Pamela Hill Institute

Chemical peels are not a cure-all, and clients who are considering a chemical peel should have realistic expectations.  It is best that they be in good general health, be non-smokers, and be sound psychologically.  It should also be determined that the conditions they have are those that can be improved through a chemical peel rather than those which require surgical procedures.

Chemical Peels Have A Very Long History

Chemical peels have been with us since the days of ancient Egypt when skin rejuvenation was accomplished using sour milk.  In the Middle Ages old wine was used.  These same ingredients are actually the basis of light peels, or alpahydroxy acid.

Possible Complications and Effects Should Be Considered

A client considering a deep peel, or phenol peel should realize that it can cause permanent skin lightening, but that it reduces the skin’s ability to produce pigment, requiring protection from the sun.  It can also take several months to heal. Also phenol peels can pose a risk to those who have heart problems.  Lighter alphahydroxy acid peels and medium TCA peels have much less risk and shorter healing times, but the results are not as permanent.  AHA peels can cause stinging, skin redness, mild skin irritation, dryness and can require multiple treatments to get the results desired. TCA peels may require Retin-A or AHA cream treatment, require the use of sun block for several moths, take several days to heal, and can require repeat treatments to achieve desired results.

Regenerated Skin Is Usually Smoother and Wrinkle Free

However, provided the client understands potential risks and the issues involved with the various types of chemical peels the regenerated skin is usually smother and less wrinkled than the old skin, giving the client what they desire in a fresh and more youthful appearance.  It is however important to determine that the client is having the treatments for the right reasons, and has an overall healthy sense of self-esteem and realistic expectations regarding the outcome of treatment.

A History of Medical and Dermatological Treatments Should Be Taken

It is also important that a history be taken of the client to determine the amount of sun damage the skin has, the amount of hypertrophic scarring or keloid formation, and a general medical history.  In general, most clinicians use the Fitzpatrick Skin Typing in combination with either the Glogau or Rubin Classification. Also, as an aesthetician, you must enquire about previous peels, prior surgeries, laser therapy and dermabrasion so you have a clear understanding of the causes of the current skin condition.  The types of medications taken should also be known in order to maintain the safety of the client.

For more information, you should read Peels and Peeling Agents

Many injectable micro-implant fillers are available on today’s market including Radiesse, Artecoll, Aquamide and Silicone. Let's take a closer look at each of these so that as an aesthetician, you are educated and prepare to answer any questions your clients may have.

ARTECOLL
Artecoll, also kown as Artecol and Artefill, is made by Artes Medial PMMA and was discovered by a chemist in Germany named O. Rom in 1902.  Used with medical implantation began in 1936, and toay common usages include bone cement, dentures, artificial eye lenses and pacemaker covers. In fact, when impregnated with antibiotics it has been used in the human body since the 1970’s.  The idea of implantation of microspheres of Artecoll for soft tissue augmentation came from Gottfried Lemperele.  These very small round balls about the size of a red blood cell and used in conjunction with denatured bovine collagen as a vector.  Lidocaine is used to relieve pin, and a phosphate buffer, sodium chloride and distilled water are used as well.  Tissue augmentation has been performed with it since 1989 and in the past ten years over 100,000 people have been treated with Artecoll. Injected deep into the skin at the dermal level.

RADIESSE
Radiance, also known as Radiesse, is not yet FDA approved for cosmetic purposes but is approved for radiographic tissue marking.  It is in essence synthetic calcium hydroxlapatite, similar to the calcium found in human teeth and bones.  Manufactured by Bioform, a Wisconsin company, from microspheres, it has been safety used in the body for many applications including dental where bone buildup is required for reconstruction.  It has also been used in block form for cheek, jaw, cranial and chin implants.  Calcium hydroxylapatite when used creates a lattice and surrounding cells are incorporated from ossification in bony areas to a stable scaffold in which soft tissue is able to grow.  When it is injected in soft tissue and away from bone, fibroblasts work by building a non-scar tissue much like collagen.

AQUAMID
Aquamid is manufactured by Ferrosan, a Danish pharmaceutical company and is 2.5% hydrophilic polyacrylamide and 97.5% water.  Polyacrylamide can hold up to 400 times its own weight in water and has been popular for many years in medical applications, drug delivery, water purification and agriculture.  Used in cosmetic applications for more than a decade now, it has immediate results and it should not be over corrected or  under corrected. On the downside the implants are susceptible to bacterial infections for up to several years after injection

SILICONE
Silicone injections are quite controversial.  Some of the controversy is for good reason, and some is not.  Injections of silicone oil are not approved for cosmetic use in the United States. However, a physician can prescribe an FDA approved device as he sees fit and for this reason silicon oil is used to treat detached retinas of the eye to save eyesight.  But it is not to be kept inside the body  Silicone oil is also being investigated now for facial soft tissue augmentation use.  If it passes the tests it may come into common use for cosmetic purposes.

Temporary injectable fillers like collagen are widely used for cosmetic enhancement.  Collagen itself is in fact used for many purposes, though its use is declining.  Since it is bovine derived, meaning that it comes from cows there is a slight risk of transmission of prion disease, and some people have allergic reactions to it.  Also many alternative fillers are now readily available, one of them being the patient’s own fact removed from elsewhere in the body. Some of the alternatives in common use include Restylane, Perlane and Hylaform. All of these products have their uses and are gaining in popularity.

HYLAFORM
Hylaform is a clear, transparent gel made from avian hyaluronic acid, developed by the Genzyme Corporation and distributed by Inamed.  It comes from rooster combs and provides both moisture and elasticity in the skin.  It is beloved that the hyaluronan in the human body breaks down eventually and causes dry, winked and aged skin.  A clear, transparent gel, it contains no pain reliever so many patents request a local anesthetic or regional block.

RESTYLANE
Restylane is a non-animal product created by Q-Med Laboratories, a Swedish company and one of the prime ingredients, hyaluronic acid, occurs naturally in the human body which means that no pre-test is required.  It is injected into the lips as well as wrinkles and provides the desired augmentation effect.  Working with the body’s natural hyaluronic acid, it lasts much longer than collagen.  Different grades vary in their concentration.  Restylane comes prepackaged in sterilized syringes.  It is recommended for wrinkles, lips – giving that pouty look – and is available in a product with smaller particles resaved for fine lines called Restylane Fine Line.

PERLANE
Perlane is also a non-animal hyaluronic acid from Q-Med Laboratories.  It is a clear gel and is designed for injection into deep folds and wrinkles, in addition to facial contouring such as the cheeks.  It can be used as well in the lips, providing augmentation and the pouty lip effect.  Many professionals believe that Perlane should be used in the fleshy part of the lip and Restylane in the borders.  One injected Perlane works with the body’s natural hyaluronic acid and lasts longer than collagen.  Perlane comes prepackaged in a sterilized syringe and is recommended for folds such as nasolabial folds, shaping facial contours such as the cheek and the chin.  It is very similar to its sister product, Restylane.

Obagi Skin Care products, for use by medical aestheticians, were created by Dr. Zein E. Obagi, an expert in skin care and an internationally known dermatologist, educator and many say innovator.  Board Certified of the American Board of Dermatology and a fellow of the American Academy of Dermatology, Dr. Obagi is one of the most famous skin care and health experts in the world.  

Many Skin Conditions Corrected by Dr. Obagi

He has corrected many skin conditions including facial melasma, precancerous lesions, age spots, acne scars, sun damaged skin and deep wrinkles.  His practice is at the Obagi Dermatology, Plastic Surgery and Laser Center in Beverly Hills, California and the Obagi Dermatology and Plastic Surgery Centers in many counties.  As a speaker he has discussed skin health and the transformation of the skin extensively, speaking to the medical societies of more than 20 nations, and he has trained hundreds of plastic surgeons and dermatologists privately.

Providing Education On How Skin Ages

Dr. Obagi educates people on how skin ages.  Damage is accumulated in the skin from many sources over time, including exposure to the sun, hormonal changes, pollution and trauma.  As skin ages it becomes discolored, wrinkled, dry, lax and rough.  Cell turnover slows down and essential nutrients are less available.  Instead of producing healthy new cells, the skin products abnormal cells.  Collagen and elastin production slows down, and the skin wrinkles and sags.  Dull, lifeless skin is the result.

Obagi Skin Care Products Treat the Problems

The Obagi Nu Derm System utilizes a combination of both active and prescription ingredients.  These include Tretinoin and Hydroquinone 4%, designed to maximize penetration to skin layers.  Dosages are varied according to the client’s skin condition and needs.  It works through increasing the cellular turnover of abundant, healthy keratinocytes.  This pushes fresh cells to the surface faster and promotes the exfoliation of old cells.  It also suppresses emlanocyte production and reverses as well as prevents hyper-pigmentiaon.  It also promotes and even distribution of melanin and eliminates unwanted dark patches on the skin and age spots.

Other Products Include…

Products also include Obagi Professional-C Serum, a new formulations in Vitamin C created to neutralize free radicals at all layers of the skin before they can damage skin cells and accelerate the  aging process.  In addition Obagi products include the Obagi Blue Peel, which is different from alpha hydroxyl peels and others in common use.  It uses Tricloraceetic Acid and a blue mixing base with built in safeguards to ensure that results are consistent and allowing the client to control the procedure.  Dr. Obagi’s reputation is behind all of his products and they are worth checking out by the medical aesthetician.

Permanent cosmetics are becoming quite popular and provide another service to be offered by aestheticians.  This process also called permanent makeup, derma-pigmentation, micro-pigmentaiton, and cosmetic tattooing, is essentially a method of applying tattoos that mimic traditional makeup.  Eyelining or eye shadows or instance, the production of artificial eyebrows, and methods of disguising scars and skin spots, such as those that come from vitiligo.

Learning the art of application of permanent cosmetics by an aesthetician or any other professional includes ands-on instruction as well as watching live demonstrations of lip liner, eyeliner and other procedures, and such topics as color selection, tips for beginning technicians, health considerations, what is covered by client insurance, operation of pen machines, sterilization, troubleshooting, and other areas.  Each state has different rules regarding qualifications but generally an aesthetician can become certified by taking a course in this popular technique.

One of the most important things for the aesthetician to be aware of when learning the art of application of permanent cosmetics.  All material that touches a client’s skin needs to be sterilized before every use.  

Professional organizations that exist to serve technicians who apply permanent cosmetics include the National Cosmetic Tattooing Association, the Society of Permanent Cosmetic Professionals, and the American Academy of Micropigmentation.  The stated goals of all of these organizations are to ensure professionalism and high standards. In addition, many states have their own organizations.  A trade magazine, Cosmetech, is also available to serve the industry.

Permanent cosmetics actually date back to ancient times.  Egyptian mummies have extensive tattooing and the ancient Japanese made full body tattooing an art form.  Many cultures have traditions of tattoos used for cosmetic purposes.  Cleopatra herself is believed by historians to have used permanent cosmetics.  The first machine to apply tattoos electrically was created by Samuel O’Reilly of New York City in 1880.  Early efforts included those of occuloplastic surgeon Dr. Crowel Beard who performed an eyeliner procedure to replace lost eyelashes through the use of tattooing, or permanent makeup.  Of course, technology advances have impacted cosmetic tattooing, with a variety of both manual methods and machines available to place color under the skin safely and effectively.

Aestheticians wishing to add the service of applying permanent makeup to their business should check with their own city and state and make sure that all requirements are met.  The field is growing and is a perfect addition to an established aesthetics practice.