So what's exfoliation's secret? Skin generates a new layer every two to four weeks. As we age, this process slows. However, thanks to numerous techniques we can improve the skin's complexion by sloughing off the old layers and bringing the fresh layer up to surface. The skin experiences sloughing as an "injury" and automatically creates healing in the exfoliated area by generating a new healthy layer of skin. The results are softer skin, a more even skin tone, and firmer skin. Exfoliation also enhances the production of fibrous proteins such as collagen and elastin.
Exfoliation can be used to fight acne and help skin breathe by removing the dead skin cells that accumulate on the top layer of the epidermis and trap oils inside the pores. For those of us who are sporty, or men who tend to have larger facial pores, exfoliation is a great way to keep skin clean and even on the face, back and chest. It can also help soften rough feet and hands or even out Keratosis Pilaris (those hereditary tiny bumps on the back of your arms).
There are multiple methods of exfoliation available to the clinical aesthetician as well as to the consumer. Mechanical exfoliants, which are comprised of hard ground botanical or natural products, such as walnuts, sugar, or micronized silicate are "mechanically" applied to the skin using your fingertips. There are different types of mechanical peelings, those that are worked into the skin in a wet state and then rinsed off or those that -- dry on the skin, with a longer drying time produce increased exfoliation. Concurrently, enzymatic exfoliation contains ingredients that naturally exfoliate the skin such as pepsin, pineapple, pumpkin, and cranberry. Microdermabrasion is a mechanical process of skin exfoliation in which the skin is vacuumed at a high pressure with particles of micro crystals. Newer microdermabrasion techniques such as the diamond microdermabrasion buff the skin to reduce scarring and even out dimples while improving the overall texture of the skin.
Chemical exfoliants and peels perform the same work, but use different strength acids, such as Alpha-hydroxy, Beta-hydroxy, Lactic acid, Salicylic acid, and vitamin A. These are found in fruit such as apples and grapes, as well as in ingredients like sugar cane and milk. For peels, the patient must be educated concerning the peel process and give signed consent if performing a medium or deep peel. Clients with severely damaged skin may not be good candidates nor are those at the opposite end of the spectrum with excellent skin. The clinician can vary the number of coats, the strength of the acid and the pH level depending on the depth of the peel desired. The peel frost, or facial whitening indicating the depth of epidermal damage, can aid in the determination of this number.
Most patients can tolerate a monthly superficial peel, while medium-depth peels can be performed at six-month intervals, if necessary. Types of chemical peels include TCA, Jessner, and Salicylic. Another category of peels is herbal peels. These are effective for Mediterranean skin profiles. They can resolve acne lesions, assist in correcting hyperpigmentation in ethnic skins, and cause resolution to capillaries. This makes them appropriate for the treatment of rosacea and folliculitis.
The most modern approach today is "Layering". The clinician analyzes the skin, makes a choice of the depth of the treatment, and utilizes the various above- mentioned techniques in one sitting. After the depth of necessary correction is determined, the treatment begins with mechanical exfoliation followed by the application of AHA, microdermabrasion, herbal buff, and a light layer of acid either 7% of TCA or one coat of Jessner to finish. These can be done in a series of three or six repetitions and can be deeper if the skin is left to dry and peel or can be lighter if the skin receives a fair amount of hydration at the end of the session and at home. The most important factor is to prescribe an aggressive and thorough approach for the client at home, beginning with sun management that utilizes broad spectrum and physical blocks. In addition, antioxidants, Idebenone, vitamin C, skin bleachers both botanical and chemical, Retinol/ Retinoic acid are necessary components to the home management phase of exfoliation. The prescription of AHA's can be excessive but may be suitable in certain situations.
To fight the aging of the face alone is not enough, our hands, feet, décolletage and bodies need to be exfoliated too! The positive benefits of exfoliating the body are numerous but the most obvious is looking and feeling younger. Shaving also acts as an exfoliant for the body (and yes, men and women for the face too!). However, it's important to space out the time between exfoliation and shaving to not create hypersensitivity. Other things to watch for are sun, rosacea, and certain prescription drugs. Body exfoliation can be enhanced by a dry brush made of natural vegetable bristles or by using a loofah, which helps cleanse the entire lymphatic system.
Exfoliation should be performed once a week for dry skin, up to twice a week for combination skin and every other day for oily skin. If you have sensitive or problem skin, then avoid exfoliating. The typical in clinic/spa methodology is to commence by prepping and washing the skin, followed by exfoliating and concluded by hydrating the skin. One can also add-on massage, hydrotherapy, or a Vichy shower component.
Over exfoliation can age the skin! Too much of anything good is just too much. Exfoliating more than needed creates the opposite effect of a sensible regimen. Side effects include dry skin, capillary exposure, self- inflicted rosacea and sensitivity to sun. How does one know when it is too much? Not all skins are alike and the rule is not universal. Each person's skin has to be analyzed by a professional and a goal needs to be set. If the exfoliation is used to correct a condition then the correction level needs to be monitored for the desired result to be achieved. Once this result is achieved; a moderate maintenance routine needs to be put in place. Protecting the skin is the most crucial in the skin correction phase. A great level of attention and emphasis needs to be placed on protection and high level sun management at all times of the day. This is the most crucial element of any exfoliation program. If the exfoliation is done for general well- being and as a modest routine, there should be less risk posed.
Exfoliation techniques around the world can be drawn back to the natural resources, culture, and customs of a particular area. Be it almond grinds or salt scrub, the rejuvenation process always includes both physical and spiritual components. In ancient Egypt, nobles used topical Lactic Acid, an active ingredient of sour milk as part of an ancient skin rejuvenation regimen (Kuwahara, 2005). Cleopatra, known for her vibrant beauty and extended youth, was rumored to bathe in an herbal milk bath mixed with 'ylang-ylang' and frangipani flower. To this day, Dead Sea salts from the Middle East are renowned for their exfoliating and healing properties. Dead Sea resorts and spas in Jordan and Israel boast a multitude of facial treatments and body exfoliations based on these salts. In Europe, exfoliation treatments incorporating natural water sources like the Evian springs or seaweed from the Mediterranean have been a part of European women's anti-aging arsenal throughout time.
Europeans are not the only ones incorporating water therapy with exfoliation. In North Africa, the ritual Hammam or Turkish baths, a remnant from the Ottoman Empire, are a way of life and community bonding. After rinsing oneself by pouring purified water from marble basins and drying off on a heated marble slab, Hammam attendants scrub you down with a "kese" or "gant de gommage", a dry mitt that scrubs off old superfluous skin, and then give you a soap massage using "savon noir," a dark, olive oil-based soap that leaves your skin smooth. Skin is exfoliated clean of impurities when a technician scrubs your dead skin off with a mitt and the savon.
Japanese women who are known for their ability to keep a youthful complexion have seized the energizing properties of native botanicals such as ginger and bamboo for their ability to provide energy and increase blood-flow capacity. But one secret reigns supreme, Azuki bean powder, has been used as a face wash in Japan for over 1,200 years, and is still popular today. In ancient Japan, courtesans would scrub their face and body with small silk bags containing Azuki powder. Today, Japanese women use cotton bags or apply the creamy powder directly to their skin.
Exfoliation also holds a central part in traditional Ayurvedic philosophy. Ayurvedic herbs such as Indian Valerian using the natural organic texture or coarseness of the herbs to scrub the face and body have been used for over 5,000 years. It is believed that, in conjunction with the exfoliation, the therapeutic properties of the herbs used are absorbed into the bloodstream. But the traditional body, mind, spirit approach to rejuvenation is taken a step further in treatments such as the Bindi herbal body treatment. Bindi, a Sanscrit word meaning "point of origin," adapts traditional Pancha Karma rejuvenation therapies by massaging the Marma face points and applying a hot Ayurvedic herbal wrap, botanical mask, exfoliation, dry brush massage, and aromatherapy to the body.
The old world is not the only place incorporating community riches into potions of youth. Wine regions took notice of the age old practice of mixing old wine with Tartaric acid (Kuwahara), when they decided to develop antioxidizing exfoliation treatments based on local wine crush. In desert or frosty areas of the country, one can find a plethora of body exfoliation treatments incorporating native aromatherapy oils like pine or lavender. A host of American spas have also taken their cues from their South American brethren with the latest fad of exfoliation treatments based on coffee, cacao, and sugar cane.
The spa industry has transformed in the last decade with more and more luxurious and elaborate facilities and clinical settings coming to the marketplace. If we analyze any menu of offerings, in each setting, the removal of old skin for both face and body plays a major roll in all of our aesthetic treatments. The more expansive the variety of body exfoliations, scrubs, and rubs the better. For the face, acids, lasers, microdermabrasion, and all other modalities have re-energized the spa industry and created a boom. For the professional in the aesthetics field, choosing a variety of exfoliation methods appropriate to their particular facilities whether a day spa, resort spa or medi-spa is crucial to offering effective anti-aging treatments and running a successful business, so get educated and make targeted choices among the array of offerings.
LaBelle CEO and Founder, Bella Schneider is the Bay Area's leading spa personality. After studying economics at U.C. Berkeley, she opened her first spa in 1976. She operates several thriving spa-salons and the Center for Advanced Esthetics, leads 250 staff, is an international educator and speaker, formulates her own products, consults, creates private label products for top brand companies and distributes her own brand of products and equipment to more than 600 spas and salons worldwide. Concurrently, she maintains a hands-on presence in every LaBelle Day Spa & Salon both creatively and operationally.
References
Briden ME: Alpha-hydroxyacid chemical peeling agents: case studies and rationale for safe and effective use. Cutis 2004 Feb; 73(2 Suppl): 18-24[Medline].
Kuwahara, Raymond T: Chemical Peels. eMedicine 2005 Aug;

 Review Questions

1. Why is it important to know a variety of exfoliation techniques?
2. What are the long-term effects of over- exfoliating?
3. How can abuse of exfoliation age the skin?
4. Why do different regions exfoliate and treat the skin with different ingredients?
5. Which ingredients should I look for in my body exfoliation treatments?