Understanding Chemical Peels and How to Talk to Your Patients About Them


If you ask me what my favorite treatment to perform is, I don’t have a second of hesitation. I love chemical peels! 
 
Chemical peels are my favorite treatment for a number of reasons, but mainly because they’re so versatile. 
 
The sheer number of acids and combinations of acids you can use allows you to remedy such a wide variety of skin issues, and finding the best combination, makes the science-loving part of my heart pitter patter. 

Unfortunately, I’ve found a lot of my clients, who would be a good candidate for a chemical peel, don’t share the same love and can be skeptical since peels sound like a harsh and scary treatment. 
 
Because of this skepticism, and the fact that we should be knowledgeable about our industry, it’s important to stay informed so we can clearly explain chemical peels and provide the best care for our patients before, during, and after their treatments.
 
So, with that in mind, today I’m going to provide a brief overview of chemical peels and different types offered in the aesthetic industry as well as specific components and ingredients of chemical peels. I'll also touch on how to properly discuss chemical peels with your clients and help put them at ease if they’re a good candidate for the treatment. 

What is a Chemical Peel?

Although the popularity of chemical peels and the development and innovation behind them has rapidly increased in the past 5 to 10 years, chemical peels have actually been around for much longer.
 
In fact, they’ve been used for ages, but chemical peels were introduced into the clinical setting back in the 1880s when doctors, specifically plastic surgeons, started combining different acids on the skin for the purpose of skin rejuvenation. 
 
Fast forward to today, and the process and ingredients within chemical peels have become much more refined, but the most basic definition is still the same. 
 
A chemical peel is the use of an acid or a combination of acids on the skin to achieve rejuvenation. 

Typically, chemical peels are a blend of AHAs, BHAs, TCA, and/or Retinoic Acid, which we’ll talk more about shortly, but to start off broad, let’s talking about the three top categories of chemicals peels. 
 
Categories of chemical peels are determined by what the acid is, where it goes in the skin, and any alteration of the formula, which can be broken down into superficial, medium, and deep categories. As an aesthetician, the vast majority of the time you’re going to be working with superficial peels.  
 
1) Superficial chemical peels are synonymous with epidermal peels. 
 
2) Medium chemical peels go down to the dermis, either the papillary dermis which is referred to as the upper dermis or the reticular dermis also known as the lower dermis. 
 
3) And with deep chemical peels, namely a phenol peel, it’ll pass through all the layers down to the reticular dermis. 
 
The main differentiation with peels is how deep does it go in the skin and its boundaries. Each acid has its own mechanism for how deep it will go, but there are also other factors that contribute to where they work such as whether you pre-treated the skin with a retinoid or other agents beforehand, or if your patients have had other peels in the past. 

Knowing Which Acids to Use and When

The next and most important factor you’ll want to consider when choosing acids to use in a chemical peel is the strength of the acids you’ll be using, which you measure by the acid’s pH level. 
 
If you have an acid with a low pH like a 1.5 or 1.6, you’re working with a strong acid and if you have a higher pH, say around a 3.5, you have a weaker acid. 
 
You’ll notice that the states regulate the types of chemical peels that aestheticians can perform based on their pH level.  

There’s a lot of factors that go into targeting acids for specific conditions, but first, you want to look at the overall groups of acids. 
 
First, you’ve got the alpha hydroxy acid family, which includes glycolic, lactic, mandelic, malic, and citric acids. 
 
Glycolic acid is one of the most popular acids for peels because it loves both water and oil, which allows it to be one of the best acids for penetrating and acting well with the skin. 
 
Lactic acid, on the other hand, is a water-loving acid that absorbs water, which is why it’s ideal for peels where you want to bring hydration to the skin. It’s also famous for treating early signs of photodamage and photoaging in sensitive skin. 
 
Next, you have peels using beta hydroxy acids, the most notable being salicylic and lipohydroxy acids, which is a derivation of salicylic acid. 
 
These acids love oil, which is why they’re perfect for peels used to treat acne and blemishes, as well as excess oiliness of the skin. 
 
Finally, you have a Jessner solution, which is an acid blend that combines Lactic Acid (AHA), Salicylic Acid (BHA), and Resorcinol to create a peel with enhanced efficiency of each ingredient. 
 
The beauty of this peel is it can be reformulated in so many different ways to create different peels that can be used to highly target and pinpoint various skin conditions and concerns including acne, melasma, hyperpigmentation, sun damage, and anyone wanting to incorporate anti-aging treatments into their regimen.
 
With all those conditions it’s easy to see why chemical peels are truly an excellent treatment for a wide variety of patients.
 
The key to knowing who is the right candidate for what type of peel will react best with their skin and condition is having a keen understanding of the results they’re looking to achieve and how much downtime they’re able to tolerate. It's also helpful to know if they’re willing to commit to a series of peels to achieve the best results and what will work best for them given their demographics such as age, level of skin pigmentation, previous experience with peels, and so on. 

How to Discuss Chemical Peels with Your Patients

As you can see, it’s easy for us to claim how great chemical peels are, but that’s because we’re trained professionals who understand all this science lingo. But we have to remember that for some when we say “chemical peel,” their mind goes to Samantha from Sex and the City. (Easy to understand why they’d be skeptical.)
 
So, let’s take a moment to talk about the way to explain chemical peels to our patients. 

Since I’m a visual learner, I like to use examples that my patients can visualize, but use a method that will be most effective for you when educating your patients. 
 
If you were my patient, this is how I would explain a series of chemical peels to you:
 
“Chemical peels are an excellent treatment for skin regeneration and a series will certainly improve the appearance of fine lines, texture, and tone.  If you were to look at our skin under a microscope, it would look like bricks and mortar and what the acids in the chemical peel do is dissolve the mortar or the glue that holds those skin cells together. That is why you often experience some flaking or peeling of the skin.  

The real benefit from a chemical peel is in the regeneration of those connections, but if you don’t see a significant amount of flaking don’t worry - you’re still getting the benefit.”  
 
Then, I continue to let them know pre/post care instructions and always mention that to receive the best results; they should do a series of 6 peels received in 2-week intervals twice a year. 
 
Also, be sure to photo-document your clients progress.  Patients can sometimes have difficulty seeing the results between the peels within your series or may wonder if they’re actually getting results if they’re not shedding like a snake. 
 
Having this photo documentation is just another way we can be of service to our patients and provide them with proper information on how the chemical peel process works. 
 
And one last tip before I wrap up, I also want to note that it’s imperative to familiarize yourself with the specific brands of professional chemical peels you’re using. 

They all will have specific instructions on how to perform the peel, and to ensure the safety of your patient or client, it is incredibly important that you follow the instructions carefully and note any specific contraindications. 

So there you have it, a quick reference guide for brushing up on your chemical peel knowledge! 

Now I would love to know, do you currently offer chemical peels for your clients or perform peels at your workplace? Is it a treatment you’d like to start performing? 

Let me know in the comments! 

Until next time, keep making the world a more beautiful place, inside and out.

Service Spotlight: Thermi


If you’re in medical aesthetics, how many of your patients come in asking for results along the lines of smoothed wrinkles, skin tightness, renewed firmness? 

My guess would be those results are what almost 100 percent of your patients are looking for! If you agree, I know you’re going to love today’s Service Spotlight highlighting Thermi. 

Thermi is the world leader in minimally invasive thermistor-regulated energy solutions for aesthetics, dermatology, and women's health and there are a variety of applications of the technology all aimed at producing rejuvenating, tightening, and smoothing results through dermal heating. 

In this week’s dose of inspiration, education, and encouragement, we’re covering all the bases on what you need to know about Thermi and a variety of modalities of this treatment, specifically ThermiSmooth, ThermiTight, and ThermiVa.  
 
Even if you do not work in a medical environment or perform these types of treatments, knowing other treatments within your industry is what allows you to stand out as a trusted source of information with your clients. 

And the more helpful you can be with recommendations, references and teaching your clients and patients, the more you’re building your credibility as an aesthetic expert. 

Now let’s get into it. 

All of the Thermi modalities use radiofrequency or RF to heat the tissue and cause subdermal collagen stimulation. This collagen stimulation is what smooths out fine lines and tightens the skin. With thermismooth, on the face, we use a wand like applicator that moved continuously across the area being treated for a set amount of time. The concept is to heat the skin to somewhere between 42 - 45 degrees celsius and maintain that temperature for a set amount of time to reach the desired clinical endpoint. You’re able to treat the eyes, forehead, cheeks, mouth, and neck.  

For best results with ThermiSmooth a series of 3 to 6 treatments received in 1-2 week intervals is recommended.  

Let’s move on to ThermiTight. ThermiTight is an injectable RF. A tiny probe is injected into the area being treated by the physician and actually heats the tissue internally. The most common areas to be treated are the neck, breast, arms, abdomen, thighs, and knees. Because the tissue is being heated under the skin you get a greater response and ThermiTight produces a greater firming than ThermiSmooth.  

In the majority of cases, a single treatment of ThermiTight is sufficient. The physician performing the treatment will do a consult with the patient ahead of time and will advise the patient on the best treatment plan for their specific needs. 

Alright, now we are going to finish up this treatment spotlight with ThermiVa. The Va in ThermiVa stands for vaginal so ThermiVa uses radiofrequency for vaginal tightening. ThermiVa is one of the less-talked about modalities but is one I think is extremely helpful to know about, especially if you perform services such as laser hair removal in the bikini area and have patients who ask for your opinion on vaginal rejuvenation/tightening. 

With ThermiVa a small wand is interted into the vagina to internally heat the tissue and stimulate the collagen production.  This tightens up the vaginal tissue which is a welcomed benefit from women who have given birth and feel that “it’s just not the same down there”.  The increased blood flow to the area after a ThermiVa treatment has also helped several women who struggle with reaching orgasim. 

For optimal results with ThermiVa a series of 3 treatments received in 4 week intervals is recommended. 

Have any questions about Thermi or have your own experiences performing the treatment to share? 

Let me know in the comments or start a discussion in the Aestheticians Connect Facebook group.

Until next time, keep making the world a more beautiful place, inside and out!