Though product fads come and go in the skin care world, it appears that microbiome skin care is here to stay. According to recent market studies, one of the fastest-growing segments within the industry is microbiome skin care. ^1,2 Products containing various prebiotics, probiotics, and postbiotics fall within this category, with the purpose to nourish the skin’s microbiome and modulate it back into balance. Restoring balance to the microbiome may potentially resolve numerous skin ailments including acne, rosacea, eczema, psoriasis, and many others. Though traditional treatments and medications, such as steroids or antibiotics, frequently provide successful relief of these skin conditions, the results are often temporary and may come with unwanted side effects. These treatments can negatively impact the microbiome, causing a host of other challenges. Alternately, microbiome products encourage the skin to heal itself by returning the microbiome to homeostasis or balance.

THE MICROBIOME

So, what is the microbiome, exactly? It is a delicate balance of trillions of microorganisms living and functioning together. This balance includes gram-negative and gram-positive bacteria, fungi, viruses, mites, and protozoa. Humans have more microbes living in and on them than their own cells, and it is estimated that the microbiome can weigh up to five pounds. ³ Internally, the microbiome primarily resides in the digestive tract, while externally. While it surrounds and inhabits the skin. It is extraordinarily diverse, and it varies from person to person throughout different locations of the skin on the body.

 As an analogy, the skin’s microbiome could be compared to the earth’s climate and living organisms. Just like the earth, there are areas of dry, desert-like climates with little to no moisture content or sebum production. These areas would include skin on the elbows and front of the knees. There are also humid, rainforest-like regions with copious production of sebum and sweat, such as the skin behind the ears and on the face and décolleté. Like different earth regions, specific microorganisms only reside in certain climates of the skin. ^4,5 When in balance, various organisms protect the skin, defending against potentially harmful pathogens and environmental damage, functioning as a part of the skin’s barrier that maintains overall hydration levels. The microbiome varies throughout one’s life cycle; it is ever-evolving and changes based on the environments it encounters, including hygienic habits, the aging process, and other factors.⁶

      Many experts believe the microbiome is not just a separate entity living on the skin but is instead a functioning organ of the body.⁷ Like an individual’s organs, the microbiome has pathology and physiology, and when altered, it impacts overall health and wellness, potentially resulting in disease. The skin’s microbiome is dependent on food for nourishment, which is provided by dead skin cells and the sweat and oils secreted. Anything that hinders skin’s natural excretions could have a negative impact, such factors include the use of harsh foaming cleansers and over-exfoliation, as well as the natural aging process, which decreases the excretion of sweat and sebum. Other external influences that could damage the skin’s microbiome include antibiotics, sanitizers or disinfectants, preservatives, pollution, and excessive ultraviolet exposure. These are important considerations to highlight regarding skin’s overall care and health, especially now that most clients are exposed to these factors more than ever. New discoveries show that many popular aesthetic treatments on the market can disrupt the microbiome. These treatments include laser resurfacing, microneedling, microdermabrasion, and many other modalities. Many of these treatments destroy skin cells, harshly remove other components of the skin’s barrier, and induce inflammation. It is critical to consider the client’s post-care routine after these treatments, ensuring it is microbiome-friendly and helps to re-establish the skin’s barrier function.

Another crucial factor that determines the microbiome’s strength and robustness is its diversity. Diversity in species living throughout the microbiome, both internally and externally, has been shown to contribute to a more resilient immune system.⁸ For example, those living in rural areas who are exposed to the outdoors, dirt, nature, and animals have been shown to have a more diverse, healthier microbiome. However, not all exposure is positive. People who reside in urban areas with increased pollution are shown to have a less robust immune system and overall lower microbiome health.⁹

ROLE IN SKIN HEALTH

The significance of the microbiome’s role in the skin’s overall health cannot be overstated. Studies show the microbiome can affect almost every aspect of the skin, including hydration levels, inflammation response, immune system regulation, and the ability to build new, strong skin cells.^10,11 Dysbiosis, or an imbalance in the microbiome, is implicated in various skin diseases. It is not merely the existence of these microbes on the skin that cause disease, but rather their overgrowth and invasion into areas of the skin in which they do not belong. Though these imbalances are not necessarily the sole cause of skin diseases, their role in disease formation is well established. Various skin conditions and microbial imbalances associated with them include the following list:

Acne

1. acnes bacteria and formerly known as p. acnes bacteria was traditionally viewed as the primary culprit in causing acne. However, it has been shown that c. acnes also live on healthy skin without an occurrence of acne.¹² It is now understood that only specific strains of c. acnes bacteria are involved in the creation of acne. How these strains interact with other microorganisms living on the skin, as well as the immune system’s response, also play a role in acne formation, not just the organism’s presence on the skin.
2. epidermidis — the most prevalent bacteria living on the skin. Recent studies point to the disharmony of c. acnes bacteria with s. epidermidis as a cause of acne.¹³ Whether through injury to the skin or changes in oil production with puberty, c. acnes can thrive and overgrow, potentially leading to acne formation.

Malassezia is a species of yeast or fungi, implicated in causing acne. Though Malassezia lives harmoniously on healthy skin, its imbalance and invasion into the follicle can cause folliculitis, which appears to the naked eye as traditional acne.¹⁴

Rosacea

Demodex mites reside in the skin, specifically within the sebaceous glands and hair follicles. Their population is relatively harmless for most people; however, those with rosacea have a nearly six-fold increase in these mites’ population density.¹⁵ The mites release a compound called chitin, which can activate an inflammatory cascade seen as redness, telangiectasia, pustules, and thickening of the skin observed in rosacea. Presumably, if there is a six-fold increase in the density of mites populated in rosacea skin. There is also a substantial increase in chitin release, thus impacting the severity of the aforementioned symptoms.

Demodex mites are also the host of a bacterium known as b. oleronius. While this bacterium is relatively harmless on its own, the mites overpopulating the follicle can cause it to become distended or expanded, creating a leak. When the mites die, they release toxins from the b. oleronius bacteria that potentially penetrate through the leak into the follicle. This encounter can lead to a chain reaction of inflammation, creating pustules, redness, and other symptoms related to rosacea.¹⁶

Dermatitis, Eczema, & Psoriasis

1. aureus is more commonly known as staph. This bacterium has proven prevalence in cases of atopic dermatitis and eczema.¹⁷ Though its presence has not been directly correlated as the cause of dermatitis and eczema lesions, it is implicated in the condition’s severity and flare-ups. Interestingly, healthy skin with a balanced microbiome does not allow colonization of s. aureus. However, skin that exhibits dermatitis shows reduced production of antimicrobial peptides that will enable s. aureus colonization, suggesting an imbalanced microbiome.¹⁸

Candida is a yeast-like fungus, and its species have shown some correlation with psoriasis and a flare-up of symptoms.¹⁹ Though candida usually is present on the skin with a healthy microbiome, overgrowth may be due to altered immune function.

PREBIOTICS, PROBIOTICS, & POSTBIOTICS

Microbiome skin care can be incorporated in every step of a client’s routines, including cleansers, toners, serums, and moisturizers. Other emerging applications include probiotic patches that show promise in treating a multitude of skin conditions. As mentioned previously, “microbiome-friendly” products often contain various biotics, such as prebiotics, probiotics, and postbiotics. With all this biotic talk, it can seem overwhelming and confusing. Let us define these components and their role in the skin’s microbiome health.

Prebiotics play a substantial role in the microbiome’s overall health, as they provide food for beneficial microorganisms, or probiotics, that reside internally in the digestive tract and topically on the skin, allowing them to thrive. Though their studied prominence primarily lies in their role in gut health, the skin care industry is beginning to understand the value of prebiotics in treating various skin conditions. By nourishing specific probiotics with targeted prebiotics, skin care professionals can effectively increase probiotic colonies and fend off microbes that cause harmful skin conditions. Sources of prebiotics in skin care include various plant sugars, such as xylitol and galactomannans, and inulin, a plant fiber derived from chicory root. There are also food sources, such as barley, flaxseed, or wheat bran, used as effective prebiotics in skin care to nourish the beneficial probiotics.

Probiotics are live microorganisms with beneficial properties when digested internally or applied topically to the skin. Probiotics are arguably the most well-known and studied object of discussion when referencing the microbiome. Even so, new information is unveiled daily about various probiotic strains and their topical benefits. Historically found in cultured and fermented foods such as yogurt, probiotics are now commonly utilized in supplements and beauty products. Probiotic use in skin care has been shown to improve many skin conditions, including acne, rosacea, and sun damage, as well as slowing the skin’s aging process.

The most recent discovery in biotics is postbiotics, which are the waste materials of probiotics. These include essential fatty acids, amino acids, and other leftover components after a probiotic’s life cycle. Initially viewed as non-beneficial waste, postbiotics potentially play a critical role in flora’s overall health. These spare components lend themselves towards creating an ideal environment on the skin, including establishing an ideal pH for the skin’s barrier function, which allows good microbes to thrive.

To use another analogy for explaining these various biotics, if skin care professionals envision the skin as the soil in a garden, then prebiotics would be fertilizer and probiotics would be the plants that grow in the soil. Postbiotics would be the nutrients leftover after the plants die, eventually recycling back into the soil, providing nutrients to make it an ideal environment for future plant growth. Using harsh surfactants, antibiotics, sanitizers, and anything else that could disrupt the microbiome is the equivalent of a natural disaster ravaging the garden. Imagine these negative factors as a hurricane, flood, or tornado ripping up an entire established ecosystem and creating a blank slate. This opens a window of opportunity for harmful pathogens to establish dominance, causing an infection or skin disease due to an absence of beneficial microbes that keep these pathogens in check. Another important consideration is that each component of the skin’s “garden” is dependent on the other, so it is essential to nourish them all.

CHOOSING BIOTICS FOR THE SKIN

The magnitude of what is still unknown about biotics and their power to restore the skin’s health makes it challenging to determine what is best or most important to incorporate into skin care routines. Additionally, skin care professionals must be mindful to review an entire skin care routine as needed to ensure ancillary products used do not wipe out the client’s skin nutrients and the microbiome itself.

An essential factor to consider when choosing biotics to incorporate into a skin care routine is utilizing specific strains that have verified efficacy in impacting the skin condition – distinct strains and their proven efficacy matter. Research that will make this possible for the masses is still in development, so patience is necessary for both spa professionals and clients. At present, two promising probiotics to explore in skin care are lactobacillus bacteria species and ammonia-oxidizing bacteria (AOB), as both have shown to be effective in addressing a plethora of skin concerns.^20,21

In summary, the microbiome plays a substantial role in the skin’s overall health. This role includes the microbiome itself, how it communicates with the immune system, and how the body responds, as they are all tied together. Skin care professionals are just beginning to understand the microbiome’s various interactions and functions. This creates endless possibilities, exciting prospects, and the potential to treat challenging skin conditions without using chemicals and medications with harmful side effects.

References

1. “MICROBIOME IN SKINCARE MARKET.” Verify Markets. Accessed December 17, 2020. https://www.verifymarkets.com/pages/microbiome-in-skincare-market.
2. Markets, Research and. “Skin Microbiome Modulators Market to Reach $2.97 Billion by 2030.” GlobeNewswire News Room. "GlobeNewswire", July 22, 2020. https://www.globenewswire.com/news-release/2020/07/22/2065875/0/en/Skin-Microbiome-Modulators-Market-to-Reach-2-97-Billion-by-2030.html.
3. Hair, M, Sharpe, J (2014). Fast Facts About the Human Microbiome. Center for Ecogenetics & Environmental Health, University of Washington.
4. Grice EA, Kong HH, Conlan S, Deming CB, Davis J, Young AC; NISC Comparative Sequencing Program, Bouffard GG, Blakesley RW, Murray PR, Green ED, Turner ML, Segre JA. Topographical and temporal diversity of the human skin microbiome. Science. 2009 May 29;324(5931):1190-2. doi:
5. Human Microbiome Project Consortium. Structure, function and diversity of the healthy human microbiome. Nature. 2012 Jun 13;486(7402):207-14. doi: 10.1038/nature11234. PMID: 22699609; PMCID: PMC3564958.
6. Aleman FDD, Valenzano DR. Microbiome evolution during host aging. PLoS Pathog. 2019 Jul 25;15(7): e1007727. doi: 10.1371/journal.ppat.1007727. PMID: 31344129; PMCID: PMC6657895.
7. Baquero F, Nombela C. The microbiome as a human organ. Clin Microbiol Infect. 2012 Jul;18 Suppl 4:2-4. doi: 10.1111/j.1469-0691.2012.03916.x. PMID: 22647038.
8. Flies EJ, Clarke LJ, Brook BW, Jones P. Urbanisation reduces the abundance and diversity of airborne microbes - but what does that mean for our health? A systematic review. Sci Total Environ. 2020 Oct 10; 738:140337. doi: 10.1016/j.scitotenv.2020.140337. Epub 2020 Jun 22. PMID: 32806360.
9. Fouladi F, Bailey MJ, Patterson WB, Sioda M, Blakley IC, Fodor AA, Jones RB, Chen Z, Kim JS, Lurmann F, Martino C, Knight R, Gilliland FD, Alderete TL. Air pollution exposure is associated with the gut microbiome as revealed by shotgun metagenomic sequencing. Environ Int. 2020 May; 138:105604. doi: 10.1016/j.envint.2020.105604. Epub 2020 Mar 2. PMID: 32135388; PMCID: PMC7181344.
10. Nørreslet, L.B., Agner, T. & Clausen, M. The Skin Microbiome in Inflammatory Skin Diseases. Curr Derm Rep 9, 141–151 (2020). https://doi.org/10.1007/s13671-020-00297-z
11. Beri K. Skin microbiome & host immunity: applications in regenerative cosmetics & transdermal drug delivery. Future Sci OA. 2018 Mar 28;4(6): FSO302. doi: 10.4155/fsoa-2017-0117. PMID: 30057781; PMCID: PMC6060389.
12. Platsidaki E, Dessinioti C. Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne. F1000Res. 2018 Dec 19;7: F1000 Faculty Rev-1953. doi: 10.12688/f1000research.15659.1. PMID: 30613388; PMCID: PMC6305227.
13. Claudel JP, Auffret N, Leccia MT, Poli F, Corvec S, Dréno B. Staphylococcus epidermidis: A Potential New Player in the Physiopathology of Acne? Dermatology. 2019;235(4):287-294. doi: 10.1159/000499858. Epub 2019 May 21. PMID: 31112983.
14. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014 Mar;7(3):37-41. PMID: 24688625; PMCID: PMC3970831.
15. Casas C, Paul C, Lahfa M, Livideanu B, Lejeune O, Alvarez‐Georges S, et al. Quantification of Demodex folliculorum by PCR in rosacea and its relationship to skin innate immune activation. Exp Dermatol. 2012;21(12):906–10.
16. Lacey N, Delaney S, Kavanagh K, Powell FC. Mite-related bacterial antigens stimulate inflammatory cells in rosacea. Br J Dermatol. 2007;157(3):474–81.
17. Leyden JJ, Marples RR, Kligman AM. Staphylococcus aureus in the lesions of atopic dermatitis. Br J Dermatol. 1974 May;90(5):525-30. doi: 10.1111/j.1365-2133.1974.tb06447.x. PMID: 4601016.
18. Hata TR, Kotol P, Boguniewicz M, Taylor P, Paik A, Jackson M, Nguyen M, Kabigting F, Miller J, Gerber M, Zaccaro D, Armstrong B, Dorschner R, Leung DY, Gallo RL. History of eczema herpeticum is associated with the inability to induce human β-defensin (HBD)-2, HBD-3 and cathelicidin in the skin of patients with atopic dermatitis. Br J Dermatol. 2010 Sep;163(3):659-61. doi: 10.1111/j.1365-2133.2010.09892.x. Epub 2010 Jun 9. PMID: 20545685; PMCID: PMC2966528.
19. Pietrzak A, Grywalska E, Socha M, Roliński J, Franciszkiewicz-Pietrzak K, Rudnicka L, Rudzki M, Krasowska D. Prevalence and Possible Role of Candida Species in Patients with Psoriasis: A Systematic Review and Meta-Analysis. Mediators Inflamm. 2018 May 6; 2018:9602362. doi: 10.1155/2018/9602362. PMID: 29853795; PMCID: PMC5960518.
20. Muizzuddin N, Maher W, Sullivan M, Schnittger S, Mammone T. Physiological effect of a probiotic on skin. J Cosmet Sci. 2012 Nov-Dec;63(6):385-95. PMID: 23286870.
21. Notay M, Saric-Bosanac S, Vaughn AR, Dhaliwal S, Trivedi M, Reiter PN, Rybak I, Li CC, Weiss LB, Ambrogio L, Burney W, Sivamani RK. The use of topical Nitrosomonas eutropha for cosmetic improvement of facial wrinkles. J Cosmet Dermatol. 2020 Mar;19(3):689-693. doi: 10.1111/jocd.13060. Epub 2019 Jul 1. PMID: 31257694.

Brian Goodwin is an award-winning international educator for Éminence Organic Skin Care. As a master medical aesthetician, master herbalist, and consultant, Goodwin leverages over 10 years of spa industry experience to bring fun, engaging education to spa professionals around the world. Voted ‘Favorite Brand Educator’ in DERMASCOPE’s 2019 Aestheticians' Choice Awards, he delivers influential trainings which continue to raise the bar for professional education and garner worldwide peer recognition. Goodwin embraces every opportunity to share his passion and guide industry professionals on their path to success. He has educated and consulted to more than 2,000 distinguished spas and has notably been invited to deliver keynotes at major industry events across North America.

Perhaps one of the most incredible things about the human body is that everything in it is connected. And when one piece of the biological puzzle is compromised, it causes a ripple effect, impacting a host of other functions, organs, and vital systems. So, when talking about skin – the body’s largest organ – skin care professionals would be remiss if they did not discuss the importance of the lymphatic system to its overall health and appearance.

The lymphatic system is an intricate network of tissues and organs that are imperative to the body’s detoxification process. It also plays an important role in the body’s ability to nourish and regenerate tissue, filter metabolic waste, and keep the immune system healthy. When working correctly, the lymphatic system dispels toxins that can be harmful to both the immune system and skin health. However, when the system becomes sluggish, impurities may get trapped in cells, leading to acne, loss of elasticity, and premature aging of the skin.

Fortunately, the lymphatic flow can be stimulated through movement – a technique skin care professionals are using in the treatment room to benefit clients who suffer from rosacea, acne, puffiness, overall sluggish skin, and post-surgery inflammation and bruising. But, before diving into how to invigorate the lymphatic system in the treatment room, it is imperative to gain a deeper understanding of the system itself and its connection to the skin.

A LOOK AT THE LYMPHATIC SYSTEM

Most associate the lymphatic system with the lymph nodes in the throat, armpit, or groin that can become swollen and even sensitive to the touch when the body is fighting an illness. The lymphatic system spans the entire body, comprising a network of tissues, vessels, and organs, which include ducts, nodes, and the lymph –– all located just below the skin. This system collects excess fluid (lymph) that drains from cells and tissue and returns it to the bloodstream. It is also an important part of the immune system, producing and releasing lymphocytes – white blood cells, that monitor and destroy foreign invaders like bacteria, viruses, and fungi.

The lymph collects extra fluid drained from cells and tissues. It transports the all-important lymphocytes. It is often recognized as the clear, yellowish fluid that accompanies blood when a pustule is extracted.

 Lymph nodes filter lymph fluid, produce immune cells to fight infection and rid the body of foreign antibodies like bacteria. When bacteria or infection is identified in lymph fluid, the lymph nodes go to work producing more white blood cells to eliminate the bacteria, which causes the swelling. The nodes are also where the body clears or purifies itself of the bacteria or any debris the lymph collected from the cellular tissue.

A CLOGGED LYMPHATIC SYSTEM

Since lymph is not a part of the vascular system, it does not have the benefit of a pump like the heart to keep it circulating and moves only one way – upward and away from gravity. Already at battle with gravity, the lymphatic system is especially susceptible to other external factors, mainly the overexposure of environmental toxins that may overload the system. Furthermore, inadequate sleep, a poor diet high in processed foods, dehydration, stress, and a lack of exercise can stagnate lymph flow and sometimes stops it altogether.

Not only can a compromised lymphatic system lead to acne, loss of elasticity, and premature aging of the skin, it can also weaken the body’s immune system, contributing to a slew of autoimmune conditions that are detrimental to a clients’ overall health. With that in mind, how can a skin care professional identify an underperforming lymphatic system? A few signs include,

• Swelling in fingers, bloating, and excess weight
• Feeling stiff and sore when waking up
• Cold hands and feet
• Chronic fatigue
• Digestive issues
• Dry or itchy skin
• Increased colds, flu, and sinus infections
• Enlarged lymph nodes
• Skin hardening and thickening

SUPPORTING THE LYMPHATIC SYSTEM IN THE TREATMENT ROOM

In the treatment room, stimulate sluggish lymph through a technique called manual lymphatic drainage or stimulate the lymph flow, as well as other ingredients and treatments that can stimulate the flow.

 Stimulating lymphatic flow is a precise skin movement technique that occurs at the surface level of the skin. The technique does not involve moving any of the tissue underneath the skin. It stimulates the lymph to move more efficiently, helping the body to purify and cleanse itself.

 The manual lymphatic flow technique can be used in tandem with acne, rosacea, and post-surgical treatments to help heal, reduce inflammation, and restore the skin back to its optimal health.

LYMPH FLOW FOR ACNE

Stagnation in the lymphatic system can cause toxin-filled lymph to build up around lymph nodes. Considering 38% of the body’s lymph nodes are located in the neck, once lymph slows, the area around the neck, jawline, and ears are the most susceptible to breakouts due to the concentration of toxic fluids in this area.

For clients challenged by acne, the manual lymphatic flow technique may be used with an acne corrective facial to assist in the healing process by reducing inflammation and swelling. The relief of pressure on acne lesions is an important step in recovery and brings solace to the client. Lymphatic flow also supports the clearing of toxins.

 For the facial treatment, a glycolic-based cleanser followed by a salicylic scrub will deeply cleanse the skin and provide antibacterial support. After the cleanse, a digestive enzyme may be applied to dissolve dead cells, clean up impurities, and stimulate cellular turnover. Once the enzyme has been removed, apply nutrients and anti-inflammatory ingredients and then perform a lymph flow technique. Next, apply a mask with wasabi to continue increasing circulation and provide healing support. To finish, a combination of nourishing and corrective ingredients like grapeseed oil, benzoyl peroxide, allantoin, epidermal growth factor, and natural zinc will protect, and provide calming, soothing support.

LYMPH FLOW FOR ROSACEA

Lymphatic vessels are responsible for removing inflammatory immune cells that cause chronic facial redness and flushing, which is why it is important for those with rosacea to understand the importance of healthy lymphatic vessels. It is imperative to recognize and treat these issues early before the lymphatic vessels are physically damaged, functionally inactive, or too inflamed to flush excess fluid buildup and toxins. The goal for rosacea clients is to provide strengthening and reduce the underlying inflammation using the manual lymphatic flow technique.

The treatment begins with a green tea and salicylic-based cleanser, which provides antibacterial support, followed by salicylic peeling cream blended with a milk-based mask. After the mask and peel cream has been thoroughly removed, apply a nourishing cocktail of essential fatty acids, sea buckthorn oil, and vitamins. This might be followed by a second mask application using the same milk-based formula blended with a nourishing serum of essential fatty acids and vitamins. While the mask is on the skin, gently roll chilled ice globes over the face to reduce inflammation and redness. Finish with growth factor serum and perform a lymphatic flow technique. 

 In the case of rosacea, it may be best to leave the manual lymphatic flow technique for the end of the treatment so as not to disrupt the flow. Typically, this yields complete results because the skin is able to continue to drain after the client leaves.

LYMPH & INFLAMMATION

When clients have puffiness around the eyes, or even come to the spa post-cosmetic surgery, manual lymphatic flow supports the movement of the fluid creating the edema (or swelling), and aids in the reduction of inflammation and bruising. For post-surgery, offer the stimulate lymph drainage as a stand-alone treatment.

 When performing a manual lymphatic flow treatment, the clearing will always start at the base, working to clear the area so the lymph has a place to go. Using the thumbs, begin with parallel strokes from the middle of the chest to the collarbone. Progress up to the middle of the neck to the top of the neck, moving the lymph down. Then, move along the bottom of the face, to the cheek area, to the bottom of the jawline. Finish with the forehead, continuing to move the lymph down. This technique does not require a lot of pressure, rather it is a feathery touch with the movement coming from the body to create an even pressure. Movement is in a circular motion in the direction the lymph must flow.

 As noted, this is a very precise movement, and technique that takes time to learn. Do not expect to master it in a day. If new to the technique, take a course through a school that specializes in lymph flow. It can take hours to learn proper technique, but once it is mastered a skin care professional can offer it as an add-on service in the treatment room to further results.

OUTSIDE THE TREATMENT ROOM

Fortunately, lymphatic system support is also something clients can do on their own between treatments. Advise clients on the number of simple changes they can make to their daily routines to keep lymph stimulated or to jump start it when it is sluggish. Some tried-and-true ways to keep the lymph in motion, include regular exercise. This is perhaps the most effective way to stimulate lymph flow. The contraction of muscles during exercise pumps lymph movement from the inside out. Hot and cold showers also aid in lymph flow. Hot water helps to dilate the blood vessels while cold water causes them to contract. Alternating between the two can create a natural pump action to force toxins out of the body. Dry brushing and scrubbing is more than just a fad, dry brushing or using a body scrub in circular motions for 10 minutes a day before showering can help increase lymph flow. Deep breathing (in the diaphragm) is also beneficial. This technique also acts as a pumping action to help the lymphatic system transport toxins into the bloodstream and then to the liver for detoxification. By drinking an adequate amount of clean water – at least up to half of your weight in ounces per day can help further cleanse one’s system of toxins. Similarly, decreasing caffeine and alcohol intake can help avoid dehydration.

A regular massage can produce many important physiological effects on the body, including increased lymphatic drainage and removal of toxins. Gua sha, an ancient Chinese healing technique, utilizes a tool (usually a natural stone) to massage the skin and can increase lymphatic drainage. Release neck and jaw muscle tension by stretching neck and jaw muscles. Lean the head toward either shoulder, as this will move the muscles by the neck lymph nodes, stimulating lymph flow. Wear loose-fitting clothes as tight clothing can reduce circulation in the lymphatic system and can lead to an accumulation of toxins.

A proper diet rich in nutrients is also essential to lymph health. Some of the best cleansing foods for the lymphatic system include:

• leafy green vegetables
• low sugar fruits
• ground flaxseed
• chia seeds
• avocados
• garlic
• brazil nuts
• almonds
• walnuts
• cranberries

In addition to these, drinking herbal teas can stimulate lymph flow. Look for herbs like echinacea, peppermint, astragalus wild indigo root, goldenseal, cilantro, poke root, and parsley.

The pandemic has been stressful for most and has made daily rituals, like going to the gym and stocking up at the grocery store a bit more difficult. Now is the perfect time to have open conversations with clients to learn about their current habits, identify whether they are exhibiting any signs of a clogged lymphatic system, and determine if delivering a long-overdue boost to the system is needed to get it back on track.

Shannon Esau is the CEO and national educator at Rhonda Allison Cosmeceuticals, where she oversees the company’s strategic growth, development of new product formulations and innovations, and the educational and instructional programming. She brings more than 20 years’ experience in the aesthetic industry. Esau has also completed advanced chemistry studies in cosmetic formulation and formerly owned and operated three advanced skin care clinics in the Dallas and Fort Worth metroplex.

Most individuals have heard how essential oils can be used to reduce stress. Most skin care professionals are likely familiar with oils, such as lavender and eucalyptus to promote calming and relaxation benefits that soothe and ease tension. Many are already familiar with these aromatic scents andyou may have already used some of them.Perhaps these oils have been used in bathing products like bath salts, in body scrubs, skin care products, on clients’ facial towels, or while massaging. Personally, I love using essential oils in all of my treatments. I also love to educate on the many beneficial uses of essential oils and the powerhouse impact they can have in our lives on a daily basis. 

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ESSENTIAL OIL USES

There are three ways to use essential oils. Through aromatics(smell or inhalation), and you can use this method by diffusing oils into the air, by applying a drop into your hand and inhaling, or wearing it as a personal fragrance. They can be used topically – oils are absorbed through the skin.You can massage oils into the skin.Apply to targeted areas of the body and add them into products like lotions and moisturizers. Essential oils can also be used internally, as in ingesting oils to be transported throughout the body. This method can be used by dropping oils into a glass of drinking water, putting them into a vegetable capsule to ingest, or placing drops under the tongue. 

It is important to know how to safely use all essential oils. For example, if ingesting oils, they must be deemed safe for internal use. When using topically, dilution combined with carrier oil will minimize skin sensitivity. 

ESSENTIAL OILS FOR STRESS

Lavender is known as one of the most calming essential oils because it has significant relaxing properties when used aromatically, topically, and internally. Suggest that clients add a few drops to bath water to ease tension, diffuse in the bedroom before bed for a restful night’s sleep, or take internally to calm anxious feelings. 

Bergamot provides a wonderful way to promote a calming atmosphere, while simultaneously encouraging uplifting feelings. Try diffusing to promote a calming atmosphere, rubbing on the bottom of feet before bedtime, or mixing with fractionated coconut oil for relaxing massage balm. 

Clary Sage is one of the most relaxing, soothing, and balancing essential oils. If clients are experiencingtrouble sleeping, combine a few drops of clary sage oil with water in a spray bottle and have them spritz over their pillow before going to bed for a restful sleep. Diffuse clary sage at the end of a long day to help promote feelings of calmness and relaxation orwhen you need a quick and simple way to relax.Apply clary sage oil topically to the pulse points (neck and wrists) to create a sense of calm.

Roman chamomile is known to have calming effects on the skin, mind, and body. Add one or two drops of roman chamomile oil to herbal tea to soothe the body and mind. Apply to the chest over the heart for a feeling of well-being. To avoid bad moods, diffuse roman chamomile oil to soothe any feelings of anger and irritability.

YlangYlang has several impressive qualities, including its ability to uplift a mood while also having a calming effect. Combine a few drops of YlangYlang oil with Epsom salts and place them in a warm bath to promote relaxation.Apply this essential oil to the back of the neck for a calming, uplifting effect or rub on wrists for a natural perfume that will give off a soothing and calming aroma throughout the day.

Petitgrain is inviting and comforting but also provides calming and relaxing benefits that can ease feelings of stress. In addition to calming feelings of stress and tension,taking petitgrain internally eases feelings of tension and calms the nervous system.When in the middle of a stressful day, diffuse petitgrain oil to promote feelings of calmness.Spritz a few drops and other calming essential oils, like lavender or bergamot over pillows and bedding to promote feelings of relaxation.

Vetiver is known for its grounding, calming effect on emotions, and for its calming nature. The rich, exotic aroma of vetiver is quite unique; however, it has the ability to promote grounded, calm feelings after a busy or frazzled day. After a difficult day, massage vetiver oil into the neck and feet to promote feelings of calm.Diffuse with other calming essential oils to calm emotions and lessen stress.

STRESS RELIEVING DIFFUSER BLENDS

Try three drops of lavender plus three drops of lime plus one drop of spearmint. Another blend to indulge in is two drops of geranium, two drops of frankincense, and one drop of basil. A final option to utilize is three drops of lavender plus three drops of clary sage, followed by two drops of ylangylang, and one drop of marjoram. 

Essential oils are a plus to creating a welcoming place for clients when visiting the spa. Clients and skin care professionals alike can indulge in wellness using essential oils and their many benefits. With this in mind, skin care professionals should utilize these to create blends that bring calm and peace into their spa space. Allof these blends will bring a sense of calm and allow you and your client to celebrate wellness.

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Catherine Kooiman is a licensed aesthetician with over 25 years’ experience in the beauty industry. As the founder and CEO of Skin So Sweet and Get Sugared?!, the two companies were established in 2006 as one of the first sugaring for hair removal establishments in Orange County, California. Kooiman has spent the last 15 years cultivating her passion for providing excellent service, leading Skin So Sweet, and Get Sugared?! She is also a master sugaring educator who started an education,professional supplies, and product distribution company called “Sweet Professional” in November of 2012. While operating Sweet Professional Inc. to help lead the sugaring movement for five years, she cultivated a training and certification platform that successfully certified over 1,600 sugaring practitioners. She returned her focus to the treatment room servicing clients and leading staff and continues to passionately focus on her career as a multi-location business owner, operating her Orange County-based skin care studios. Kooiman continues to aspire and dream to lead Skin So Sweet and Get Sugared?! into a conceptualized sugaring-based franchise brand opportunity. Kooiman is also a mother to two beautiful children in which she gleams is her favorite and most important job ever. 

You always hear about the mind and body connection. But, what about the skin and gut connection?If an individual constantly eats a diet lacking in nutrients, they will suffer the consequences of inflammation.Skin is a person’s largest organ. It is made up of many, tiny living microorganisms that fight off harmful bacteria and keep the body’s bacteria balanced.This is the same for the gut.In order forthe gut to function at its capacity, it needs to have a proper balance of bacteria.What one eats can affect the balance of good bacteria and cause skin conditions like rashes and breakouts. 

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Everything put into the body reflects on the skin.When analyzinga client’s skin, I bet you can tell if they are not sleeping, if they drank too much alcohol, or if they are taking a new medication.You can probably also tell if it looks like they have been eating too much sugar and processed foods and not drinking enough water.Now let’s take a look at four popular diet trends and their impact on the skin to better your analysis.

PALEO DIET

The Oxford Dictionary defines the paleo diet as a diet based on the types of foods presumed to have been eaten by early humans.Meat, fish, fruit, vegetables, nuts, and seeds – foods that in the past could be obtained by hunting and gathering.A paleo diet limits foods that became common once farming came into the picture – processed sugar, dairy, starches, (legumes and grains) and refined oils.Doctors agree that added hormones in processed foods disrupts normal body functions and can trigger various skin conditions like acne and eczema.People on this diet also report a dramatic increase in the growth of their hair and nails, attributing it to the protein and zinc found in the meat they are consuming.

KETO DIET

The Ketogenic diet (keto diet) shares many similarities to the Atkins diet.A typical breakfast on both diets may consist of a bacon and egg sandwich between two fried “chaffles” (fried cheese that looks like a waffle). A mouthwatering choice to some and a not a chance in this lifetime to others.Doctors say a diet high in fat increases the production of sebum on skin and as a result can lead to acne and other inflammatory conditions like psoriasis.Doctors also say that, in certain rare conditions, the keto diet has been known to trigger a skin condition in some people called “prurigo pigmentosa,” an itchy rash that looks like small pimples on the back, chest, or stomach. However, it has also been reported by some people on both diets that their skin appears to be softer and more glowing because of the higher oil content in the diet. Doctors attribute the glow to metabolism changes and more oil production.

VEGAN & PLANT-BASED DIETS

People who consume mostly plant-based foods do not really need to focus on calorie counting because they fill their plates with nutrient-dense foods that are naturally low in calories.As a result, they have lower cholesterol levels, blood sugar levels, and blood pressure stats.But, did you know eating whole grains, vegetables and fruits can transform skin?When you fill your plate with the colors from the rainbow, your body is getting nutrients like lycopene (protects skin from photodamage), vitamin C (stimulates collagen), and potassium (hydration).These antioxidants keep free radicals in check. 

THE H2O Connection

With any of these diets, the number one thing to remember is to add water.Water is life.Not drinking enough water puts added pressure on the heart to deliver oxygen and nutrients to organs.It also shows up on your face as an uneven, dull complexion with very noticeable fine lines.It can be temporary, and it is a relatively easy thing to fix with a few lifestyle adjustments.

It is important to know how food may impact the skin, especially if the primary goal has more to do with the body mass, rather than the completion.What works to reduce the body, may wreak havoc on the skin. Clients came to the professional for the answers so remember to stay informed on the latest diet trends. 

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Annette Hanson is the founder of Atelier Esthétique Institute of Esthetics in Manhattan, a New York state licensing, NACCAS-accredited skin care school, post-graduate facility, and the first United States aesthetics college to be recognized by London’s International Therapy Examination Council (ITEC).Her professional experience spans more than 30 years as a Paris-trained aesthetician, waxing specialist, body therapist, salon manager, and spa consultant.A creator of two product lines, she is also a published author and sought-after lecturer at leading professional conferences worldwide.She was instrumental in the development of the 600-hour curriculum for the New York state aesthetics license, as well as the written and practical exam. She served as an educator on the Appearance Enhancement Advisory Committee to New York’s Secretary of State. She was inducted into the Aesthetics International Association (A.I.A.) industry legends in August 2009 by DERMASCOPE Magazine.She is on the leadership committee of the ASCP Skin Care School Council (Associated Skin Care Professionals).

First things first, what is the skin barrier? The skin barrier consists of cells and is made up of lipids (fats) and it forms the skin’s outermost layer. Also known as the permeability barrier, moisture barrier, or lipid barrier, the skin barrier is responsible for making sure essential water and electrolytes do not evaporate from the skin. 

When the skin barrier is damaged, signs of redness or inflammation, dehydration, itchiness, flakiness, or acne flare-ups will occur. A weak or damaged skin barrier is mostly dry or dehydrated, so it is unable tolock in moisture, making it easier for irritants and bacteria to penetrate the skin. If a client’s skin easily reacts to products and feels a stinging or burning sensation during product application, chances are their skin barrier is damaged.

The skin barrier can become compromised through over-exfoliation. Harsh scrubs can cause damage to the skin barrier. Alcohol-based toners, pollution,some essential oils, smoking, dry climates, environmental stressors, sun exposure, genetics, aging, as well as airplane travel can cause skin barrier damage.

DAMAGED SKIN BARRIER

First, re-assess the client’s skin care routine and figure out the culprit. Did they recently try a new product that madetheir skin react poorly? Or perhaps they are piling on way too many products that are actually doing more harm than good?

The skin has its own microbiome – the natural levels of bacteria which work with the oils and natural hydration of skin to keep the barrier strong from the outside environment and to keep it at the ideal pH level (around 5.5). This contributes to a healthy skin barrier. 

INGREDIENTS TO AVOID

There are plenty of products that can help restore a natural protective barrier. Since the client’s skin will not be able to protect itself, suggest products that are formulated with skin-restoring ingredients. Recommend clients to stay away from sulfates, parabens,and alcohols as these ingredients only make things worse for a compromised skin barrier. Avoid all actives, such as alpha hydroxy acidslike glycolic, lactic, and malic acids, salicylic acid, benzoyl peroxide, vitamin C, vitamin A, retinol, and harsh or high pH cleansers, and scrubs. These can cause further damage to the barrier.

For a considerable amount of time, keep the client’s routine consistent and simple. Go for a low pH cleanser, as this will not disturb the natural pH level of the skin and will keep it balanced. Certain types of alcohol are damaging as they strip the skin of its moisture. Avoid toners that contain denatured, isopropyl, or benzyl alcohol. Fortunately, not all types of alcohol are harmful, so do not worry if there iscetyl, ceteryl, glycol, or stearyl alcohol. These fatty alcohols are great for the skin. Plus, they also keep all the other ingredients in the product stable. Serums are a must as they contain a high concentration of ingredients that repair the skin barrier. Look for serums and moisturizers with hyaluronic acid, niacinamide or ceramides, oils, including jojoba, sea buckthorn, CBD, Abyssinian, pomegranate, carrot, squalene, sweet almond oil, and all forms of vitamin E (tocopherol), as these ingredients not only nourish the skin but also protect it against further damage. They are also gentle and help repair skin damage. Last but not least, apply sun protectant factor. When a client’s skin barrier is damaged, it needs all the protection it can get. Skipping on the sun protectant factor will worsen the situation. No matter the weather, apply a layer of sun protectant factor every day on top of a moisturizer and underneath makeup.

Going through skin issues can be tough, but one thing to remember is to give the client’s skin time. Remind clients that there are no shortcuts, and products may not miraculously give them perfect skin within a day, week, or even a month. With the right combination of products that suit their skin type, soon enough they will have skin that is glowing, hydrated, and supple.

Compromised skin can affect a large group of the population, including oncology patients. According to the American Cancer Society, in 2020, there will be an estimated 1.8 million new cancer cases diagnosed.1Among complaints, cancer patients can experience dry skin, hand and foot skin reaction, and dermatitis.2

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Oncology patients can alsopsychologically suffer from their condition, as well and aestheticians can impact these patients in a positive way.One Italian study found 88% of female cancer patients had a significant reduction in depressive symptoms, anxiety, and body image issues, as well as an improvement in self-esteem levels.3

It is for this reason that oncology aesthetics is an emerging field. Proper training and certification is essential to the practice of oncology esthetics. Certification in oncology aesthetics has become more readily available throughout the United States, through organizations such as Oncology Training International. It is also important to remember that with oncology aesthetics, no two clients are alike. Each oncology client comes with an entirely unique set of circumstances that must be accommodated correctly in order to have a beneficial treatment.

It is particularly important to follow health and sanitation guidelines when dealing with a client who has compromised skin, especially if they are an oncology patient. Always follow the local, state, and national regulations and guidelines applicable to one’s spa or business.See the Center for Disease Control and World Health Organization websites for additional information and go to OSHA through the United States Department of Labor for the latest guidelines and documents on occupational safety during COVID-19.

In addition to using a face mask, shield, and non-latex disposable nitrile gloves, consider using additional safety equipment during the treatment, including a face screen for facials – a clear, washable screen affixed on a moveable stand that can be placed over the client’s head during the treatment and adjusted to suitable heights.

More information on oncology aesthetics, as well a detailed protocolsand ingredients and products to use, is available in the textbook“Oncology Esthetics” from Oncology Training International. 

SKIN ANALYSIS & CONSULTATION

A proper intake form is the key to designing a facial treatment for an oncology patient.This asks important questions such as what type of treatment they are undergoing, any side effects of the treatment, and any important concerns to be aware of such as skin sensitivity or prosthesis.

Once a client is situated in the facial bed or chair, use a magnifying lamp, and analyze the skin.Take a look at the condition – whether the skin is dry, compromised, oily, or whether the client is experiencing any kind of sensitivity. 

Examine the skin correctly and have a consultation with the client.When doing a consultation, move forward and sit next to them.Always look at them and make sure they are making eye contacts as well.Make sure their ears are not blocked in any way, so they can hear and see. Very often, clients that are undergoing chemotherapy or radiation are super sensitive and might not be able to listen as attentively.It is important to have a very calming demeanor and speak clearly and slowly. Always pay attention and use proper etiquette.

PROTOCOL

Cleansing

Moisten cotton with a mild, seaweed-based makeup remover. This should be a neutral base eye makeup remover, which can also be used as a pre-cleanse for removing makeup from the skin.

Take two pieces of cotton that have been saturated in the mild makeup remover and place them on the eye area. Leave one of the pads on while working on the first eye. 

Gently remove the eye makeup, working downwards first, stroking through the eyelashes, then wiping under the eye. Turn pad inside out for a clean surface then repeat, going downwards on the lashes and wiping under the eye area. Dispose of the cotton and move to the other eye. Repeat on the other side. Take a dry piece of cotton and dry the area.

Use disposable brushes to apply the cleanser. Disposable brushes are a very hygienic alternative to fingers and help prevent cross contamination.These will also provide mild exfoliation.Use a gentle, non-irritating, seaweed-based cleanser and apply it the skin in very gentle, upward, and outward motions on the face and downwards on the neck – never rub. Always finish all movements at the temples. Take cotton moistened with luke-warm water to remove cleanser residue in an upward and outward motions.

Exfoliation

Use a cleansing device, such as a Dr. Lucas Pulverizer Championniere instead of hot steam, which can irritate and inflame compromised skin. Combine distilled water with a mild hydrating seaweed and mastic water-based essence to calm, soothe, and hydrate the skin.Mastic Essence from the island of Chios in Greece has been used for centuries for the purpose of calming all types of irritation. 

Provide a Dr. Lucas Pulverizer Championniere misting for about five minutes. Apply the spray from the back, rather than from the front to prevent the spray from going up the clients nose. Use cotton to pat dry the skin with no rubbing.Be sure to have no water dripping down the neck of the client.

If the client needs additional exfoliation, use a mild alpha hydroxy acid exfoliant. Look for one that has a perfect pH a blend of mild, gentle, and effectivealpha hydroxy acids combined with seaweed and marine hydroxy acids, and is pre-measured and opened at the time of use with no cross contamination.

Open the swab and swipe on the skin in gentle strokes all over the face.Once on, use a fan to cool the skin down.Remove after five minutes with moistened cotton and water.Use a water spray bottle or repeat using the Dr. Lucas Pulverizer Championniere.

Always ask the client if they feel tingling from a scale of one to 10.Anything up to six is normal.If they are feeling tingling from eight up to 10, this is the time to remove the solution.

At this point, various forms of massage, including effleurage, a kansa wand,silver ball massage, as well as light emitting diodes, and radio frequency, or hand and foot massage can be employed in the facial.

Sheet Mask

Uni-dose, individually wrapped sheet masks are perfect for oncology patients because they are hygienic.Take scissors from the sterilizer and cut open a sheet mask packette with a mask that is saturated in calming, soothing, and hydrating aloe, seaweed, and spirulina extracts, and remove mask from inside of pouch.

Open the mask, apply to the face, remove the plastic backing, and throw the backing away. Position mask to fit correctly and place soothing eye pads saturated in soothing green tea over the eyes to reduce the appearance of puffiness and dark circles. Often the client may be experiencing extreme dryness on the lips.Use a pure essential oil containing seaweed, mastic oil, or vitamin E on this area for relief.

After 10 to 15 minutes, remove the mask by gently peeling off the skin.Hydrate with seaweed mist, then use dry cotton to dry the face, patting gently.Work with one hand and rest the other on the top of the forehead.Once the treatment is over, apply a barrier cream that combines zinc, titanium, and seaweed, which is also fragrance and water-free.

Makeup Application

Use makeup that contains seaweed extracts and minerals to finish the service, starting with a mineral based concealer, then foundation.Apply makeup with disposable sponges, and finish with a light application of lip gloss applied with a disposable brush. 

Performing this type of treatment in the proper sanitary conditions can help the oncology patient and client see themselves looking healthy and feel emotionally better after receiving a nurturing treatment.This type of practice can bring the highest level of satisfaction, both for the client and the aesthetician. 

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Most skin care professionals are all seeing many more clients with some sort of compromised barrier these days and this skin condition shows no signs of ending soon. So, how do skin care professionals approach it, and what will they need to treat this skin condition plaguing clients?

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First let’s define compromised skin and what it looks like.Compromised skin is when the skin’s barrier becomes damaged, and it is not able to function as it should.

The functions of the skin is to protect, control heat regulation, secrete, feel sensation, absorb, provide immunity, and synthesize vitamin D.

Although each of these are very importantfor healthy skin, let’s focus what is in the scope of aesthetics –protection.When the barrier is healthy, it will protect by keeping allergens, bacteria, and viruses out, while also keeping water in.

When the barrier is compromised, it cannot do either of those two functions as well as needed or wanted.

BARRIER IMPACT & HEALTH

What kinds of thingscan impact the skin barrier? 

• health

• environment
• medications
• stress
• diet and lifestyle

What ingredients can restore skin barrier health? 

Hydrating and moisture binding ingredients like hyaluronic acid, sodium hyaluronate, oat kernel oil, and glycerin all provide this support.Strengthening ingredients includeceramides, glycerin, hyaluronic acid, vitamin C, and squalene. Anti-inflammatory options arerosehip seed oil, hemp oil, argan oil, marine collagen, frankincense, vanilla, and rose essential oils, vitamin C, andshea butter. Soothing and calming ingredients includejojoba, frankincense, colloidal oatmeal, willow herb, and shea butter.Skin replenishing ingredients to utilize include retinol, niacinamide, linoleic acid, linolenic acid, ceramides, adenosine, and peptides.

Rebuilding the skin is a two part process – extrinsically (what is put on the skin) and intrinsically (what is put in the body.) Eating a balanced diet rich in iron, calcium, zinc, amino acids, carbohydrates, healthy fats, and vitamin B, C,and D is an important step to restoring a compromised skin barrier.Have a nutritionist in the spa’s network that practitioners can learn from and refer clients to when necessary. 

BARRIER BREAKDOWN

What kinds of ingredients can degrade or breakdown the barrier? Anything that is classified as a skin or immune irritant or toxin, including aluminum, coal tar derivatives, andcosmeceutical- grade mineral oil. Diethanolamine and triethanolamine,ethyl acetate, andtriclosan are also known toxins that contribute to barrier breakdown.

As a skin care professional growstheir knowledge of ingredients,they will learn about these and many more.Also, these and similar ingredients are still being used in cosmetics and personal care products today. It is no wonder why there are so many clients with a compromised barrier.Make this a priority and research ingredients.Know what is in the products being retailed.

REPAIR ROUTINE FOR CLIENTS

Morning

 Splash face with warm water or gently use a washcloth (no cleanser). Apply a serum likehyaluronic acid, vitamin C, or peptide cleanser. Then apply a skin-loving clean oil, followed by a

moisturizer.Finish with a proper sun protectant factor and begin makeup application if desired.

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Evening

Pre-cleanse with oil and then use a gentle cleanser with lukewarm water to rinse. Use ahyaluronic acidserum with marine collagen to cool, soothe, and increase skin hydration.

Apply two to three drops of a skin-loving oil that will protect and keep moisture in. Finish with a moisturizer that will hydrate, calm, soothe, and protect skin.

Spa treatments can also include a hydrating mask, body care, hydration, and LED light therapy.Keep it simple, keep it clean, and clients will love and return for more skin love.

Most aestheticians face clients with a compromised barrier several times a day.To provide the best services and achieve the ideal outcomes without inflaming the client’s skin, it is essential that every aesthetician knows the signs of a compromised barrier.Once this has been identified, it is also critical to know what limitations are necessary in such cases.

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BARRIER FUNCTION

The epidermal barrier provides five important functions, including protection from infection, prevention of absorption of unwanted substances, protection from the elements, prevention of moisture loss, and durability with daily contact and activities.The bottom line is that an intact barrier is critical for good skin health, including proper moisture levels, reduced ultraviolet damage, and aging.A known philosophy is that if a client is exfoliating away their barrier lipids and layers every day or many times a week, their skin is being forced to work even harder to maintain itself.This means that valuable nutrients related to dermal collagen and maintenance are being diverted away for this newly created burden.The skin’s cellular turnover rate does not need outside help.The only reason skin slows down its turnover rate is because it has a limited supply of the nutrients it needs, and it may take 40 days to complete a turnover cycle. This is not a defect of the skin, it is an intelligent response to the ever-shrinking supply of vitamins, fats, minerals, and proteins that drop by about 1% a year in adulthood.Exfoliating often only serves to drain that supply even further. Alcohol or acid-based toners, physical devices or scrubs, and certain ingredients like acids, most retinols, and other chemicals are all guilty of weakening the barrier.

For compromised barriers that are not self-induced, the starting point is to remember that the skin works around the clock.The barrier can be limited by physiologic or nutrient shortages resulting from chronic inflammation (rosacea) or a weak immune system (from disease or medication mostly) that limits the skin’s activity. Rosacea often results in a constant state of inflammation and repair that can steal from what is needed for an intact barrier.Similarly, when an individual is sick, the focus of the immune system (which is inseparable from the skin’s immune system) can be elsewhere, and this preoccupation prevents healthy repair and maintenance activity of the skin.Both of these sources of a compromised barrier can be deduced from taking a skin and health history, as well as through an examination.

EXAMINATIONS

A physical examination of the skin is best done after cleansing because that is when it is easier to see mild peeling, contact-generated redness, and other possible signs like dull, oily, or texture changes in skin.If a client says they are sensitive to many different types of skincare products or ingredients, that is a strong indicator.If they describe having an oily T-zone, there is a pretty good chance that they have dehydrated skin overall and that is often a sign of barrier issues. For oily skin and T-zones, the first question to ask is about their daily routine with product and ingredient choices as part of the consultation.About half of oily skin cases are from dehydrated skin increasing sebum output as a protective mechanism to their overly exfoliated, dry skin and half are from estrogen toxins causing a testosterone imbalance, resulting in more oil in their skin. The client’s skin history will help figure this out.

FACIAL TREATMENTS

Facials should be focused on products that preserve or support barrier health for these clients.One should be careful not to overstimulate their skin with actives.Homecare should exclude exfoliation going forward.A lipid for temporary barrier protection is phosphatidylcholine because it does not trigger a slowing of turnover like ceramides have been shown to do.It clinically proves moisture support and ultraviolet-B protective properties.Superfoods like sea buckthorn oil can be a great source for feeding a healthy barrier from within. With inflammatory skin conditions, the key for their barrier health is to address the internal sources of their issue and to calm the skin from the surface.Face masks can contribute to dryness, sometimes from constant rubbing of those areas, but is more likely the client’s barrier was compromised beforehand, and the mask is only serving to exacerbate the problem. Moisturizers are also not the solution, as they can increase moisture losses because of the emulsifiers they contain. Focus on gut health for rosacea sufferers because that is the source of their condition. 

Always take an inside-out approach to barrier challenges for best results since topicals provide only temporary relief at best. Even so, it is still important to take a knowledgeable approach when working with clients who have compromised skin barriers. Overstimulation is often the culprit, and it can be difficult to understand that less is sometimes more. 

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For some aestheticians or aesthetic nurses, working at a medical spa is their dream job. These types of spas provide an advanced level of clinical results for clients and in some cases higher paying salaries and commissions. The saying, “the bigger the risk the greater the reward” is true for a medical spa. Their clients expect better results than if they were just having a facial. They want a results-driven corrective treatment, not something that only feels good for an hour.

LEVEL UP

There is a time and place for feel-good treatments, but most patients in a medical spa atmosphere want something a little more corrective. This means that professionals and owners need to level up. They need to have the right equipment for the job, which means investing money in devices, that are both safe and effective. The owner takes this risk financially and by reputation. While working in a medical spa may be a skin care professional’s dream, remember it has been the dream of medical spa owners for a longer time, and they have more at risk with more to lose. Because of this, it is imperative that the owner hires individuals that have the same goal –to deliver safe and effective treatments; the same vision, to improve people’s lives by giving them confidence; and the same character for the culture, being respectful of clients, their privacy, and time. When a medical spa owner is looking to hire a new employee, they will be looking for someone that understands their business. Leveling up one’s knowledge is going to be key to landing a job in a medical spa.

There are four major areas to focus on when applying for a job in a medical spa. These are the professional’s education, training or certifications, references, and portfolio. Having an aesthetician license or nursing license is number one. Make sure the license is up-to-date and be familiar with the physiology of the four most common skin conditions – aging, acne, pigmentation, and sensitive skin. Have a firm grasp on what these skin conditions look like, how they occur, and what ingredients are used to treat them. Many aesthetic and nursing programs do not focus or have any information on medical aesthetics, which is unfortunate, but there are several training programs to help get the training. However, these cost money, so do research to determine which one will be most beneficial. Depending on the state, some will require a laser certification in order to perform laser hair removal, while other states do not. In that case, it might not be necessary for an aesthetician to attend a laser certification course, but it would look better on a resume and give clients peace of mind that the practitioner has knowledge in performing the treatments.

The most popular treatments in a medical spa are neurotoxins and fillers, laser hair removal, body contouring, intense pulsed light, and facial exfoliation, which includes microdermabrasion and chemical peels. Becoming familiar with these modalities and how they work is imperative. Whether or not a skin care professional can perform them will depend on their license, the state board, and their employer. Again, there are several companies and independent professionals that provide continuing education on these specific topics. When hired for a job, the employer will typically train the new professional on the laser machine or device that they own. Major device brands will have a representative come in and do the training. If not, the owner or someone more advanced will provide the training. This keeps the staff on the same page and ensures the clients are getting the same treatment every time regardless of who is performing them. Remember, the overall goal is to provide safe and effective treatments.

FAMILIARITY

If not familiar with the list mentioned above about neurotoxins and fillers, laser hair removal, body contouring, intense pulsed light, and facial exfoliation, then it is time to get familiar. Look into getting additional training or certificates for each treatment. Neurotoxin or neuromodulators are a class of medications that act as muscle relaxers to prevent wrinkles. Filler or dermal fillers, on the other hand, are gel-like substances that deliver volume to the face reducing the appearance of lines and wrinkles as well. They work differently from neurotoxins but both work to improve aging skin. The next most important thing to understand is light-based treatments and the electromagnetic spectrum. The electromagnetic spectrum is a range of energy or radiation that is used to deliver heat or light to the skin to create a response and induce change. Laser (light amplification by stimulated emission of radiation), LED (light emitting diode), and IPL (intense pulsed light) are all aesthetic modalities based on the electromagnetic spectrum, as well as radio frequency treatments, such as skin tightening and body contouring. Body contouring can be accomplished in many ways – through devices that deliver heat, cold, or even chemicals to destroy fat cells and create a more sculpted silhouette. And lastly, both physical exfoliation like dermaplaning or microdermabrasion or chemical exfoliation with alpha hydroxy acids, beta hydroxy acids to trichloroacetic acids. Knowing the difference between alpha hydroxy acids, beta hydroxy acids, and trichloroacetic, how they function, and who they are beneficial for will help a skin care professional understand peel selection. But, do not expect someone to be familiar with a particular brand so know the basics of the treatments listed above.

REFERENCES

Next, choose references wisely. References are people who can talk not only about one’s work habits and skills but also the professional’s character. In a medical spa, people expect a higher level of results, as well as professionalism. Be respectful of other people’s time. Not only the time of the client that is in the chair but also respect the owner’s time. Having someone that can speak about one’s work ethic and character will be a make or break conversation that the owner will have. And it does not have to be with a previous spa if this is a skin care professional’s first job in aesthetics. This type of general information is valued across the board for all industries.

PORTFOLIO

The last piece of the puzzle is the skin care professional’s portfolio. In aesthetics, these are usually images of clients’ before and after photos. If the professional has a social media page or a book they can print photos of clients before and after images, bring those in, and be able to eloquently talk about what was done to accomplish that desired outcome. For example, what the client’s concern was and how it was fixed. This will show the interviewer that the skin care professional is a problem solver and has the same vision of improving people’s lives because they resolved a client’s problem.

Now when should one apply to have the best chance? The busiest time of year in the medical spa industry is the fall going into winter and the new year. This is not the time to look for a job in a medical spa. There are probably no aesthetician’s that are leaving their jobs at this time because they are making all their commissions and tips that will get them through the slower summer months. The same situation or the owner because they will not be taking time away from patients and treatments to do training or use a bed for a discounted procedure as a model for training when there are full price patients waiting for a spot. The best time would be after January and into the spring and summer, maybe even in early fall, so that the prospective professional can be properly trained and ready for the holiday season. Be willing to work hard and be motivated as medical spas can become very competitive. Sometimes it is hard to get clients in the door, and it is just as much a skin care professional’s responsibility as it is the owners to help get those clients there.

Start a professional social media following immediately to help build relationships and a reputation with the spa community. Even if the account is just about fun facts and tidbits of information, this will start to build trust with the engaging audience. There can be a lot of unpaid hours building clientele, following up with clients, and tracking down leads, but it is worth it in the end. Level up with education, training, references, and a stellar portfolio to easily land a job at a medical spa. Working in a medical spa is a dream job as it allows professionals to help clients on a whole new level.

Erin Lucie, an Oklahoma native, is family nurse practitioner and licensed cosmetologist with over 15 years of experience in the aesthetics industry. Known in Tulsa, Oklahoma as an expert cosmetic injector, she completed her Botox and filler training in Beverly Hills, California in 2011 and has attended many advanced trainings since. Lucie has further specialized in optimizing and balancing the hormone dysfunction created by stress and the overwhelming life management issues relating to all professionals by providing clients with integrative options in health, lifestyle, medication, and appearance enhancement. She is a member of the American Academy of Anti-Aging Medicine.

Spa sanitation has been one of the hottest topics in our industry in recent memory due to COVID-19 concerns. It affects everyone, literally. Remember the panic when you couldn’t find toilet paper? This is now happening with cleaning and disinfection supplies. On top of that, is the effects these products have on the environment. With unprecedented supply chain issues, and priority positioning of disinfectants in hospitals, it’s getting harder to find the disinfectants, cleaning supplies, and personal protective equipment spas have been so accustomed to employing. Now, that begs the question, if, and when, spas can reopen for business, how is it done safely, within regulatory guidelines, environmentally ethically, and efficiently? The answer may be alternative, and natural sanitation methods. So, let’s chat about what those alternatives could be, how they can be effective, and, of course, how to implement these methods to suit the spa’s needs. 

ALTERNATIVE METHODS 

Some tried and true alternative methods of cleaning have been around long before modern techniques were adopted. We’re talking about going all the way back to Ancient Babylon and Egypt. According to cleaninginstitute.com, “The Ebers papyrus, a medical document from about 1500 B.C. describes combining animal and vegetable oils with alkaline salts to form a soap-like material used for treating skin diseases, as well as for washing.” Although we’ve adapted these methods, the principal is the same and can be evidenced through time.Using soap for cleanliness can reduce widespread disease and the transmission of viruses. This insight is more important now than ever in recent history.Simple hand washing can make a huge impact on the spread of disease and aiding in the decline of transmission. Even hand washing now has an alternative – hand sanitizer. If it’s at least a 60% alcohol, according to the Mayo Clinic, and you let it dry before switching tasks, it can be just as, or even more, effective than washing to reduce microbes. Many studies have been done, including the one by Andreas Widmer of Oxford University, that shows, “It is microbiologically more effective in vitro, and in vivo, it saves time. Preliminary data demonstrate better compliance than with hand washing.” Considering they state that, “healthcare workers frequently do not wash their hands, and compliance rarely exceeds 40%,” this is compelling evidence to think of alternatives at every step of the infection control plan. So, in a world gripped by pandemic, it’s increasingly important to not only wash your hands, with plain soap and water, but to keep those alternative methods within reach to protect you, your clients, and the community. 

CLEANING THE SPA

Now that your hands are clean, let’s tackle the task of finding a potential alternative for hard surface disinfection in the spa. According to the Environmental Protection Agency, “Using the least hazardous and most effective products available will protect the health of those in your care, staff, the custodial personnel, and other building occupants. Using these products is also better for the environment.” They recommend seeking out products that have received the Green Seal; you can find a list of these at the Green Seal website. In addition, the Environmental Protection Agency’s Design for the Environment “Antimicrobial Pesticide Pilot Project is the only program that can legally certify disinfecting products that are less hazardous for human health and the environment in the United States.” 

Many medical practices, med spas, and day spas have begun to implement the use of alternative cleaning and disinfecting methods to keep up with infection control during the COVID crisis and now, beyond that.  We see that they are typically utilizing protocols that include ingredients such as acetic acid, also known as white vinegar, to keep up with the cleanliness of their treatment areas. Some are also implementing the use of sodium bicarbonate, a.k.a baking soda, to break down even some of the most stubborn bioburdens in the clinic. According to Stephen Cornish of the David Suzuki Organization, both white vinegar and baking soda were shown to be “highly effective against potential bacterial pathogens,” which is promising considering the unprecedented infection control supply chain issues we currently face in the spa industry. 

Additional household ingredients that position themselves as encouraging alternatives are hydrogen peroxide, lemon juice, essential oils and Borax. According to a study done by SFEnvironment, hydrogen peroxide solutions “have very few, if any, environmental warnings. Hydrogen peroxide is not toxic to aquatic species, and it rapidly degrades in the environment into oxygen and water.” Armed with this information, it appears that hydrogen peroxide can certainly poise itself as not only a great alternative method for cleaning but also as a sustainable and environmentally-friendly substitute for disinfection.  

Now, let’s talk about lemon juice.  Lemon juice, or any citrus juice for that matter, features citric acid which is naturally anti-bacterial and antiseptic.  These benefits can be closely compared to that of bleach while offering a pleasant and refreshing aroma.  Using this as an additive can enhance the cleaning capabilities of a solution as well as helping to deodorize a space without the use of aerosol sprays or air fresheners. For additional sustainability and environmental mindfulness, utilize organic lemons or organic citrus fruits!

Additionally, due diligence would not be done if we didn’t discuss essential oils. Namely Thyme Oil.  Thymol is an ingredient that can be found in high concentrations in thyme oil and in EPA-registered disinfectants, sometimes as the main active ingredient.  Its primary function is, according to www.bccdc.ca, “to impair cell membrane integrity and aid in the decrease in ATP within the cell”.  This essentially means that the cell of the microorganisms cannot sustain life therefore ceasing to function and ending mitosis. It has even shown to have efficacy against E.coli after 5 minutes and S. Aureus after 15 minutes, in varying concentrations, according to bccdc.ca.  This information should encourage you to delve deeper into your research of essential oils, especially thyme oil, as a substitute disinfecting agent. Be sure to include tea tree oil and lemon essential oil in your research as they often accompany thyme oil in homemade preparations.

Lastly, lets introduce Borax to the conversation. Borax has been in use for its ability to clean for 4,000 years.  The old adage “tried and true” comes to mind when thinking of the use of Borax.  Chemically speaking, according to Anne Marie Helmenstine, Ph.D., “Borax and other borates clean and bleach by converting some water molecules to hydrogen peroxide (H2O2). This reaction is more favorable in hotter water.” Additionally, she states that, “The boron, salt, and/or oxygen of boron inhibit the metabolic processes of many organisms. This characteristic allows borax to disinfect and kill unwanted pests.”  While having an alkaline pH (~9.5), Borax can be added to solutions to potentially enhance their effectiveness against bioburdens or even to function as a buffering agent to keep chemical reactions occurring correctly. Borax can also help to suspend other cleaning agents on surfaces longer to magnify their potential disinfectant properties. Whichever way you lean, hospital-level, natural, or a customized approach, it is always encouraged to research your options and then use that gathered information and data to make an informed decision on what’s right for you, your business, and your reputation. Some great websites to visit are those of the EPA, OSHA, and of course your state regulatory agency and/or Department of Health.

MIXING SOLUTIONS

For those that wish to employ natural sanitation practices, it is a considerable recommendation to not only research a list of employable ingredients, but to also be well versed in mixing, storing, and implementing these solutions.  The goal should be to maintain a level of efficacy that mirrors that of standard regulation, as closely as is feasible, in order to use these procedures in the spa. There are many articles, blogs, Pinterest and other social media posts that promise to enlighten us to natural alternatives, however, there appears to be much variation in what actually works. One must filter through this information with a proverbial fine-toothed comb for literature with a factual basis or scientific references to claims.  One such place that you can find this information is www.thoughtco.com.  There you will find a plethora of scientifically based articles to support your decisions.  For example, a search of cleaning alternatives populates a list of numerous support pieces for research, such as an article titled Which Sponge is Better for the Environment?, wherein the author, discusses a very similar topic to this article, more specifically about alternatives to sponges, with a multitude of references to scientific facts.  So, in essence, research isn’t just important to perform, it's important to do it thoroughly and well.

So what mixture is recommended for general cleaning in the spa?  According to mom.com, “To make thyme disinfectant, combine 2 cups hot water, 20 drops thyme essential oil and ¼ cup citric acid powder into a plastic spray bottle. Shake well before use. Spray onto surfaces and wipe with a dry cloth or towel.”  Additionally, you can utilize an equal parts vinegar/water mixture either in a spray format or a soak for up to a 20-minute contact time. You can even include that EPA approved thymol additive of thyme essential oil to this mixture. If you haven’t heard already, you can also scour tougher jobs with a baking soda paste and water/vinegar mixture.  Allow a baking soda paste mixture to rest on the area for up to 15 minutes, then, saturate with your water and vinegar mixture and scrub-a-dub the mess away.  Lastly, it is imperative to understand that for best results, you should be mixing these solutions immediately prior to use.  If mixing large batches for later use, be sure to label and date the mixture; store away from direct sun, at room temperature, and in a suitable storage container.  It should go without saying that you need to inform yourself on specific methods and become a subject matter expert on your preferred alternative cleaning procedures.  Pandemic or not!

CUTTING BACK

The environmental impact that our industry has is palpable. With the consumables during a treatment, retail product packaging, laundry, and even the cleaning products we choose to use, it’s a hard fact to ignore. You would be surprised at all the waste from just one busy day of treating clients. It is a documented and ongoing concern. You can do your part by partnering with brands that have a robust social responsibility initiative to cut down their carbon footprint and environmental impact, by virtue of, reducing yours. Use products, like those on the list mentioned above, that have been researched, studied, and certified as safe not only for you, and your clients, and for aquatic life and the environment. Compare that list against the approved Centers for Disease Control and Environmental Protection Agency list of disinfectants for use against COVID-19 for an additional layer of protection for the community. Infection control has become more important to consumers now more than ever, so being properly informed will only serve you well during this time. 

Additionally, careful consideration should be taken when choosing your vendor partners. Their philosophy on sustainability and reducing waste should be at the forefront of what they do. If it’s important to you, it should also be important to them. A couple ways that companies can contribute to this effort starts during the manufacturing process. Utilizing sustainable ingredients in bio-degradable bottles and packaging can have not only a huge impact on the environment but also your bottom line. Using less cellophane to wrap product boxes and opting for recyclable packing materials are just some of the ways these companies can reduce costs (and waste) that they can then pass on to you through their wholesale pricing. Be aware of their efforts and ask questions regarding their social responsibility platforms. Then, you can use this information to weigh your options of partners and brands that feature a philosophy that is similar to your own.

Whether you have a solid pulse on where to get your cleaning products, or you have no clue when you’ll get more in stock, it’s always important to remember the direct impact you can have on the planet. Using that in your decision-making process is critical. With dwindling supplies of our beloved brands of disinfectants, it’s a good idea to research alternative options and how to implement those into an infection control plan. While doing so, be mindful of what brands you choose to partner with and their stance on social responsibility. Philosophies lining up is always good business, especially now that disinfecting has become the most important part of your job these days. So, do it well, do it efficiently, do it ethically, and of course, do it safely. Remember to wash your hands and stay safe out there.

Brittany Facio is a Phoenix-based educator-turned-business development manager, passionate about how proper aesthetics education and sophisticated protocol implementation can create business-changing revenue. As a business development manager, she is responsible for not only educating her clients on skin care products and protocols, both on an individual basis and in regional training seminars, but also for providing marketing, merchandising, and branding assistance to generate leads and capture a new audience. When she is not working, Facio can be found enjoying play time with her family and Havanese rescue, Spruce, trying a new dinner recipe, and binge-watching comedies on Netflix.