Peel Manual Sept, 2013 What is chemical peeling? Chemical peeling consists of the application on the skin of exfoliating agents to obtain first, destruction and then regeneration of part of the epidermis and/or dermis. Chemical peels produce a controlled wound that will result in renewal with the reduction or disappearance of sun damage, pigmentation, acne lesions, fine lines and wrinkles and superficial depressed scars. Depth and results depend on the strength of agents used. Levels of peels  Very Superficial  Superficial  Medium  Deep Very Superficial Superficial Medium Deep Skinstitut Peel Manual Page 2 of 18 The Fitzpatrick skin scale The Fitzpatrick skin scale I. White - always burns, never tans II. White - usually burns tans with difficulty III. White - sometimes mild burn, tan average IV. Moderate brown - rarely burns tans with ease V. Dark brown - very rarely burns tans very easily VI. Black – never burns, tans very easily Wound healing process Inflammatory 1-3+ days Redness occurs, platelets form to prevent further bleeding and commence the release of growth factors. The motive behind the inflammation stage is to seek and destroy bacteria. The area is swarmed by an array of substances (white blood cells, neutrophils, macrophages) that de activate bacteria and activate growth factors. Skin at this stage is red, warm and swollen. Proliferative 3-10+ days Increased fibroblast activity stimulates collagen and fibronectin creating more elasticity in the dermal layer. New blood vessels are formed (angiogenesis). Skin cells divide and produce new cells. Skin starts to flake and peel. Type 3 collagen is produced Skinstitut Peel Manual Page 3 of 18 Maturation 28+ days up to 2 years Collagen is remodelled and realigned creating a plumper dermis. Scar tissue is flattened (if surgical for example) epidermal layer becomes denser. Type 3 collagen is replaced by Type 1 stronger collagen. Skinstitut AHA Enzyme Peel The AHA Enzyme Peel incorporates the use of peel accelerator to degrease and refine the skin resulting in a gentle peel. Redness and mild peeling may occur if the skin is not prepped. This peel is able to be performed on those clients who come into our clinic and are not currently using the Skinstitut products. Designed to renew and restore skin’s radiance while soothing, hydrating and micro exfoliating dry, flaking and sensitised skins The term "proteolytic" refers to an enzymatic reaction that can digest dead or diseased protein material without harming living healthy cells. Unlike abrasive scrubs or other mechanical methods, proteolytic enzymes are selective and extremely unlikely to cause irritation from pressure or over manipulation. Contains:  Papain enzymes – Proteolitic enzymes microexfoliate to promote a softer, smoother skin without irritation  Niacinamide – vitamin B3, strengthens skins immune defence thus reduces sensitivity and irritation, maintains treatment for hyper pigmentation through inhibition of melanin transfer and regulates sebum production  Camomile – Soothing and calming  Hylauronic acid – Hydrating  Grape seed extract – Antioxidant and strengthening  D-Panethenol –form of pantotenic acid, provides healing and soothing abilities and prevents erythema Skinstitut Peel Manual Page 4 of 18 Skinstitut AHA Enzyme Peel Post Care  No active products for 3 days (Glycolic Cleanser, L-lactic Cleanser 4%, Glycolic Scrub, Retinol, Vitamin C, Even Blend Serum) The following products may be used within the first 3 days:  Gentle Foaming Cleanser  Rejuvenate 15  Multi-Active Mist  Multi-Active Oil  Repair Balm (1/2 a pea size amount pressed over the face for the first 2-3 days)  Age Defence SPF 50+ to be worn daily and reapplied every 2 hours  Moisture Defence  Enzymatic Micro Peel maybe used to remove peeling skin as and when required. After 48hrs Skinstitut Peel Manual Page 5 of 18 Skinstitut Peel Accelerator The Skinstitut Peel Accelerator will renew, brighten and smooth the skin while proving antibacterial support and improving hydration. This unique peel is suitable for most skin types and can be intensified by layering or customized with Vitamin C according to specific skin needs. Vitamin C will intensify the peel. This may be beneficial for sun damaged skins, skins that require anti-oxidant protection or skins that may have had previous peel accelerator treatments and are requiring a more intensive treatment Peel Accelerator is used to degrease the skin before each peel and as a peel itself Contains:  Niacinamide – vitamin B3, strengthens skins immune defence thus reduces sensitivity and irritation, maintains treatment for hyper pigmentation through inhibition of melanin transfer and regulates sebum production  D-Panethenol –form of pantotenic acid, provides healing and soothing abilities and prevents erythema  L.Lactic Acid 20% – Alpha hydroxy acid for a more luminous skin  Glycolic Acid 17% – Alpha hydroxy acid that is known for its anti-inflammatory properties  L.Mandelic Acid 5% – Alpha hydroxy acid that is used for its anti-bacterial properties  Canadian Willowherb – a plant extract that has soothing, anti-inflammatory and anti- microbial activity and is an excellent free radical scavenger  Witch Hazel Extract – a botanical extract that has potent antioxidant, anti-irritant, anti- inflammatory and anti-bacterial properties  Kakadu Plum Extract – powerful antioxidant and free radical scavenger  D-Biotin –form of vitamin H, stimulates cell development and growth of nerve tissue Skinstitut Peel Manual Page 6 of 18 Skinstitut Peel Accelerator pre-peel prep The following protocol should be followed for 2 weeks prior to the Skinstitut Peel  Glycolic Cleanser 12% (at least once per day) This will allow the skin to be able to better tolerate peel (less chance of epidermal sliding or unwanted blanching of the skin)  Even Blend Serum both morning and evening to be used to reduce the risk of hyperpigmentation. Can be omitted if client never suffers from Post Inflammatory hyperpigmentation or is a Fitzpatrick skin type 1-2. * When treating stubborn pigmentation add a rice grain size amount of Vitamin C to the Even Blend Serum.  Age Defence SPF 50+ morning. This can be omitted if the client is currently using an SPF  Patients with history of cold sores should be encouraged to prep prior to peel and post peel with anti-herpetic medication - eg acyclovir and zovirax. Skinstitut Peel Accelerator Post Care  No active products for 3 days (Glycolic Cleanser, L-lactic Cleanser 4%, Glycolic Scrub, Retinol, Vitamin C, Even Blend Serum) The following products may be used within the first 3 days:  Gentle Foaming Cleanser  Rejuvenate 15  Multi-Active Mist  Multi-Active Oil  Repair Balm (1/2 a pea size amount pressed over the face for the first 2-3 days)  Age Defence SPF 50+ to be worn daily and reapplied every 2 hours  Moisture Defence  Enzymatic Micro Peel maybe used to remove peeling skin as and when required. After 48hrs Skinstitut Peel Manual Page 7 of 18 Skinstitut Ageless Peel Anabolic resurfacing treatment. This peel will assist in re building the dermis. Skin Rejuvenating anti-oxidant and amino acid peel To reduce the appearance of the visible signs of ageing and sun damage. This revolutionary peel works deep within the skin encouraging healthy new cell production resulting in a revitalised, smoother radiant complexion Contains:  Ceramide Complex - a plant derived mixture of phospholipids that restore the lipid barrier of the stratum corneum, thus provides a balanced moisture content and improves skin condition  Natural SMEC – a natural delivery system, that is non-irritating and absorbs quickly with no greasy after-feel while providing excellent moisturising for the skin  L-Mandelic Acid 7% – an Alpha Hydroxy Acid that is used for its anti-bacterial properties  L-Lactic Acid 15% Is an Alpha Hydrox Acid for a more luminous skin. Exfoliates while assisting in skin hydration.  MDI Complex – inhibits the matrix metalloproteinase enzyme activity that degrades collagen. It protects against UV radiation and other irritants, thus increasing resistance to physical assaults on the skin  Oceagen LS – a collagen of marine origin, similar to type 1 human collagen, it smoothes and softens fine lines and improves moisture levels of the skin  Vit-A-Like 3% – of botanical origin, used as an alternative to retinol without undesirable side effects such as irritation, photo damage, oxidation and instability. It stimulates collagen through fibroblasts and enhances proliferation of keratinocytes, contributing to skin renewal resulting in a smoother, brighter complexion Skinstitut Peel Manual Page 8 of 18 Skinstitut Ageless Peel Prep The following protocol should be followed for a minimum of 2 weeks prior to the Skinstitut Peel  Glycolic Cleanser 12% (at least once per day) This will allow the skin to be able to better tolerate peel (less chance of epidermal sliding or un-wanted blanching of the skin)  Even Blend Serum both morning and evening to be used to reduce the risk of hyperpigmentation. Can be omitted if client never suffers from Post Inflammatory Hyperpigmentation or is a Fitzpatrick skin type 1-2. * When treating stubborn pigmentation add a rice grain size amount of Vitamin C to the Even Blend Serum.  Retinol or Rejuvenate 15 to be used at night to stimulate the retinoic acid cell receptors  Age Defence SPF 50+ morning This can be omitted if the client is currently using an SPF  Patients with history of cold sores should be encouraged to prep prior to peel and post peel with anti-herpetic medication - eg Acyclovir and Zovirax. Skinstitut Ageless Peel Post Care  No active products for 3 days (Glycolic Cleanser, L-Lactic Cleanser 4%, Glycolic Scrub, Retinol, Vitamin C, Even Blend Serum) The following products may be used within the first 3 days:  Gentle Foaming Cleanser  Rejuvenate 15  Multi-Active Mist  Multi Active Oil  Repair Balm (1/2 a pea size amount pressed over the face for the first 2-3 days)  Age Defence SPF 50+ to be worn daily and reapplied every 2 hours  Moisture Defence Skinstitut Peel Manual Page 9 of 18  After 48 hours Enzymatic Micro Peel may be used to remove peeling skin when required. Peel Precautions  Do not apply over open lesions, eczema, or inflamed psoriasis  Do not use on Accutane patients. Must allow at least 6 and up to 12 months post completing medication (check oil levels and sensitivity). Anti-inflammatory, hydrating treatments only  Topical Retinoic Acid– wait at least 3 to 4 days  Facial waxing and hair dyeing, wait at least 7 days  IPL/Laser treated skin must wait at least 2 – 4 weeks  No Salicylic peels for aspirin allergy suffers  No Peels for at least 3 months post facial surgery  Note: Must allow 4 weeks between last dermal peel and surgery  Always wear gloves  Apply Repair Balm corners of the eyes, lips. May apply to flares of nostrils if skin is irritated. Apply over cosmetic tattoos.  Have a small hand fan handy  When removing peel use a cotton pad /fibrella as this will be much gentler than using gauze and at that time the skin will be in quite a sensitive state.  When removing the peel do not rub off as this could cause epidermal sliding, use compression technique  Always use cold water both to soothe skin and remove excess peel  Note: Never perform peels on severely dehydrated skin. There could be extreme penetration of the peel resulting in an adverse reaction Skinstitut Peel Manual Page 10 of 18