Peels remain one of most powerful, non-surgical ways to deliver the youthful appearance so many clients strive to achieve. Today however, peels offer so much more than pro-youth results. They can be dialed in to correct or manage very specific skin challenges from acne to pigmentation issues and even sensitive and rosacea skins.

There is an art form to chemical peeling that comes with an understanding of skin, knowledge of the variety of solutions and how they affect the skin, as well as technique. Particularly with the advancements in peel formulas we now have available to us, understanding the dynamics of peels will go a long way in helping you identify how to create customized treatments for clients and enhance the outcomes.

Let’s look at some of these formulas, how they can be used, and some ways you can start to build upon your peel treatments to deliver enhanced rejuvenating results.

EXPLORING THE WORLD OF ACIDS

Chemical peels came into practice in dermatology in the late 1800s when salicylic acid, resorcinol, phenol, and TCA were primary choices for rejuvenating and brightening the skin. Over the decades, as dermatologists and chemists began experimenting with different formulations and applications, they started seeing promising results. Chemical peels soon became a popular choice among skin care professionals because it gave them a way to get true change and results on the skin.

Thanks to the emergence of next-generation acid formulas, we’ve been able to tailor treatments more specifically and, in many cases, enhance the efficacy. We’ve also been able to get results with skin types that normally would not be considered a peel candidate.

FLOWER ACIDS

Obtained from hibiscus chalices and lotus root, these acids give back to the skin cells and are much friendlier to the skin than most other choices. The properties range from high antioxidant support to increasing hydration in the skin, while creating lifting and exfoliation. These are ideal for acne and sensitive skins.

MANDELIC ACID, ARGININE, PYRUVIC ACID, AND PHYTIC ACID

Mandelic acid is highly beneficial in treating photo-aging, acne, rosacea, and irregular pigmentation. This complex increases cellular energy, provides antioxidants helping to prevent the formation of free radicals, and increases wound healing with the amino acid l-arginine. L-arginine is one of the 20 main amino acids. It accelerates wound healing, promotes collagen synthesis, firms and intensifies antioxidant properties.

CARNITINE, RETINOL, AND PEPTIDES

This blend stimulates the natural desquamation process and with the addition of peptides and the chiral form of carnitine, it will intensify the toning and firming of the skin, while also supporting energy production within the mitochondria. The vitamin A derivative converts to retinoic acid and is a DNA regulator. It assists in the synthesis of collagen, aids in the formation of blood vessels, and encourages healthy cell formation. Retinols are very important to support the cellular injury and give back to the fibroblast cells caused by other acids.

HYDROGEN, ALPHA HYDROXY ACIDS, AND SALICYLIC ACID

This blend is highly beneficial for photo-damaged skin. It stimulates blood flow and increases oxygenation, brightens skin tone, and reduces pigmentation. Hydrogen peroxide delivers brightening benefits, antibacterial support, and it synergizes with other acids to assist with absorption. Alpha hydroxy acids such as glycolic, lactic, and salicylic acid rejuvenate, hydrate, and strengthen collagen and are excellent choices for acne skin.

These acid combinations fall into the superficial range, creating minimal to no downtime. Still, they deliver potent rejuvenating results. As exciting as these new formulations are, a conversation about peels is not complete without addressing some of the tried-and-true classics. These time-tested formulas, many of which you are likely familiar with, also provide superficial, epidermal exfoliation and work to reverse the visible signs of aging.

ALPHA HYDROXY ACIDS

These are naturally occurring, nontoxic, organic acids. The most commonly used alpha hydroxy acids include glycolic and l-lactic acid. These acids loosen the desmosome junctions (glue-like substance) that hold the cells together.

AZELAIC ACID

Created by oxygenating oleic acid azelaic acid is unsaturated fatty acid found in milk fats and grains, such as barley and wheat. This is used as a lightening, lifting and antibacterial agent.

SALICYLIC ACID

A beta hydroxy acid and is a relatively safe, low-risk acid, as it is self-neutralizing and produces a drying and lifting effect. It also dissolves layers of the epidermis and depending on the percentage used can create heavy lifting of the cells.

TCA

TCA penetrates only if it used in an aqueous base. It is nontoxic, self-neutralizing, keratolytic, and is very effective in low strengths. It can be used alone or in tandem with other acids to create a deep exfoliation.

JESSNER

A combination of lower-strength acids (salicylic, resorcinol, and lactic acid) Jessner peels synergize to produce an efficient exfoliating agent with less risk.

RED WINE VINEGAR

An all-natural acid with a high antioxidant content and creates a firming and tightening effect on the skin. Though not proven, it is said to produce exfoliation with less free-radical damage, and thus cause less injury to the skin.

Keep in mind, these classics may be used to create customized treatments, as it all comes down to education, knowing the client’s skin, and the results you both want to achieve. In addition to layering and blending these complex solutions, treatments may further be enhanced and customized with advanced technologies. While we can enhance treatments by blending specific acids or integrating other modalities, success and desired results is absolutely dependent on good pre- and post-care.

ENHANCING RESULTS WITH PRE- AND POST-CARE

Pre- and post-care treatments can be easy to overlook. However, these will have a significant impact on results and should be a part of every peel.

Why? Think of it like an artist. Before they begin a painting, they prime the canvas and once they’ve finished, they seal it to preserve their masterpiece. The skin, much like a canvas, needs to be primed to stimulate the rejuvenation process and prepare the skin for what is to come. Following the peel or any resurfacing treatment, the skin needs to be rebuilt and brought back to optimal health with proper wound care.

MAXIMIZING THE PRE-TREATMENT

Pre-treatment will vary based on the skin type and the goal of the treatment. This is an opportunity to create a truly custom treatment based on your client’s skin care needs and desired results. The following are a few pre-treatment ideas based on skin challenges.

Pigmentation

For clients who may have pigmentation issues, higher Fitzpatricks or if you are performing a deep peel, using a brightener or tyrosinase inhibitor will help suppress melanin, and may help eliminate post-inflammatory hyperpigmentation (PIH), as well as brighten overall skin tone. This process will also pave the way for the acid formula to penetrate deeper. Ingredient suggestions: bellis perennis flower, l-arbutin, kojic acid, and l-lactic acid.

Acne

Antibacterial support prior to treatment will not only help eliminate bacteria, but also the potential for excessive purging that occurs with acne skin. Ingredient suggestions include salicylic acid, totarol, and azelaic acid.

Acne Scarring

Depending on the build-up underneath skin, performing a pre-treatment will help enhance results, however a more aggressive approach is needed. Ingredient suggestions: salicylic serum, glycolic acid, L-lactic acid.

Aging

The right pre-treatment can help stimulate collagen and elastin and support healing. It will also prepare the epidermis for acid penetration. Ingredient suggestion include an encapsulated vitamin A.

Rough and Thicker Texture

A more aggressive pre-treatment will help stimulate the skin and begin to soften the epidermis for optimal acid penetration. Ingredient suggestions include glycolic acid, L-lactic acid, and retinol.

Sensitive Skin

For sensitive, rosacea-prone or thinner skin, a pre-treatment will start the building process, help the epidermis layer loosen, increase energy, and provide anti-inflammatory and antibacterial support. Ingredient suggestions: mandelic acid, arginine, phytic acid, pyruvic acid, and vitamin A.

Pre-treatment will ready the skin’s surface by reducing lipids, decreasing inflammation, suppressing melanin, and helping to ensure greater absorption of the peeling solution. Skin care professionals should suggest a one to two week pre-treatment plan for best results.

REPAIR AND REBUILD WITH POST-CARE

When performing peels, you are creating a controlled injury in the skin that disrupts the protective barrier resulting in a wound. Supporting the skin through the trauma will ensure proper healing and reduce the probability of complications. Note that a peel should never be performed if you are not prepared to treat the complications of that peel.

Common post-peel complications include:

• Pruritus (itching) – post-peel itching is common for many skin types and not just sensitive skin. Hydrocortisone and willow herb – a natural cortisone will help soothe and calm the skin during the peeling process.

• Post-inflammatory hyperpigmentation (PIH) – this is often caused by picking, so be sure to educate clients about the importance of not picking the skin that is peeling. If clients are particularly prone to post-inflammatory hyperpigmentation, send them home with epidermal growth factors to support the healing and repair process.

• Discomfort or pain – this will generally ease after the first 24 hours; however, you can support clients with ingredients that will reduce inflammation and provide cooling, soothing relief. Arnica Montana is a wonderful, natural ingredient for this.

While there are other complications that may occur, ingredients that support healing, and provide anti-inflammatory and soothing support will be important components following any corrective procedure that uses acids or intense enzymes. It is vital to add epidermal growth factor to the skin during the peeling phase and, of course, an sun protectant factor with a clean ingredient deck is essential.

Taking the time to learn the art of peels will be the best way to enhance their rejuvenating results. When you have a solid, foundational knowledge of the dynamics of peels, you will be better prepared to see the ways to manipulate them to create the outcomes you and your client want.

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, which is offered to aesthetic professionals around the globe. She brings nearly 20 years’ experience in the aesthetic industry, as well as a strong background in business and corporate development and growth.