That is the question I get asked by many of my patients.
We predominately peel or exfoliate to help speed up cell turnover, to even out pigment, improve texture, soften micro-scarring, and to regulate the water and oil balance in the skin. The trick is to find the best skin plan in clinic and at home to achieve your desired results, while keeping your skin strong and vital.
Too much?
It’s not uncommon the hear horror stories about uber aggressive lasers and peels that left faces severely damaged. Or moderately unsatisfactory results, where the skin pigmented and lost a high amount of water content.
There is a time and place for strong peels. I perform a lot of strong peels either pre or post facelift procedures. If a patient neglected their skin and gets a lift, the skin and muscles look toned, but the appearance of the skin will still not look youthful.
It can also be a proper choice with particular acne or hyperpigmented patients.
Granted, if you take a more aggressive route, it is a process, and you can have some temporary adverse effects, but under the proper care, the result can be successful and safe. The key is to follow the aftercare and to make sure you are committed for the long haul.
Whether at home or under professional care, over exfoliating can create the illusion of smooth skin, but it’s not always adding to your skin health. Your skin can only recover so many times in its life. The “wound to heal” route has its limits and its dangers. Many times, skincare providers over peel to give their patients a sense of instant gratification, but ultimately, this takes away from the long-term integrity of the patient’s skin.
Too little?
When the skin isn’t turning over fast enough, this can exasperate acne, rosacea, pigment, and aging concerns.
With acne, slow turnover adds to blocking the hair follicle and “trapping” excess dirt, bacteria, and oils on the skin’s surface.
Rosacea is a very controversial subject in the industry, so I choose to keep my thoughts and treatments of the issue private between my patients and myself. That being said, it is mainstream practice to encourage rosacea patients to gently exfoliate.
Hyperpigmentation is a major concern of many of patients. Being based out of Beverly Hills, California, I have patients from diverse backgrounds, but we all have to deal with living in an environment consisting of strong solar exposure and heavy pollutants. With pigment, so many systems are at play. Your circulatory system, immune system, and barrier defense mechanisms, your hormones, diet, and stress levels, are also at play.
Exfoliating can be very beneficial in treating pigment.
That being said, since so many factors are at play, choosing the proper way to treat the pigment with exfoliation has to be individualized. A slow and steady treatment of chemical and physical exfoliation is historically the most advantageous.
Some patients are prone to hyperkeratosis; a thickening of the stratum corneum on the face and/or the body. This is very common to see on the elbows and knees.
KP – Keratosis Pilaris, is also very common. It’s a benign skin disorder. It causes numerous small, rough bumps around the hair follicle. I see this mostly on the upper arms and buttocks.
These concerns need to be addressed with proper ongoing physical and chemical exfoliating options.
Physical vs. Chemical
Physical exfoliation such as; dermaplaning, dermabrasion, scrubs, brushes, and shammy cloths are a great way to exfoliate for people that have allergies or sensitivities to chemicals, pregnant women, and for patients who don’t have the downtime to “peel.” It’s great anywhere on the body, but especially the back, arms, and hands. It’s instant, and you can take advantage of the barrier’s state, and infuse in beneficial serums, etc. As long as you repair the barrier and care for the skin responsibly post treatment, there are little undesirable reactions to be concerned about. Small knicks from the planing, or too high of suction on a vacuumed dermabrasion machine – which could cause bruising or weakening of the connective tissue – can be easily regulated by your technician.
Chemical peels are mostly solutions that will penetrate the skin to deliver ingredients that will target specific concerns. Don’t let the word chemical phase you. Chemical does not mean toxic!
From Thoughtco.com:
Question: What Is a Chemical?
Short answer: Everything is a chemical.
Long answer: A chemical is any substance consisting of matter. This includes any liquid, solid, or gas. A chemical is any pure substance or any mixture. It doesn’t matter whether it occurs naturally or is made artificially.
I could go on for hours (don’t worry, I won’t now!) on how misleading the branding of “chemical free” is! Water is a chemical! So if you read “chemical free” on a product, they are either lying or have ZERO knowledge of chemistry. Either way, I wouldn’t put my trust in that company.
Back to peels. Chemical exfoliants range from light fruit enzymes to phenol. The key to peels can be its ability to deliver ingredients to the lowest layers of the skin – where it needs to go, to create a true change in the climate of your skin.
Too traumatic of a peel can most commonly cause hyper/hypo pigmentation, or micro-scarring.
The bummer about stronger peels is the downtime. Luckily, there have been advances in peels where they’re left on for a few hours, where a lot of the digestion of the skin needed to take place occurs. Then a homecare product will keep infusing the skin with the necessary ingredients to get the desired results.
Heavy exfoliation is most often not necessary. Unfortunately, many patients are actually disappointed and don’t think they have had a good result unless heavy peeling occurs. This has lead to the creation of potentially “dangerous” peels that just add more phenol, or other corrosives to the mixture.
I’ve stopped using the term “peel” with many of my solutions. I believe it’s a bit outdated. The best solutions I use would be termed as: an application of beneficial ingredients that may create some flaking. That doesn’t have a tight ring to it, but I believe in respecting the patient’s intelligence and informing them of why I’m doing something. The best applications of peels should be thought of as treatments versus the old school term of a peel.
A mentor of mine, Ole Henriksen, told me that aestheticians would never use the word peel in the ‘80’s. It was a big no-no. It would scare the patient. Then in the ‘90’s when med spas took over, they wanted the aggressive connotation so they could create more wounding and charge more.
If you want to achieve true, vital skin health, you have to be a full and responsible participant. Understand the risks and rewards. Find an individualized skincare provider that treats you as a patient and not a number. Follow your instincts! You may not be an expert in skincare but on many levels, you know your skin better than anyone else. Find a provider that truly listens to you, and together you can create beautiful skin.
In the name of beauty, Mia Belle seeks to elevate the future of skin care.
Mia Belle is a well-traveled paramedical aesthetician with nearly two decades of experience in the fields of skin care and preventative aging. Her passion to be a part of the rapid advancements in health care and her continued training on a global level, allows her to develop the best treatments and products possible. She has trained in Montreal, Paris, London, Norway, Iceland, New York, and San Francisco with some of the most internationally renowned chemists, engineers, physicians and alternative health practitioners.
Mia Belle is a published skin care expert who has been featured on Oprah, EXTRA, “E” Entertainment, Access Hollywood and KTLA.
