop and allow it to calm completely. The skin will likely peel in the areas where frosting is visible. Salicylic can also be used in a more advanced peel for sun damage, discoloration and pigment issues.

Price estimate: Six treatments every two weeks, $175 to $225 per treatment.

Normal, dry, damaged and aging

Level 1: Dermaplane and glycolic

Dermaplane is a manual exfoliation of two to three layers of skin, which stimulates the epidermis and allows for better penetration of each level thereafter.

Price estimate: Once a month, $150 to $200.

Level 2: Dermaplane, microdermabrasion, glycolic acid and designer peel

At this level, dermaplaning and microdermabrasion have significantly exfoliated the epidermal skin, leaving it silky smooth, clean and vibrant. Application of the glycolic acid removes about 20 dead layers. Now it is topped off with a designer peel, which could be a combination of salicylic, TCA, azelaic, malic and/or retinol.

Price estimate: Once a month, $175 to $225.

Level 3: Dermaplane, microdermabrasion, glycolic, designer peel and lactic acid (30-50%)

You have now established a great foundation of continued exfoliation and deep cleaning while addressing hyperpigmentation, fine lines, wrinkles and skin laxity. Lactic acid, an alpha hydroxy acid derived from sour milk, is often called the “beginner” peel because the lactic is gentle yet effective with few side effects. With a 30-50 percent lactic peel, clients may experience a significant tingling sensation. Neutralize after one to three minutes.

Price estimate: Once a month, $200 to $450.

Sensitive and rosacea or Fitzpatrick 1, 2 , 5, 6

The very light and darker skin types may need more time to become acclimated to treatments. Fitzpatrick types 1 and 2 normally become more reactive, but heal very fast too. Fitzpatrick types 5 and 6 can also be very sensitive and slow to heal due to advanced melanin production. For this client, a bromelain and a lactic combination is just as effective as the above combinations. Allow time before working up to higher strengths. A 2 percent lactic peel is a good place to start, eventually moving up to a 10 percent glycolic peel. This peel can also be used to spot treat a breakout or hyperpigmentation.

Price estimate: Once a month, $175 to $200.

Customized peel treatments can be combined with dermaplaning, microdermabrasion and many other modalities. While you should always refer and adhere to manufacturer instructions and guidelines, don't follow the same standard peel each time. Create a customized experience for your client that leaves them radiant and shows them that your work — just like their skin — is one of a kind!