The urge to tap into this vast array of new products and technologies can be hard to resist. Like a kid in a candy store, how does a client choose among countless products that all sound so promising? This is exactly why many clients have adopted a skin care routine involving a number of complicated steps and many different products. Of course, professionals are not immune to the siren song of new product formulations. In fact, many of the complicated skin care regimens implemented by consumers are ones that were prescribed by their dermatologist, plastic surgeon, or aesthetician.
So what is the problem with a tedious skin care regimen if the client is willing to invest the time to implement it? Consider the following:
First, the more complicated a skin care regimen, the less likely the client will be to implement it consistently. As we all know, consistency is key to getting results. While clients are likely to invest time in a skin care regimen that is new and promising, after a few weeks their dedication can wane if results have not yet been achieved. Unfortunately, few products are capable of generating quick results.
Next, with more products comes an increased risk of negative reaction. Of the thousands of clients I have seen throughout my nearly 30 years in practice, only a small percentage have demonstrated truly sensitive skin. In most cases, the client presents symptoms which typically include redness, stinging, and dryness, all due to irritation or an allergic reaction. Similarly, I have often encountered those who believe that they suffer from persistent acne when, in reality, they have dermatitis caused by regularly-used skin care products.
Also keep in mind that no matter how gentle the formulation, allergic reactions are common. When the client’s skin care regimen involves many products, not only are allergic reactions far more likely, it also becomes hard to pinpoint the cause due to the lengthy list of ingredients being applied to their skin.
Finally, use too many products and they begin to cancel each other out… or worse. Potentially negative outcomes from the interaction between active ingredients must be taken into consideration when building a skin care regimen. For example, if a client uses a product that containing L-ascorbic acid in combination with one that features niacinamide in the presence of ultraviolet light, the two compounds have the potential to generate hydrogen peroxide, a pro-aging compound.
Present these facts to clients and they might assume that they have to pick and choose the skin care issues they can address. Not so. By employing a simple, four-step skin care routine, they can address all of the skin’s basic needs while seeing a dramatic improvement in skin aesthetics and overall skin health. This argument is equally beneficial for clients who implement too few skin care steps rather than too many.
The premise of a four-step skin care regimen is not new. Many dermatologists and plastic surgeons advise the approach. However, to many consumers, the concept is novel since it flies in the face of the marketing messages they regularly receive. The four basic steps, outlined below, follows a logical order. Products that are washed off are applied first, with subsequent products applied from lightest weight to heaviest to offer maximum benefit.

FOUR-STEP SKIN CARE REGIMEN
Step 1: Cleanse
Clients rarely need to be convinced of the importance of facial cleansing to remove makeup from the skin’s surface. Yet many people consider it an unnecessary step in their morning skin care routine or think it appropriate to skip it on days when they have not worn makeup.
Throughout the day, skin collects dirt, pollution, bacteria, sebum, and more. Overnight, sebum and dead skin cells accumulate on the skin’s surface, and by cleansing with a properly-formulated product, morning and night, clients not only rid their skin of these elements, but can also properly prepare the surface of their skin with the following steps.
When selecting a cleansing product, clients must be mindful of their skin type and be sure to utilize a gentle formulation to avoid disrupting the acid mantle, the slightly acidic protective film on the skin’s surface. When harsh cleansing products, such as bar soap, are utilized, the acid mantle is temporarily dissolved. This can lead to a host of consequences. I recommend use of glycerin bars or products formulated with glycerin, a natural humectant.

Step 2: Exfoliate
In our youth, skin that is in good health exfoliates properly on its own. As skin cells are produced in the bottom layer of the epidermis, they migrate up to the outermost layer, where dead skin cells are regularly shed. This natural process takes approximately 30 days and keeps skin in perfect balance. However, as we age, and in those whose skin has sustained significant damage from environmental factors, this process of cellular turnover slows, allowing dead skin cells to build up in the keratin layer. In response to a thickened keratin, the dermis layer thins to ensure that the overall thickness of the skin remains consistent. This causes the dermis to slow its production of skin proteins like collagen and elastin. The result is that fine lines and wrinkles become more pronounced, skin tone appears uneven, texture becomes rough, acne breakouts may become commonplace, and much more. In essence, skin appears unhealthy because, frankly, it is!
To correct this cycle, exfoliation is a necessity. By thinning the skin’s keratin layer, exfoliants encourage the dermis layer to once again thicken and function optimally. As collagen and elastin production amplifies, skin begins to appear more youthful.
While clients will see significant skin improvement through professional treatments that utilize mechanical exfoliation, including microdermabrasion or dermaplaning, at home, chemical exfoliants should be used. Most individuals will see best results from formulations that feature glycolic acid, the gold star of alpha hydroxy acids. Conversely, those with oily or acne-prone skin should consider formulations that feature beta hydroxy acids, like salicylic acid. Many formulations combine alpha hydroxy acids and beta hydroxy acids; generally speaking, such products can be used by all skin types.
There is some controversy regarding the frequency with which individuals should implement the exfoliation step. Many professionals advise exfoliating just once or twice a week, claiming that exfoliating more than this can cause the skin to thin. However, there is no study that backs this claim. I suggest that a daily exfoliation practice, when implemented with a high-quality,
properly-formulated product, ensures optimal epidermal turnover rates, a smoother complexion, and a more even skin tone. Each client’s skin will tolerate exfoliation differently. Some will need to begin by combining the exfoliant with moisturizer to allow skin to adjust before building up to regular, full-strength applications. Others will tolerate the exfoliation step from the first application and be able to jump into a daily exfoliation habit without the need for adjustments.

Step 3: Moisturize
For many clients, the use of a moisturizer is a soothing step in a skin care regimen, especially during dry, winter months when the skin feels significant relief upon its application. However, those with oily or acneic skin often discount moisturizer’s benefit for their skin type. What they are not considering is that oily skin produces more oil when it becomes dry. Therefore, a moisturizer’s function of preventing the evaporation of moisture from the outermost layer of skin and helping to draw moisture back into the stratum corneum is essential.
While moisturizers are a vital part of every skin care regimen, they also have the potential to cause allergic reactions due to their use of fragrance, parabens, and vitamin E – the three most common allergens likely to be found in a product. Therefore, it is essential to not only recommend a formulation that is appropriate for the client’s skin type and any skin conditions they have, but also one that does not include ingredients to which the individual has demonstrated a sensitivity.
Also, keep in mind that the moisturizer formulation that is best-suited for a client today might not be the product most appropriate for them in the future. Moisturizers should be reevaluated occasionally to ensure that they meet evolving skin needs. This especially applies to women who, as they approach menopause, often experience dramatic shifts in their skin such as the skin becoming dry after years as an oily or vice versa.
A rich, high-quality moisturizer has the potential to dramatically improve skin texture. These formulations tend to be heavier, which is why they are typically classified as nighttime moisturizers. As their name implies, these products should be applied before bed, with a lightweight formulation being used during the day. For those with dry skin, nighttime moisturizers may also be considered for use during the day.

Step 4: Protection
The final step in the four-step skin care regimen is the use of sunscreen products that protect the skin from the sun’s UVA and UVB rays. This is a necessary, morning-only step for all individuals, regardless of their skin tone, the season, and geography. Excess sun exposure is the primary environmental factor for skin aging. Photoaging damage due to sun exposure, is cumulative for clients who spend a good deal of time outdoors without adequate protection. These clients will likely see hyperpigmentation, fine lines, wrinkles, uneven skin tone, and significant texture shifts as they age. Much of this damage is due to the breakdown of collagen and elastin caused by ultraviolet radiation.
Beyond providing aesthetic protection from harmful ultraviolet rays, sunscreen also offers a degree of protection from skin cancer. Protection on these two fronts is only possible, however, when sunscreen of an adequate SPF is properly applied.
Look to products with an SPF of 30. Many products tout SPF 60 and beyond, but the minimal increase in protection makes these unnecessary. Consider that SPF 30 protects against 95 to 96 percent of ultraviolet rays. Between SPF 30 and SPF 60, there is only a 0.1 percent increase in protection.
Most individuals are surprised to learn that they simply do not apply enough sunscreen to get the benefits promoted on the product label. For full-body coverage, as needed at the beach, at least an ounce of sunscreen should be used. This is an amount equivalent to a shot glass. However, on an average day, when sunscreen is applied to just the face and neck, an amount equivalent to a teaspoon should be utilized. Sunscreen does break down upon exposure to ultraviolet rays, which is why the message of “reapply, often” is so prevalent. Ultraviolet exposure can happen indoors, such as when sitting next to a window, and outdoors. Clients should take into consideration the environmental factors of their day when determining how often to reapply sunscreen.
While sunscreen should be applied after a moisturizer, many clients benefit from the use of a lightweight daytime moisturizer that offers sun protection. It is imperative that they utilize a separate sunscreen product to protect other exposed areas of the body.

By implementing a four-step skin care regimen consistently and properly, most clients will see a positive improvement in their skin within just a few weeks, with more noticeable improvements coming over the course of several months. When optimal improvement is achieved, clients will often need to be reminded of the importance of maintaining the regimen. For individuals who do not experience skin improvements through this regimen, it is necessary to take an inventory of other factors that may be impeding results. This may be the case in a client who smokes, tans, maintains an unhealthy diet, or fails to get enough sleep. Unfortunately, no skin care regimen is strong enough to overcome the impact of these habits.
While many clients assume they can do the four-step regimen themselves, and in many cases that is true, best results are achieved under the guidance of a skin care professional. As such, the client’s role of determining the most appropriate products for home use and modifying this assortment as needed is crucial. Conduct voracious research regarding the available products that fall under each step to ensure that, rather than settling for the line you know best, you offer a potentially disjointed product selection that will most certainly meet the needs of varied clientele.

Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S. is author of the forthcoming book, Simple Skincare, Beautiful Skin: A Back-to-Basics Approach, CEO and founder of Lexli International, Inc., and formulator of the company’s Lexli® line of professional skin care products. A board-certified plastic/reconstructive surgeon and a leading aloe researcher, Abdullah travels the world, educating licensed professionals and consumers alike about the proper ways to utilize aloe in skin care applications, the essential steps to ensuring the skin’s basic needs are met, and setting the record straight on prevalent skin care myths. He regularly sees patients at his practices in Fargo, N.D. and Dubai, United Arab Emirates. www.lexli.com