While it may seem simplistic, pre- and post-care are essential to bringing results to the optimum level. The peel or resurfacing treatment may be the star of the show, however, pre- and post-care absolutely impact results.
Why? Think of it like an artist. Before they begin a painting, they prime the canvas. Once finished, many will seal it to preserve their masterpiece. The skin, much like a canvas, needs to be primed to enhance the rejuvenation process and prepare the skin for treatment. Following a peel or any resurfacing treatment, the skin needs to be rebuilt and brought back to optimal health with proper homecare.

Pre-Treat to Maximize Results
Pre-treating the skin is an important step to ensure success of any corrective treatment, particularly acid peels. It prepares the skin by thinning the stratum corneum, which increases absorption of the peeling agent, thus enhancing the results of treatment. It also acclimates and prepares the skin for the procedure. Not every client will require pre-treating. It mainly depends on the type of peel or resurfacing treatment being performed. However, it will always provide an advantage.
Aside from improving results, pre-treatment may also reduce or prevent certain complications from occurring. It limits the potential of post-inflammatory hyperpigmentation, desensitizes the skin, and fortifies its strength.
To realize the full benefits of a pre-treatment, the following components are involved.
Tyrosinase Inhibitor: This inhibitor will reduce the probability of post-inflammatory hyperpigmentation. Support ingredients include bellis perennis (daisy) flower extract, kojic acid, azelaic acid, and hydroquinone.
Antibacterial Support: This support will eliminate excessive purging after the peel, while enhancing the skin’s purity. Support ingredients include resorcinol, totarol, salicylic acid, and mandelic acid.
Skin Rejuvenator and Exfoliator: A good skin rejuvenator will jump start the exfoliation and cell-turnover process and assist with acid penetration, skin strengthening, and a more even peeling. Support ingredients include trichloroacetic acid, salicylic acid, retinol, glycolic acid, and L-lactic acid.
Skin Strengthener: This group will add value to a peel due to the cellular support, antioxidant influence, and collagen-building properties. Support ingredients include L-mandelic acid, L-arginine, phytic acid, pyruvic acid, and retinols.

Customized Approaches
Pre-treatments will vary based on the client’s skin type and the goal of the treatment. This presents an opportunity to create a truly-custom treatment based on the client’s skin care needs and desired results. The following are a few pre-treatment ideas based on specific skin challenges that migh arise.
Pigmentation: For clients who may have pigmentation issues, such as higher Fitzpatrick skin types, or if a deep peel is being performed, use a brightener or tyrosinase inhibitor to suppress melanin. This will also brighten the overall skin tone, as well as reduce the potential for post-inflammatory hyperpigmentation to occur. Ingredient suggestions include 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 acneic skin. Just prior to the peel or resurfacing treatment, the skin may be cleansed with a glycolic-based cleanser. Ingredient suggestions include salicylic acid, totarol, and mandelic acid.
Acne scarring: Depending on the buildup underneath the skin, performing a pre-treatment will enhance results. However, a more aggressive approach is needed. Similar to the acne treatment mentioned above, a glycolic-based wash and a botanical- and glycolic-based enzyme will work to prepare the surface. Ingredient suggestions include retinol, salicylic acid, glycolic acid, and L-lactic acid.
Aging: The right pre-treatment starts the stimulation of collagen and elastin and supports healing. It will also prepare the epidermis for acid penetration. In the treatment room, a pumpkin-based cleanser and either a scrub or L-lactic acid will lift away surface proteins, allowing the acid to penetrate and go further. Ingredient suggestion includes vitamin A/peptide.
Rough and Thicker Texture: A more aggressive pre-treatment will stimulate the skin and begin to thin the stratum corneum for optimal-acid penetration. In the treatment room, prepare the skin with a glycolic wash and follow with a second cleanse, a scrub, and the application of a glycolic or L-lactic acid. Ingredient suggestions include glycolic acid, L-lactic acid, and retinol.
Sensitive Skin: For sensitive, rosacea-prone, or thinner skin, a pre-treatment will begin the corrective process, loosen corneocytes from the stratum corneum, increase energy, and provide anti-inflammatory and antibacterial support. In the treatment room, sometimes a double cleanse is sufficient. Ingredient suggestions include mandelic acid, L-arginine, phytic acid, pyruvic acid, and vitamin A.

Post-Care to Repair and Rebuild
To ensure the safest outcome and maximize results following any skin rejuvenation procedure, post-care is imperative. Post-care begins with occlusion and soothing relief to the traumatized skin. For this, antiseptic and antibacterial support will be essential. Also, post-care topicals that reduce inflammation and itching, encourage cell renewal and wound repair, and enhance skin rejuvenation overall are a valuable part of the process.
When a peel is performed, it creates an injury to the skin that disrupts the protective barrier, resulting in a wound. Supporting the skin through this trauma will ensure proper healing and reduce the probability of complications.
Be sure to thoroughly review post-care instructions with clients. Remind them that less is more in most scenarios, particularly during the first 24 hours. It is very common for too much to be used too early, so it is extremely important to stress to clients that this is as needed for specific skin responses, such as itching, tightness, discomfort and pain, swelling, and heat. With this in mind, a good regimen will include a gentle cleanse in the morning and evening, using light pressure, and a broad-spectrum SPF protection formula designed for wounded and traumatized skin.
It is also important to remind clients to stay out of direct sunlight and avoid heat during the healing process. Exposure to either of these may create deep or permanent damage.
Prepare the client’s post-care regimen based on their skin’s response to treatment and overall goals. It is often a good idea to talk with clients prior to treatment to ensure that they are onboard with using the prescribed post-care regimen. If they are partial to using products they already have at home, ask them to bring them to their appointment so that the products and ingredients can be reviewed to ensure that they will support the client’s desired results.

Care for Common Reactions
Aside from the typical peeling and repair that occurs following an exfoliating treatment, there are some common complications that may occur. These are not anything for which to be afraid, however, it is important that skin care professionals do not perform a peel if they are not prepared to treat the complications of that peel. Prior to performing any corrective or rejuvenating treatment, be clear on what potential complications may occur.
The following are some of the common post-peel complications that may occur and ingredients that help remedy them.
Pruritus: Post-peel itching is common for many skin types, not just sensitive skin. The key here is to soothe and support the skin with anti-inflammatory and hydrating ingredients. Hydrocortisone and willow herb, a natural hydrocortisone, will help soothe and calm the skin during the peeling process, as well as decrease erythema. Support ingredients include hydrocortisone, willow herb, and shea butter.
Post-inflammatory hyperpigmentation: This reaction is often caused by picking, so be sure to educate clients about the importance of not picking the skin during the peeling process. If clients are particularly prone to post-inflammatory hyperpigmentation, send them home with epidermal growth factors to support the healing and repair process. Support ingredients include epidermal growth factors.
Discomfort or Pain: This reaction will generally ease after the first 24 hours, however, professionals can support clients with ingredients that reduce inflammation and provide cooling, soothing relief. Arnica montana is a wonderful, natural ingredient for this reaction. It is also okay to recommend acetaminophen or ibuprofen, if needed, if there are not any allergies. Support ingredients include arnica montana, aloe barbadensis, and Artemisia vulgaris (mugwort) extract.
Prior to creating any treatment plan, skin care professionals will also want to determine what the client is currently doing, as they may need to also eliminate some things before treating their skin. For example, if the client is using prescription topicals, like Retin-A, they should stop using it at least two weeks prior to a peel treatment. If they are using Accutane, do not do any peeling. Once they have stopped treatment, a peel may be performed in four to six months. If Botox or another injectable procedure was performed, the professional should wait 48 hours until performing the peel. If the client has undergone hair removal, wait one week. They should refrain from shaving two days prior to a peel and three to four days following the peel.

In the end, education is the best pre-treatment. Not only learning the art of peeling and the potential outcomes of specific treatments used, but also gaining a clear picture of the client’s skin – what they are currently using, medications they may be taking, and their skin history. This will also require getting the client’s compliance on offering up any details that may impact the results, as well as their commitment to a healthy post-care regimen.
Keep in mind, the proper pre- and post-care treatment will be essential to creating the most ideal outcome and will leverage the aesthetician’s work to a higher professional status and keep their clients coming back.

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