Ep 23 - Chemical Peels with Metaxia Dalikas

Metaxia Dalikas of Lira Clinical Skin Care

What is the rhythm factor of peels? How have chemical peels evolved from free acids to resurfacing combinations? From instigating two weeks of skin inflammation to a philosophy of strengthening the skin to peel all Fitzpatrick types, in any season, we have witnessed an evolutionary change in chemical peeling solutions and protocols. In this episode, we discuss chemical peels with the peel queen herself, Metaxia Dalikas.

Author Bio: 

Metaxia Dalikas

Metaxia is a licensed esthetician and internationally recognized expert in advanced esthetic treatments, education, and chemical peel formulation. She has worked side by side with world-renowned dermatologists and chemists for many years. She has more than 40 years in the medical and professional esthetic treatment industry and it is fair to say she knows her stuff!

00:00 Speaker 1: You are listening to ASCP Esty Talk, where we share insider tips, industry resources and education for estheticians at every stage of the journey. Let's talk 'cause ASCP knows it's all about you. 
00:16 Ella Cressman: Hello, and welcome to ASCP Esty Talk, the Ingredients Decked Out series. Here, we explore the fascinating world of ingredients and how they work within the skin. I'm Ella Cressman, a licensed aesthetician and owner of the HHP Collective. I am a certified organic skin care formulator and a self-proclaimed ingredient junky. Today, I can't tell you how excited I am because we're gonna talk about something super fun with one of my... I'm kind of fangirling here at my industry crushes. We're going to talk chemical peels with one of my favorite industry gurus, the Peel Queen herself, Miss Metaxia Dalikas. So if you don't know her, Metaxia is a licensed esthetician and internationally recognized expert in advanced esthetic treatments, education and chemical peel formulation. She has worked side by side with world-renowned dermatologist and chemists over many years. With over 30 years of experience in the medical and professional esthetic treatment industry, it's fair to say she knows her stuff. Welcome Metaxia. 
01:23 Metaxia Dalikas: Oh, thank you Ella for a wonderful intro. My god, it sounds like I'm pretty popular out there. [chuckle] 
01:30 EC: You are, you are and humble, which is another thing that I love. I have to tell you, You changed my life, and we'll get into that later, but... 
01:37 MD: Okay. 
01:37 EC: One of my... I have a corrective skin care studio in the Denver metro area, and I love to treat problem skin and your peels are my favorite. So I imagine... I've been licensed almost 15 years now, and I've seen changes and we won't say the year that you... It's fair to say, you've been over 30 years, unless you wanna tell the year. 
02:01 MD: I have... 
02:02 EC: But what have been... 
02:03 MD: I have no problem telling the years, in fact, it's been 40 for me, planning with chemical people. 
02:08 EC: Wow. 
02:09 MD: Forty. I started in 1979. 
02:12 EC: Oh, awesome. What are some of the biggest changes that you've seen since 1979?  
02:16 MD: I think we've learned, first of all, what chemical peels are all about. We didn't know back in 1979, 1980, when NeoStrata came out with their first intro to the market with a glycolic acid, it was an unknown territory, we didn't know. We were using phenol, TCA, salicylic and Jessner's, and those were our staples. But all of a sudden they came back with this glycolic peel and we were doing these peels without knowing that pre and post care was necessary. It was just set up for a correction, it really wasn't set up for prevention or maintenance, it was just a different animal back then, we were just learning. It was brand new to us. So what we've learned in the 30 years is that it's something that is evolving on a constant basis. For us, for example, we're learning, we're learning that certain chemicals are good together, certain are not, we're learning that there's multiple modalities out there and not just the ones that we had. 
03:11 MD: And it really is not just for correction, there's a lot more that we can do with these peels, and I associate it with the iPhone. Before when we had a phone, it would be a landline, the phone, we really would use it for one purpose, just to talk, communicate. And now all of a sudden we have these smartphones that we do so much more. So our chemical peels have really kind of evolved into an ingredient or a modality that you use multiple ways. Plus the biggest thing I found is that you just don't go ahead and peel someone that has skin that is compromised, Sometimes you would come in and their skin would be dry and dehydrated, and we would just drop an acid on their skin, thinking that it's gonna be enough to correct it. It really... 
03:50 MD: You really need a healthy canvas for the skin to kinda respond nicely and heal properly. I call it like the IV. When you go into a hospital and you have something you have to take care of, either your skin or your body, it's gonna be compromised one way or the other, you need to put an IV, why? To hydrate, to make your skin function properly, same with our chemical peels. Home care is important, hydration is important, and protection, we didn't even associate peels with SPF back then. 
04:18 EC: You mentioned phenol, salicylic, glycolic... Back then, so let's say you were five, 10 years into the game, so it's 1989 at this point, 1985 to 1989. What was your go-to peel then?  
04:32 MD: The go-to-peel then was salicylic 'cause salicylic was an immediate response. Literally, you would put it on the skin, it began to frost... It wasn't as aggressive as a TCA or a Jessner, but I can get a refinement right away. Once I would deliver refinement or change, then it would be easier for products to be easily penetrated into the skin. Home care became a little bit corrective. 
04:57 EC: So you would do salicylic all skin types?  
05:00 MD: Oh, that was the only tool back then. We had glycolics back then, but they were just primarily for lighter skin tones because of that irritation or that photo sensitivity. So the tool that I... Or the peel that I used back then was salicylic, my favorite. 
05:13 EC: What would you say now in 2020 is your favorite? Do you have one?  
05:20 MD: I... You know, I find that all of them are special. Again, associating to the phone, I can't do without my phone and I can't do without the full spectrum of peels. I think the fact that I could customize and combine and layer and create all kinds of modalities by using them in many different ways, I think I need them all. But if I had only one that I could pick from now would probably be the Green Power, 'cause my Green Power opens up pathways, and I think that's really... Again, it's an immediate response for me. I want to see the skin kinda respond, give me some kind of sign that it's getting some results, it's going for a result, it's getting... The skin has a way to express itself, and when you get erythema, not where it's burnt skin, but light erythema, there's a response. You get that you feel that the skin understands what's going on. So for me, the skin's language is really important, and identify that, and my Green Power can be altered in many different ways to get that response. 
06:19 EC: Yes, one of my favorite peel solutions as well. Solution's a double entendre. [chuckle] Solutions like literally a solution, then also results-oriented. You mentioned something a little bit ago. You were saying that the glycolic was for the lighter skin tones. One thing that I have noticed, too, is the client is a little different for me in my limited experience of 15 years. Do you agree?  
06:43 MD: Yes, the clients that were coming back then were one, clients that had problems. And we weren't treating Fitzpatrick's four or five and six because of the risk factor. And we were putting AHAs on darker skin tones and causing the skin to be usually exfoliated, alarming the melanocytes, causing an additional risk. Sometimes, you would cause hyper and hypopigmentation. So the clientele really has changed. So now that we have multiple modalities, we can actually offer treatments to all Fitzpatrick type, which is really cool, and understand that when the skin's condition, I can do a Jessner on Fitzpatrick five, I can. But I'm putting everything, aligning it properly so that it's supported by the proper ingredients, so that it can actually heal itself properly. You don't wanna walk around with inflammation. All that's doing is keeping the skin alarmed to the point that it has to protect, which melanocytes can go two ways, too much, which is hyper or hypo where you've exhausted it and you don't wanna do that. 
07:46 EC: I think there's a couple of things that you just said. For me, it's almost an analogy of walking around super stressed out all the time. Then you're exhausting your adrenal support function. So if you're... 
07:56 EC: All chronically like this, you're either gonna stay chronically like this like, "Ah!" Or you're going to, "Poof!" Put poo out, so to speak, and the same with the skin. So anything that's a nail on the head situation where you're not all peeling used to be, "Burn it off. We're going to stimulate... We want sheet peeling. We want this downtime two weeks to really re-service it, restart," right?  
08:22 MD: Yes. 
08:22 EC: Or you would schedule Fitzpatrick two with, "Okay, so we're gonna do this peel and you're gonna need to take two weeks off," or, "Let's do it over in your break on Easter or something." [chuckle] And that's not the case anymore. We're really looking at more skin health. Would you agree?  
08:42 MD: I totally agree with you, skin health is number one. So we're not going just to peel someone. Literally, we would have a treatment plan that would be peel, peel, peel for six weeks, just doing the same peel, hoping that it will give me a result that I would want. Now, it's really an art, and the art is really understanding that it's not just peeling and having that erythema for two weeks. And that erythema for two weeks is really hurting the skin and not causing the skin to respond properly. Red is good. They used to say, "Go red," and it was really important that we get... We show that their skin had a treatment. Now, people are getting peels, they look better after peel. You can't even tell that they've had a peel. You heal them in a way that their skin is changing right in front of your eyes, but yet again, you don't walk away with this inflammation 'cause inflammation is a consideration that we didn't consider back then at all. 
09:36 S1: Hey, guys, stop! Let's take a quick break. 
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10:28 S1: Let's get back to the conversation. 
10:31 EC: I should tell you, I said that you changed my life and you did. Oh, in school, and I won't mention where I went, but in school, we were taught that chemical peeling was only for a certain skin tone because of those risk factors of hyper or hypopigmentation, and that there was this peel season that we would do a series of six with a single acid, like a series of six glycolic peels, for example. Or if they had acne, it would be a series of six salicylic, but those were the differentiations. It was like box one, box two. And if they were more, needed more correction, we would move on to Jessner's or TCA. But what you had instilled in me, and I don't know if you know this, was confidence in a few different ways. One is that I wasn't limited to only peeling Fitzpatrick's one, two, and three, but also, you instilled a confidence in me to really differentiate or go outside of that single-acid peel series. So it's like, what are the immediate needs of this skin? That treatment, that appointment. And I have to thank you for that. [chuckle] But I would ask then, I know the answer, but I want to say, "Do you feel that it is the home care?" You mentioned that before, you didn't have a pre... You had a little pre-treat and then... But the home care wasn't an option, it was the skin prepped, was it the home care. How much of the health or the success of these in-clinic modalities are attributed to home care?  
11:57 MD: Well, I would say a lot, close to 80%. There's not a fine number for it, but we need to be treatment-ready. When I say treatment-ready, we need the skin to understand that every day, we're gonna have challenges. For example, we travel. The skin, it gets dehydrated. We're exposed to elements when we go outside or exercise outdoors. The philosophy has changed where we would give a little kit before you do a treatment, give a little kit after you have the treatment and it would be enough. And then we would, again, go back to what we were doing and home care really wasn't that necessary or it wasn't that specific. So now that we need to have products that are working on a daily basis and working for that particular client, it doesn't have to be just a kit for everyone. So the aesthetician is more vital right now with aesthetics because she could actually coach their home care all the way through, but you wanna be, really, not just to have a seasonal peel, but an all-year-long type of peel potential. 
12:53 MD: So you know, it's not seasonal anymore. It's not just corrective, we need to keep the skin healthy. And by keeping the skin healthy is using these peel modalities in multiple ways, so that it gives you that constant healthy epidermis. And when you are doing that, you're gonna find you're not gonna go in for this one big peel, and then all of a sudden you're gonna have a result and then the result goes back within two months to where it was. By keeping the memory at its best, you don't have to do this aggressive peels. If you notice, volume is where it's at. When we would do these aggressive peels, it will take months for the skin to come back, if it would come back, because we destroyed all of that cushion of that hydration factor in the epidermis. So home care gives us that maintenance of keeping the skin at its best. So if you just decide to get a treatment, you just go ahead and get a treatment because you've done all the hydration, the exfoliation, the melanocyte numbing. That your melanocytes are always being assured that the alarm's off, it's okay. Because the melanocytes are your alarm, and we need to keep them comfortable and not on all the time. 
13:58 EC: That's a good one. Like the calm down girl, it's gonna be okay. 
[overlapping conversation] 
14:02 EC: Thanks melanocyte but we got this. 
14:04 MD: We got this. Yeah, I like that but it's change, you know. 
14:08 EC: And that's why we can treat the higher Fitzpatrick now. 
14:11 MD: 'Cause with the higher Fitzpatrick what we've found is that okay, they said that we don't have to do these peels, but yes we do, they still need the exfoliation, they still need the hydration and they need the melanocytes to be reassured. And I think that's really, really important. So we might not use the higher level of modality or the peel, we might pick different modalities, but you can. When the skin is really healthy, it can do a lot more than when it's really not respected that way. And I think the key to this new era right now is we peel all Fitzpatrick type and we just need to be educated. 
14:44 EC: And you mentioned earlier that you can peel a Fitzpatrick IV with a Jessner's, IV or V with a Jessner's if they're prepped, so if their skin is strong enough. 
14:52 MD: I mean, I remember doing Jessner's back in school. They were doing 10 layers of Jessner's just to do adjustment so that you would have this peeling of... You know, the skin peeling as sheets coming off your skin. And all of a sudden you would have hyper and hypo. You really never wanted to look under a Wood's lamp to see the damage. You had hot spots that would later be a problem when you wanted to do additional peels. It was so dramatic, but we had to prove a point. I think the point is we have healthier skin and we could do a lot more without people knowing it. The key is not to be exposed, "Oh, look and I'm getting peels twice a year." People don't know when you're getting peels, it shouldn't. It should be part of your home care and clinic treatment plan. 
15:34 EC: Like a really intense work-out, but you don't just go to the gym twice a year. 
15:38 MD: Correct. Or you don't go to the dentist. You don't go to the dentist. We find that, you know, you brush your teeth, you brush your teeth and you floss, but then you do need to go in to your hygienist and get your teeth... Again, keeping it at its best. What is doing is avoiding cavities, avoiding future problems. Same thing with going in clinic is valuable that clients and patients go into their estheticians and get these treatments that are gonna keep their skin at its best. If you notice Ella, people don't look their age anymore. You really can't... 
16:08 EC: Me neither. [chuckle] 
16:09 MD: Yeah, you don't. 
16:10 EC: Both of us. 
16:12 MD: Look at pictures. I could tell you, if you look at pictures, you'll notice it. You know, you don't notice on a daily basis, but you have 40-year-olds looking about 20. You have 60-year-olds looking like they are you know 40. There's a huge, huge difference. When I was 20, a 60-year-old was old. I'm 64 and I'm... My career is... 
16:35 EC: Can't tell. 
16:35 MD: Yeah, but my career is really... Is in it's top right now. I'm enjoying this. I'm really engaged in what I'm doing, so I don't think I'm gonna stop, I don't wanna stop. Whereas back in the days, 65 was, you know, you're getting your Medicare check and now you're getting your retirement, you gotta kinda relax. And I don't see that happening, I don't see that happening anymore. 
16:56 EC: It's different when you love what you do, it's different when you love what they... And I think that's evident from you. I think the other way that this methodology that you have implied or impressed that has changed my life is in my business. So as a practicing esthetician, I was able to change clients who were coming in twice a year for a series of six. 
17:17 MD: Yeah. 
17:18 EC: I've moved them now for about 10 years now, to... They come in every four to six weeks, but they're prepped, right? They have the home care, and I adjust that home care based on their need, but they're coming more frequently, so it's actually stabilized my business too. So that's just another, not just skin health, but also... And it's provided results, and so those results equate to referrals, and that is one of the best marketing ways. Just wanted to point that out for whoever is listening. As a peel formulator, as an industry leader, can you give us some insight into peel creation? So what ingredients do you use, how do you do this, how do you design protocol treatment plans in addition to peel solutions?  
18:00 MD: Well, first of all, we at Lira have a full spectrum of peels where we have the enzymes, the AHAs, BHAs, the chemical, and the mechanical, so it's really important. But when you see that, for example, the modalities, you kinda look how you can improve them, for example, on the Jessner's. Jessner's are over 120-years-old, maybe even older. But how could you improve that formula? Basically, adding gold and silver and the minerals are really important to help heal within. Enzymes, blending certain modalities and adding a little spice to a retinol, for example, to an enzyme, gives you a better modality or an enzyme that's a little bit more spicy. You try to take a modality and give it's best, the latest technology, and I could tell you with the brightening agents and with all of the botanicals out there, I think we could create really cool formulations, and I could tell you I think it's the same thing as a phone. Our phones are doing a lot more, and why do you keep leveling or go to the next level, where you're gonna have your five, you have a six, you have a 10, you have 11, whichever the phone series is. 
19:04 EC: Yeah. 
19:04 MD: The same thing with our peels, you don't want to have 20, 30 different peels, you wanna have your modalities at their best. And I think... 
19:11 EC: The most current technologies. 
19:13 MD: Yes, in a peel. So you have your salicylic, for example, we have two formulations. We have the one that's more of a free acid, and we have one that has more of a pulp delivery, which is important, 'cause it'll give you more time so that you're not just dropping acid quickly into a hotspot. So keeping your modalities current with the latest technology and ingredients is what I think is the winning combination. 
19:35 EC: What you do too, it's not just creating a solution, you also create an entire protocol and you have this versatility, that... Where does that creative spark comes from?  
19:45 MD: Well, I could tell you it's coming from... Not getting a response. When you look at someone's skin, it becomes stagnant when you use the same protocol over and over and over again. Your skin needs to be surprised. So when you look at a protocol, you wanna be sure that you address from the beginning the cleanser you use. The cleanser could set up the actual start-up a protocol. You wanna be sure that you're getting that response, the little erythema. So by making protocols, you wanna have choices, and it should not be the same protocol over and over. So we love our treatment guide because our treatment guide is taking the back bar and creating multiple protocols just to kinda go in to cleanse... Get the Canvas ready, create that, for example, that refining method a detox step instead pep step. So you create things that the skin will say, "Ah, ha, this is something new," 'cause when it's something new it responds faster to kinda figure it out to kinda realign the epidermis. So it's really cool that protocols are designed, the steps are very similar, but designed with excitement. So the skin feels "Oh, this is something new." So I think our combinations have been really, really good because we have multiple opportunities with keeping the cost down and making a lot of profit with the peel, the back bar you have and the peels that we have. 
21:00 EC: And it keeps it fresh for the practitioner. 
21:02 MD: Correct. I mean... You get bored doing the same thing over and over again. The one key thing that I want that which is really important. If you notice you're not getting response, there's nothing on going off a protocol. So you really have to read the skin and understand the skin. If you're not getting the change, then add another step. When you know your ingredients and you know your back bar real well education is really vital at this point. You could actually alter a protocol to what that person needs for that day. 'cause every time a person comes into your clinic, their skin is in a totally different place, so we have to be able to adjust the protocol as needed. 
21:38 EC: And that goes the other way, if they're responding... You mentioned a detox step if there's quite a bit of erythema in the detox step, you know, listening to the skin, speaking the language of the skin, I think is what you're saying. Like paying attention, not just following a checklist. 
21:53 MD: Absolutely, if your gut says, Don't do it, don't do it. If you notice the skin is responding differently, they might have gotten waxed a couple of days before coming into your clinic, and then you'll notice the change, Something that you're not comfortable with, don't go and proceed with this protocol. You know It's really important I think we are... And this is what I find with a lot of nurses and it's changing now, nurses are set to follow protocol to the T. So if it's 15 minutes they're gonna give it to you for 15 minutes and nurses are following protocols that are given. As estheticians we can make our own protocols. So we're paying attention, so all of a sudden, if we're supposed to have a mask on for fifteen minutes, but the skin is changing and it's giving me some type of language that it doesn't like it, or it's too aggressive. Stop. So as estheticians were in a really good place that we can make our own protocols. And I find nurses that are taking more education and more classes and becoming more aware of that, they're probably even in a better situation. I could tell you with our partner, Brenda, she's the best esthetician on the market, but she really had to shift and she's come to a lot of classes, she's really shifted that, she really reads the skin and she can address it. But that's what makes an esthetician really special for me, because their primary practice is in the epidermis. 
23:09 EC: High scope. And Brenda's a nurse, so she's done a lot of shifting... She is awesome. She's awesome, awesome. 
23:16 MD: And I can tell you one more thing I wanna add, I think what's really important is that as a nurse, when you're getting Botox and you're getting dermafillers, and you're getting all these treatments, lasers, You're dealing with the dermis. So if you really wanna have a finish. You have to be able to have a healthy epidermis and this is where it's vital that home care, it's vital that an esthetician keeps that canvas as healthy and hydrated and smooth and bright and even toned as necessary, 'cause that's your finished work. 
23:46 EC: That's the siding and the paint on the house. 
23:48 MD: Yes. 
23:51 EC: If you had to guess on what the future of chemical peels looks like, let's say five years or 10 years you pick... What would you say, maybe coming down the pipe?  
24:01 MD: We are in search for different acids. We are in search for different... There's a couple of things in the pipeline as far as different acids or singling out certain parts of an acid. It's really hard to tell. I think less inflammation. I think is what you're gonna find, we're not going in for that one big peel anymore. So it's really kinda using a rhythm factor where you use multiple modalities. The latest technology in the modalities we have brightening agents are really important. Peptides are really important, they really kinda build up the skin. Couple that I can't say right now. There's a couple, and we're excited, but, it takes about two years to kinda play with the formula and be sure, to be sure that it works with all Fitzpatrick types and it works with the home care. So there's a couple that we're working on that I think that you know, we're excited, but not there yet. 
25:02 EC: [chuckle] I can't wait. 
25:03 MD: But I could tell you what I can see in the future is that moms and dads out there are gonna use SPF on their kids younger, at younger ages. I think there's gonna be respect for the environment, we're gonna be more cautious with the environment, I mean, we here in California had so much problems with our air quality control. These are things that... The environment is changing. So we're gonna be more aware at a younger age and keeping the mind that prevention is the key and maintaining that youthful appearance as long as we can, 'cause that's what we have is one chance at this. So I think that we're getting better as far as understanding that it's important, skincare is essential. That it's not just something that you pick and choose to do or not... Volume, healthy epidermis is where it's at. 
25:48 EC: The clientele starts younger. 
25:51 MD: Yes. 
25:51 EC: We used to peel 40, 50, 60-year-olds and now we're encouraging exfoliation, via peel, in younger... Or correction in younger. But responsibly. 
26:03 MD: Responsibly, you know, you would go into an esthetician when there was a problem, and now we go to an esthetician so that we maintain this youthful appearance. Prevention is where it's at. Maintenance when you can maintain someone's skin a gonna longer period they really think that you're fantastic esthetician because now you're actually coaching them, so they don't need as much, but then they need you at least every 4-6 weeks to maintain that beautiful result. 
26:30 EC: I call that the Bibbity bobbity boo factor. [laughter] 
26:32 MD: Yes. 
26:33 EC: That's my magic wand that I can come out with. Metaxia, You're amazing thank you so much. You just got me super excited to peel, and we are on the cusp of peel season for some, but we know that for others, peel season on is all year long. I wanna thank you very much. Metaxia Delikas, the Peel queen herself for joining us today. We will have contact information in the show notes and hopefully we can have you back on another episode. 
27:00 MD: Oh, thank you Ella, for this opportunity. And I have to tell you, I admire you because what I hear from the industry is that you are really, really the guru. You study a lot, you are full of energy, but you give a lot to the industry. So I'm very thankful that I have the opportunity to know you and work with you. 
27:18 EC: I am thankful to know you too. Thank you so much Metaxia. 
27:21 MD: Okay, thank you Emma, bye bye. 
27:23 S1: Thanks for joining us today. If you like what you hear and you want more, subscribe. If you wanna belong to the only all inclusive Association for estheticians that includes professional liability insurance, education, industry insights and an opportunity to spotlight your sick skills. Join @ascpskincare.com. Only 259 per year. For all this goodness. ASCP knows, it's all about you.

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