THE NATURE OF EXFOLIATION
It is estimated that humans shed, on average, almost one million skin cells every day. In healthy skin conditions, the desquamation process typically occurs in a 28-day cycle. During this cycle, new cells are created in the stratum basale, the deepest layer of the epidermis. These cells divide and push fully-formed cells to the next layer. Eventually, they reach the stratum corneum and are shed.
Turnover cycles can vary widely from 22 to 50 days, depending on a person’s health issues, medical conditions, lifestyle, age, overexposure to the sun, and immune dysfunctions. When the skin is unable to shed dead cells sufficiently, a host of issues may occur, including skin disease, dull complexion, asphyxiation, acne, uneven tone and texture, and aging.
These problems explain why great emphasis is put on exfoliation in skin care and why it is so important that professionals talk to clients about how they can continue care between treatments.

MECHANICAL VERSUS CHEMICAL
Proper exfoliation stimulates the skin and cell turnover, lifts dead cells, and begins the regenerating process. There are two primary exfoliating methods, mechanical and chemical, both of which work in very different ways.
Mechanical, or physical, exfoliants either suction, scrape, or scrub away dead skin cells by abrading corneocytes from the skin. On the other hand, chemical exfoliants, though specific results vary depending on the formula used, work by dissolving cells of the stratum corneum and breaking down surface cells.
Mechanical exfoliants include scrubs, such as jojoba beads, diatomaceous earth, bamboo, pearl powder, and pumice, as well as microdermabrasion, dermaplaning, and skin resurfacing. Chemical exfoliants include enzymes, alpha hydroxy acids, retinols, salicylic acid, pyruvic and mandelic acids, trichloroacetic acid, Jessner’s solution, flower acids, and more.
There are also a number of combination therapies; determining what is best for the client’s skin requires a skin assessment, goal outline, and ingredient knowledge.

PHYSICAL EXFOLIANTS: A GRANULAR LOOK AT SCRUBS
Scrubs use an abrasive ingredient to buff and polish skin, soften and lift dead skin cells, and provide a second-phase deep cleanse. Though highly beneficial, they are some of the more misused skin care products among consumers. Skin care professionals must talk to clients about the functionality and proper use of scrubs, including how often they may be used, if there are any skin types that must avoid them, what types of scrubs are available, and which is most appropriate for their skin. Answers to these questions will support professionals in educating clients and determine which scrub is most
effective for their skin.
There are a number of different types of scrubs used for varying purposes:
Jojoba beads are one of the gentlest exfoliants. It consists of jojoba oil that is made into minute beads that do not stress or tear the skin. Jojoba beads will naturally allow oil to melt into the skin to further soften sebum and skin cells.
Diatomaceous Earth is a naturally occurring, soft rock with an abrasive feel similar to pumice powder. It is a purified form of algae in a fine grain.
Bamboo is the richest source of silica, a silicon and oxygen compound, and is also found in many rocks and the Earth’s crust. The powder, derived from ground bamboo stems, works for both facial and body scrubs.
Pearl powder, finely milled from freshwater pearls, is rich in minerals and provides antibacterial, detoxification, and skin-nourishing properties.
Pumice is a highly porous, very light stone created from lava and is a more abrasive granular.

The Best Scrubbing Practices
All great treatments, in the spa and at home, begin with proper cleansing. Remember, the goal is to remove all surface residue, creating a clean surface without over drying or agitating the skin. Following a cleanse, a scrub may be used as an optional phase-two cleanse to begin surface exfoliation. Not all skins require this, so be sure to assess the client closely.
For facial scrubs, start with a cleansed face and use damp hands to massage the product into the skin for
several minutes. In the treatment room, some scrubs may be used in combination with steam to deepen the polish and brighten the skin tone. For added exfoliation, men can receive gentle scrubs by using jojoba beads worked into a lather, instead of shaving cream.

When to Use Caution
When it comes to skin, as with anything, scrubs are not a one-size-fits-all. For instance, only very soft jojoba bead scrubs are recommended for rosacea skin and, depending on severity, a scrub might not be used at all. Choosing a scrub also depends on the purpose and end goal. A daily, antibacterial scrub will work well with thick, acne-prone skin. Mild scrubs with brightening and polishing properties used once per week will suit normal to dry skin.
There is a tendency to overuse scrubs and when the granules are very fine, it may be easy for clients to make that mistake. Effective scrubs are generally enough and it is important to remind clients to use extreme caution when using an active scrub in combination with a motorized facial brush. Professionals should advise them to forego this all together.
When used properly, scrubs are great additions to healthy skin care regimens. Not only do they remove dead skin cells and buildup to reveal luminous skin, they may also provide brightening, antibacterial, antioxidant, and antiseptic support.
Scrubs are a tremendous asset to the home-care system, but it is important to educate clients on proper use, or they run the risk of overstimulation, dryness, post-inflammatory hyperpigmentation, and
surface demarcations.

PHYSICAL EXFOLIANTS: RESURFACING TREATMENTS
Beyond scrubs, other exfoliation treatments that fall under the physical exfoliator category include
the following:
Microdermabrasion is a non-chemical procedure that uses microcrystals to remove the outermost layers of dry, dead skin cells. It remains among the top-performed, non-invasive skin rejuvenation modalities.
Dermaplaning uses a scalpel to gently abrade the surface of the skin. In essence, it is like shaving off the epidermis, also ridding the skin of fine vellus hairs. While it provides a deep exfoliation, it is safe for almost all skin types, as it does not produce adverse effects or downtime.
Microneedling, also known as collagen induction therapy, is rapidly becoming one of the most popular treatments for improving the appearance of fine lines, acne scars, and the skin’s overall appearance. It uses tiny needles to create microinjuries, which stimulates collagen and elastin production as the skin repairs itself.

CHEMICAL EXFOLIANTS: ENZYMES AND ACIDS
Chemical exfoliants include enzymes, alpha hydroxy acids, retinols, salicylic acid, trichloroacetic acid, and Jessner’s solution. While each will vary widely in its effect on the skin, these chemicals essentially work by disrupting the stratum corneum cells, breaking down surface cells, and stimulating dermal cells into action. This affects collagen and elastin and induces cell renewal.

Enzymes
Enzymes are proteins typically derived from fruit, vegetable, dairy, or other animal origins. They produce a chemical change in the skin by way of digesting the stratum corneum. Today, enzymes, thanks to advancements in aesthetics, also provide valuable nourishing and skin-building qualities.
Fruit enzymes may be extracted from cherry, pumpkin, pomegranate, tomato, and red grape, among others and, in addition to exfoliation, delivers a potent dose of antioxidants. There are also lactose enzymes derived from pure, cultured sour milk. These enzymes provide hydration and digestion, leaving the skin glowing for days. Pepsin, papain (derived from papayas), and bromelain (derived from pineapples) are also widely used to digest keratin protein and smooth skin.
Enzymes are a main staple in the treatment room and are wonderful for providing exfoliation as well as antioxidant and anti-inflammatory support. Many of the formulas are rich in vitamins and flavonoids, which also stimulate collagen activity.

Acids
Going one level higher on the intensity scale, there are a variety of acids that may be used for skin exfoliation and each has a specific purpose and effect on skin cells and tissue regeneration. Some of the most commonly used acids include the following:
Alpha hydroxy acids are naturally occurring, nontoxic, and organic acids. The most commonly used alpha hydroxy acids include glycolic (from sugar cane) and lactic (from milk). Others include malic (apples), tartaric (grapes), and citric (citrus) acid.
Azelaic acid, up to 15 percent, is created by oxygenating oleic acid, an unsaturated fatty acid found in milk fats. This acid is used as a lightening, lifting, and antibacterial agent.
Salicylic acid is a beta hydroxy acid that is extracted from wintergreen and birch. It is a relatively safe, low-risk acid, as it is self-neutralizing and produces a drying and lifting effect. Repeated applications in high-strength doses can result in systemic toxicity.
Flower acids, obtained from hibiscus chalices, are characterized by their high level of alpha hydroxy acid-like citric acid (10 percent) and pyruvic acid (five percent). They are classified as second-generation alpha hydroxy acids because of their ability to increase cell turnover without irritating the skin and potent
hydrating qualities.
Retinol, a vitamin A derivative that converts to retinoic acid, is a DNA regulator. It assists in the synthesis of collagen, aids in the formation of blood vessels, and encourages healthy cell formation.
Jessner’s solution is a combination of lower-strength acids (salicylic, resorcinol, and lactic, all at 14 percent), which synergize to produce an efficient exfoliating agent with less risk.
Red wine vinegar (acetic acid) is an all-natural acid with a high antioxidant content.

This is a brief overview of some of the most commonly used agents. Professionals should expand their knowledge on the types of available agents, as it will prove to be the most important component in their chemical peel practice.

COMBINING EXFOLIATION MODALITIES
Oftentimes, many of the physical exfoliants may be combined with one another, an exfoliating enzyme, or an acid-like salicylic to create an active scrub. These combinations not only enhance exfoliation, but also stimulate the regeneration process.
Depending on the active ingredient paired with the granular, the outcome will vary. For instance, jojoba beads blended with key actives like kojic and L-ascorbic acid will hydrate, brighten, and smooth the skin. Scrubs with salicylic acid will provide anti-acne and anti-irritant properties.
Scrubs, enzymes, and gentle acids are great as pre-treatments for preparing the skin for other resurfacing treatments. Scrubs may be used prior to a chemical peel as a phase-two cleanse to create a clean surface and begin surface exfoliation. Similarly, enzymes and gentle acids, like alpha hydroxy acids, trichloroacetic acids, beta hydroxy acids, and retinols, may be used for a similar purpose. Enzymes used during a chemical peel will also accelerate the digestion process.
A number of exfoliating modalities may also be teamed with one another or with acids and enzymes to produce deeper or more customized results. For example, dermaplaning is great for preparing the skin for superficial chemical peels.
For microdermabrasion, enzymes and acids used prior to the treatment will typically aid in loosening the cells of the stratum corneum to complete the lifting process and more effectively smooth and polish skin. Using them afterwards will allow for lifting of cells that still adhere, prompting the enzyme or acid to work harder and enhance the rejuvenation. Look to ingredients such as L-arginine, L-mandelic acid, L-arbutin, and phytic and pyruvic acids to boost the effects of microdermabrasion while brightening and gently retexturing and regenerating the skin.
The regenerating effects of microdermabrasion may also be intensified by coupling the treatment with a cocktail of acids and enzymes. For instance, a combination of L-lactic acid, salicylic acid, and papain and bromelain enzymes will further exfoliate keratin and support tissue regeneration. Skin will be smooth, polished, and rejuvenated.
With microneedling, gentle enzymes, alpha hydroxy acids, beta hydroxy acids, and retinols used prior to treatment prepare the skin. A second-phase cleanse with a very gentle scrub or liquefying enzyme ensures a clean surface from which to work.

EXFOLIATING THE BODY
Think beyond just the face. The skin on the décolleté, back, buttocks, legs, and arms also need exfoliation. Body lotions, certain oils, sweat, and other toxins can clog pores and result in pre-mature aging, a dull tone, uneven texture, and even keratosis pilaris.
Scrubs, as part of a pre-treatment or homecare, will work to keep skin healthy and looking fresh. Typically, a more abrasive scrub, such as one that uses bamboo and using a dry-scrub method, will produce a deeper exfoliation. For homecare, this can be done prior to a shower or bath on dry skin. The scrub may be worked into the skin for a few minutes before wetting it down. This allows actives to penetrate the skin, causing granules to be more effective in removing dead skin.
Body peels work beyond just the surface to reduce course texture and fine lines, diminish age spots and hyperpigmentation, and help maintain healthier, more youthful looking skin. As clients often realize an immediate change in firmness and texture, these are akin to a workout for the skin.
With body peels, there are different techniques and skin issues to be cognizant of prior to treatment. Since the body has tougher skin, enzymes, alpha hydroxy acids like L-lactic acids, and other acid combinations may be used to lift away deeper layers of dead skin cells, provide antioxidants, regenerate, and hydrate, leaving the skin smooth and polished.
Skin assessments are essential and attention to any existing scar tissue, sun damage, spots, and moles is imperative. Also, use caution not to peel more than 25 percent of the body at the same time.

POST-CARE AND MANAGING RESULTS
With any resurfacing treatment, post-care is essential. The skin has been wounded and disturbed and now needs to be restored and nurtured to optimal health and strength. Depending on the skin type, treatment used, reaction by their skin, and desired results, each treatment and client will require a customized post-care regimen.
Following microdermabrasion, for instance, a blend of antioxidants, essential vitamins B, C, D, and K, along with potent building and fortifying extracts like growth factors will nourish, soothe, hydrate, and strengthen
the skin.
With microneedling, post-care topicals like peptides and epidermal growth factors will be imperative. These will speed repair, recovery time, and prevent redness.
For chemical peels, post-care and homecare will be dependent on the type of acid and depth of the peel. Overall, nourishing and soothing ingredients will be essential. Look for growth factors, essential fatty acids, arnica, and a mineral-based sunscreen. It must be stressed to clients that proper post-care is essential to any exfoliation procedure and ensures a more positive outcome.

While exfoliation is key to healthy skin, a number of precautions must be taken prior to prescribing a regimen to a client or performing a treatment. However, the results should be a bright, luminous tone, even texture, and a plump, healthy, and youthful appearance when administered properly and safely. 

Rhonda Allison, a pioneer in the skin care industry, is the founder and CEO of Rhonda Allison Cosmeceuticals and RA for Men. She is also an author and internationally-known speaker with more than 30 years of aesthetic experience.