We all know the general boxed skin type classifications: Aging, Dry/Dehydrated, Rosacea/Sensitive, Combination, and of course Acne/Oily. But is that fair? Is that accurate? Is acne always an oil overproduction issue, or are there other causes and approaches we should be aware of? In this episode, Ella and Maggie discuss acne by definition, by type, and by trigger to broach an alternative way of treating one troublesome condition.
About Maggie Staszcuk:
Maggie has been a licensed esthetician since 2006 and holds a bachelor’s degree in business administration from Stephens College. She has worked in the spa and med-spa industry, and served as an esthetics instructor and a director of education for one of the largest schools in Colorado before coming to ASCP as the Advanced Modality Specialist.
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About Ella Cressman:
Ella Cressman is a licensed esthetician, certified organic formulator, business owner, and absolute ingredient junkie! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.
She has spent many hours researching ingredients, understanding how and where they are sourced, as well as phytochemistry, histological access, and complementary compounds for intentional skin benefits. In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several skin care lines, including several successful CBD brands.
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Toshiana is a licensed esthetician who grew into an international educator, traveling globally to facilitate spa and beauty-related programs that she created. At one time, she led a team of 250+ estheticians nationally as the director of esthetics for an iconic luxury spa chain with over 30 locations. She was also the regional operations director of four full-service spa/salons, including two inside Saks Fifth Avenue and the education executive for the iconic brow artistry brand Anastasia Beverly Hills. Toshiana also held positions of leadership at other luxury influencer brands in spa, cosmetics, and retail. In 2016, she left the corporate space to become a full-time entrepreneur who parlays her wealth of experience to help small business owners, solo practitioners, and independent brands grow and scale.
Seeing a gap in the spa and wellness space for support, professional development, resources, and education for those of diverse backgrounds, she founded the Network of Multicultural Spa and Wellness Professionals (NMSWP) to be the gap filler. More than that, she wanted to create a community that feels like a “tribe to thrive” and to be a beacon of light and excellence for the spa and wellness industry.
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0:00:00.2 Maggie Staszcuk: Are you an aesthetician that has felt unsupported or under-represented in the industry? Have you feel isolated once you left school and have seen others making strides but are unsure how to make this happen for yourself? Do you feel that if you had education, resources, and access provided to others that you could kill the game? We are exactly what your career has been missing. Join the network of multi-cultural spa and wellness professionals, a community to help you go from simply surviving to thriving. Visit www.nmswp.com to explore our membership options for individual professionals, students, schools, and corporations or groups.
0:00:47.8 Ella Cressman: You are listening to ASCP Esty Talk, where we share insider tips, industry resources and education for aestheticians at every stage of the journey. Let's talk because ASCP knows it's all about you.
0:01:03.5 EC: Hello and welcome to ASCP Esty Talk. I am one of your hosts, Ella Cressman. I'm a licensed aesthetician and owner of the HHP Collective.
0:01:13.4 MS: Hi, Ella. My name is Maggie Staszcuk. I am a licensed aesthetician, and I am the advanced modality specialist at Associated Skin Care Professionals.
0:01:23.2 EC: I'm so excited to be joined and honored to be joined here with Maggie, and we're gonna talk about unpopular opinions today. We're hoping that this will be thought provocative and fun, mostly. So today we're gonna talk about acne/oily. Before we get into that, Maggie let's talk about skin type classifications. Let's review the standards that are discussed, like the basics in school. You have a long background in education, and I think you're the perfect person to tell us, remind us, to refresh us on what we learned in school.
0:01:56.9 MS: Oh, thank you, Ella. I think that what we teach in school really mimics what we're seeing made by the manufacturers. So you have product lines out there that are specifically for dry/dehydrated or acne/oily. And so then the schools are following that path and teaching the same thing. And so, if we look at dry/dehydrated, for instance, and it's interesting because that is a skin type and it's also a condition. So in school, we are teaching dry skin is a skin type, it's something you can't change. Dehydrated is a condition that hopefully you can correct to some degree. I don't know if that really makes sense. When I was teaching and we were in school, that's what we would say to the students, "Look first at what is the type, what is inherited that cannot change, and then what are the conditions presented before you that hopefully as an aesthetician you can correct."
0:03:04.3 EC: So it would make sense that the industry would classify there's dry/dehydrated 'cause they're related.
0:03:11.5 MS: Totally, yeah. Totally, I would say they are related, but different, a little bit different.
0:03:16.9 EC: So similar when we're looking at rosacea or sensitive.
0:03:19.0 MS: Yeah. Oh, yeah, absolutely. Same thing. And I think a lot of people get weird when you talk about sensitive skin because, is that really an inherited? Yeah, maybe. Rosacea could be, but it's all sensitive skin and what's being presented in front of you. Erythema, maybe a little edema, generally speaking, somebody just has skin that is reactive, and that's another buzzword. What does reactive mean? And that could be acne.
0:03:49.9 EC: It sure can. [chuckle] Another classification is aging, which I think is such a cop-out classification because, guess what, we're all doing it.
0:04:01.2 MS: Yeah. And what does that mean really, aging? For each person that's different. How does that present on the skin?
0:04:09.3 EC: Yeah. And oftentimes it's aging pigment, aging and pigment, but as you said, pigment come... That you alluded to, this reactive skin could cause acne or be their co-issues, and same with pigment could be dry/dehydrated or acne or sensitive. Those can all be co-issues, which is part of why we wanna talk about this today. Now on that line, let's talk about classification and skin type of acne/oily.
0:04:35.2 MS: Yeah. I think acne is such an umbrella term, and just like aging and reactive and sensitive, oily acne skin can mean so many things. And, of course, we have the acne scale, one through four, but again, your client can be presenting with comedones or pustules, or maybe it's just inflammation, a little bit of milia underneath the skin, and really, what is the root cause of acne? Are they dry acne? Are they oily acne? And again, are they, to use that buzzword, reactive causing that acne, or is it something else?
0:05:18.2 EC: Hormonal acne?
0:05:19.9 MS: Yeah, hormonal acne. Totally.
0:05:20.0 EC: Or something I've been seeing a lot of lately is maturation arrest acne.
0:05:24.5 MS: Oh, tell me about that one.
0:05:26.4 EC: Oh, it's very interesting. And we could have a whole other podcast on that. But it's basically like milia but more aggressive.
0:05:34.7 MS: Oh, interesting.
0:05:35.4 EC: Yeah, and more significant that bumpy, and when you stretch the skin out, you can see the bumpies and it's cause usually periorbital cheeks forehead. Way more aggressive than a milia. It is easily self-extracted. You could push and it'll come out sometimes.
0:05:50.6 MS: Wow.
0:05:52.4 EC: Maturation arrest, which I think is... Been seeing a lot more about it, and I think it's an opportunity for misclassification. Just to be more aware, we should do a podcast on it.
0:06:03.9 MS: Yeah, I'd love to.
0:06:04.3 EC: Okay. We'll do a whole other one on maturation arrest. But you just said something right there. You said acne/oily, this is a classification that manufacturers use, this is also a classification, not type.
0:06:17.6 MS: Yes, yeah. Interesting, right. And I think a lot of people don't think about that necessarily. And to your point, and what I was saying earlier as well, is that oily could be your skin type, and again, that doesn't change necessarily, maybe over time as you age, that oil production is slowing down, but generally speaking, you are an oily skin type and that is what your skin produces, it's not changing. But when we're talking about classification in my mind, and you have acne/oily skin, oil production can also be a condition of, say, hormones or product usage or who knows what. And maybe that's a contributor to this acne problem you have.
0:07:03.3 EC: And not always is oily a bad thing, especially when you're hitting 45 and your skin is like, it's soft and supple.
0:07:11.2 MS: Totally.
0:07:11.4 EC: So oily skin gets a bad rep, I think.
0:07:14.0 MS: Yeah, yes. So yeah, it keeps those wrinkles at bay.
0:07:17.1 EC: Yeah, bye bye, bay, bay, bay. [laughter] So what about combination skin then? We have this classification you reminded me of this and I was like, "Oh, I forgot." And I hate this one. I hate combination skin, and when people talk about T-zone. And the reason I hate it is because for me, it means imbalanced.
0:07:38.9 MS: Interesting.
0:07:40.7 EC: But this has been my stance for the last few years, but when you just said it a while ago, I'm like, "Oh, it's a co-issue, actually." So maybe I need to change my thought process around it, but let's talk about combination skin.
0:07:53.8 MS: Yeah. For me, I think combination skin is a real type or a real thing for people, because somebody could be normal, let's say, or on the dryer side, more on the cheeks or the jaw line, and I'm just defining combination skin. I mean, you know, but I think it's very plausible that the forehead and maybe into the scalp is oily or down to the nose is oily, they just have larger pores in that area, and it's not extending to the whole face.
0:08:29.9 EC: I'll disagree with you, but here's my problem with that classification or that designation is that it's a cop-out, because what does that translate to, to product development, for our industry's product development? I think back to when I was a kid, my mom was a clinic user, and we would go to the clinic counter and they had this four sliding things on it that were different colors. It was this interactive scale that came to an answer. And you could slide it over here, do you have this, do you have that? And then somehow this magical answer appeared of what you needed. Inevitably, I think it was the same for everybody. It was a bar soap that was in a green tube, it was the yellow lotion, and it was a toner. A pink toner with a green web.
0:09:21.5 MS: The pink toner. Oh, yeah. I remember.
0:09:23.7 EC: Yeah. And so, combination skin, what does that mean as a... What does that mean? Sure, as professionals, we can guide some of that balance. They're imbalanced with the pore size or does combination... Combination can mean a combination of things, but of course, it usually is indicative of oil production, would you say?
0:09:44.7 MS: Yeah, yeah, I would. And I think that you could easily argue majority of your clients are "combination skin", meaning you are going to cocktail a regimen for them to meet their combination of issues.
0:10:03.3 EC: Co-issues, absolutely.
0:10:04.7 MS: To be cliche. Because I think unless you are dealing with one end of the spectrum being young teenagers and the other end of the spectrum being aging population, everyone in the middle is going to be truly a combination, which is multiple things happening on the face. That aging population is probably more, the dry, dehydrated. And that young teen population is probably more likely to be acne/oily as they're going through hormonal changes, and that's totally a generalization. But then you have the people in the middle who you are more likely to customize and say, "You know what? Maybe you have a little bit of breakouts, maybe you have some aging, and maybe you're oiler in the T-zone."
0:10:50.5 EC: I agree. I agree with that. And I think that is the goal is to teach or to become that practitioner who can differentiate that, acknowledge that the co-issue factor and execute that with that in mind, because we understand that as practitioners what we do in treatment continues with what they take home and that's why we sell retail. So it's not this salesy thing, which is again, another podcast, but this is why what we do to support it. I think my frustration comes from the combination, it's often acne/oily combination as if they're all together and that's it, but Maggie's definition, if you didn't hear it, rewind it, listen to it again, or Maggie, if you wanna share that again, is that everyone has a combination of co-issues. We're all aging. Some of us have pigment, and some of us have at a certain age we're starting to get pimples again, and so on.
0:11:50.4 EC: So interesting. I'd love to have that one to be another topic, but today we're gonna talk about acne/oily. And we can look at... As Maggie mentioned, oftentimes, the education is driven by the products or vice versa, sometimes the products are driven by the education. And so it seems to be each is pointing at the other for guidance. In school we're trained for classes and types to identify, to decide on protocols of what we should do in our treatment room, in our facial room, whatever designation you give to that. And then we talk about plans, executing plans for what we're going to do. What kind of facial? This is another thing that drives me nuts is on a menu of services, you'll have an anti-aging facial, a pigment facial and acne facial... And then... And I'm saying this as someone who used to have those on my menu of services, did you?
0:12:49.6 MS: Oh yeah. Yeah. Yeah, absolutely.
0:12:51.5 EC: And they would sign up... Now, I only have custom facial, because they would sign up for that, and then... They did not need an acne facial or they didn't need an anti-aging facial. So I had switched it all towards all just custom, based on the philosophy that we just talked about. But I did that, initially when I was fresh out of school because that's what I was trained to do. I kind of followed the model of the school, honestly. When I did that, I followed... Oh my gosh, I followed the model of my school and the product company and their protocols that they provided when I created my menu, I am such a sucker. [chuckle] When I created that, it was probably like five years in before I was like, "This is not right, I need to change this."
0:13:37.3 EC: But, I'll tell you, as someone who consults with companies, product companies on development of products, I have steered... It is my opinion, it's not always picked up, but it's my opinion that putting these into these classifications, if it's education or if it's product, even though it's well-intended. It is not always servicing the practitioner nor the end user, because they're missing... One of the words that Maggie said is the opportunity to identify root cause. So, let's talk about acne, and let's talk about what acne is, what is the definition of acne.
0:14:14.4 EC: Hey guys, stop. Let's take a quick break.
0:14:17.9 MS: Introducing the next generation of stem cell science for skin and hair care. NeoGenesis patented S²RM technology. By harnessing the power of adult stem cell released molecules, these products awaken your body's natural regenerative power and simply returns to the damaged tissue, what was there when it was young and healthy. This enhances the result of all treatment room modalities, reduces downtime and speeds up the healing process, naturally. There are no contraindications, and NeoGenesis will offer a full money back guarantee on all NeoGenesis skin care products.
0:14:57.9 EC: Let's get back to the conversation.
0:15:01.6 EC: The definition of acne is the occurrence of inflamed or infected sebaceous glands in the skin, in particular, a condition characterized by red pimples on the face, prevalent chiefly among teenagers. Well, that's not always true, but we know... Here's another one, acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells, it causes whiteheads, blackheads, or pimples. Acne is most common amongst teenagers, so it affects people of all ages. What we can infer from that as practitioners is, it is most common in teenagers as we know, because there's a hormonal change, a shift, and that hormonal shift does a couple of things. One, it has an influence on sebaceous production or sebum production, where it increases it. But it also increases all the hormones. And so, that's what's going on.
0:15:54.7 MS: Yeah, totally, I agree. And as we said earlier, it's not just hormones that stimulate that oil production and lead to clogged pores and acne, and also it's not just affecting teenagers. But, at least back when I was teaching, we would always teach that acne is actually a disorder of the sebaceous gland and I think that's an interesting perspective as well, because I think the word disorder leads somebody to think, or at least I think, "What's wrong with my little sebaceous gland pumping out all of this oil?" You know what I mean? There's a defect here, is what I think when I hear that. And our discussion on this podcast today is, what is the root cause of acne or what's the root cause for this increase in oil production that's leading to acne? I don't know if disorder is the right way to look at it.
0:16:49.1 EC: No. And I don't know that it's always just oil production either. Because there's a well-known cosmetic chemist, and I don't know if we can say his name, but Ben Fuchs. He says there's three main causes of acne, it's going to be, oil production, and that includes over but also under production.
0:17:08.0 MS: Interesting.
0:17:09.6 EC: It's something we don't talk about enough. Keratinocytes or cell production, and exfoliation or lack of exfoliation, and hormones. And those three are the contributing factors for acne. Because if they're out of balance for any reason, whether it's the Goldilocks too little, too much. And any of that... And any of that triangle of things, then you have an opportunity for dysfunction or misfunction, maybe not disorder. 'Cause disorder, you're right, disorder implies like, "I have something severely wrong with me." But it's a misorganization of cells. And then, what happens is we can put everything back in order, whether it's calming the hormones, whether it's regulating the oil production, or exfoliating and regulating the cell production, which makes sense on a lot of therapies, traditional and then emerging.
0:18:07.4 EC: For a long time though, we just used primarily retinols, benzoyl peroxide, and salicylic acid, because those all addressed... Those addressed two things that would be, cell turnover and oil production, and that's it. But guess what happened? We had inflammation, and not always was it clearing up acne, right? I noticed that with some of my acne clients, is that they're coming to me after having been treated or overtreated, sometimes, they have red skin, it's inflamed and it hasn't gone away; or in the case of someone who has also come to me, after being on Accutane. And Accutane addresses oil production, and their acne got worse. Well, why? Because the root cause wasn't oil.
0:18:55.9 MS: Yeah.
0:18:57.5 EC: The root cause wasn't oil, it was actually their skin was dry, dehydrated. [chuckle] So that dry, dehydrated was causing slower sebum production, it also was causing slower natural exfoliation. So that sebum was plugging and getting stuck. And then, there was an opportunity for inflammation.
0:19:19.4 MS: Yeah, interesting. And bacterial growth, I'm sure. I have seen product lines for instance... And this is in line what you're saying, but I think it also speaks to the consumer's misunderstanding. I've seen product lines that advertise glycolic acid as a solution for acne, and so a consumer looking at the product line and, "Well, salicylic or benzyl peroxide, I'm familiar with, I know those buzzwords," but here's a glycolic presented in front of me and it says it's for acne, depending on if they are acne/oily or acne dry, using a glycolic acid could actually completely inflame that acne, purge it, bring it to the surface, make it worse. So I think it's a lot about educating the consumer, but maybe educating the esthetician too. There may be estheticians out there who are not fully understanding what that ingredient is doing.
0:20:13.3 EC: Yes, very important. But also beyond acids, which I think are important for exfoliation. What about calming ingredients?
0:20:19.8 MS: Yeah.
0:20:22.2 EC: What about restoring minerals like calcium even into the skin or healing... I don't know. Can we say healing? Healing minerals, colloidal silver for example that will work on that inflammation too at the same time. So do you feel like there could be an opportunity for glycolic, if it's in the right formula?
0:20:41.8 MS: Oh yeah, totally.
0:20:42.4 EC: Yeah.
0:20:43.3 MS: Totally I think so. And you're right, putting those calming products on as well to reduce that regime and inflammation, I think too, having the mindset like post-extraction, what are you doing to calm that down, you may have eliminated oil and bacteria from the pore, but now what are you gonna do to bring that bump down, so to speak, and help the skin heal.
0:21:04.7 EC: The inflammation, yeah, not just... Oh, you mean closing the pore.
0:21:10.4 MS: Yeah, closing the pore and after extraction, sometimes you still have that inflammation and of course, the skin always will do its part to heal itself, but providing those calming products and like you were saying, minerals for instance, back to the skin to help alleviate inflammation, even though you maybe have extracted the comedone, you've extracted puss and bacteria and whatever else, now the skin needs something more to help target the inflammation.
0:21:36.3 EC: Yeah, I always laugh to my... As I was saying the idea that pores have muscles, like open and close, gotta open them up and then close them down on... But you're right, like closing... We're calming that inflammation.
0:21:49.5 MS: It brings a lot of things to mind first thinking, How much are the products that we put on topically really making an impact and people are probably freaking out that I just said that. And then two, really acne is more of an internal issue than anything else. If only 9% has to do with what we are applying topically than it is about all the things that we just said before with our oil production, digestion, and I have a story that goes along with that. I'll tell you in a second. And even how much our cells are turning over, that's really probably the root of the problem, would you say?
0:22:32.0 EC: I would say, yeah, I would say... And of course, there's other times that there are ingredients that do rate on the comedogenic scale in single ingredients, but the main thing about that if you're looking at ingredient deck for one single contributing factor is a disservice because that changes that factor, that one ingredient has the potential to change comedogenic potential, when you're in the entire formula plus the comedogenic scale is, please listen to another podcast that we did on that. It's whack, it sucks. It needs an overhaul and update well intended, but not really reliable and yet as in our profession, we talk about it like this amazing thing that now we must check and get the blessing of the comedogenic rating scale before we can move on. So, just my opinion.
0:23:25.6 MS: There's another scale too, and it's not as commonly used, but acnegenic. Have you heard that?
0:23:32.8 EC: No.
0:23:34.1 MS: So comedogenic is, of course, the ability for an ingredient to clog pores, acnegenic is a scale for an ingredient's likelihood to cause acne.
0:23:43.3 EC: Oh, what is it? How does it work? Do you know?
0:23:48.3 MS: I think it more or less mirrors comedogenic scale, and it's basically the same concept, but it's like the irritancy level of an ingredient, and is it going to irritate the skin and then lead to acne if you are "acne prone".
0:24:05.9 EC: We're all acne prone though.
0:24:08.9 MS: Yeah. Yeah, I mean, I guess that kinda goes along with this topic of comedogenic rating. I mean if we're doing nothing but putting comedogenic ingredients on our skin, eventually we'll all have clogged pores. Right?
0:24:25.0 EC: According to them.
0:24:25.1 MS: In theory. Yes.
0:24:26.5 EC: Theoretically absolutely but it is not. I don't know.
0:24:29.1 MS: Yeah, yeah, but I...
0:24:32.4 EC: Unless you are a white rabbit and you're putting it on your ears or on my back, that's...
0:24:36.0 MS: Yeah, I know, those poor little rabbits, but I have to tell you this story. I worked for a doctor for a while, and he had a patient that was seeing him for... At the time, to me, it was unknown reason, but he said, "Listen, she's really struggling with acne, and I think she would benefit from seeing you." And that's all that he said to me, and she came in for her treatment, and she was probably grade three or four acne, and there was not much that I could do for her when it's that inflamed, so we kind of just did a calming facial to reduce some of that inflammation, and after her treatment, I'm in the computer entering in all her information, and I see her chart from the doctor, and it turns out she was coming to see him because she was not having bowel movement. She was going like two weeks at a time without going to the bathroom.
0:25:34.3 EC: Well, there is your sign.
0:25:36.1 MS: Yes, exactly, exactly. And I went to the doctor and I said, "Listen, just FYI, she's having all these breakouts 'cause she's not pooping. I mean it's coming out her face is what's happening."
0:25:46.7 EC: Yeah, this time, and...
0:25:48.7 MS: And she just kind of said, "Thanks for the info." And that was that. But when we're talking about triggers and we're talking about digestion and hormones, when you have toxicity in the body, it's gotta come out some way.
0:26:05.0 EC: Right, yeah, absolutely. But not to discount, there are many internal... I know whenever I eat something that doesn't agree with me, I often get a breakout near my nose, so...
0:26:17.9 MS: Oh, interesting.
0:26:18.6 EC: Yeah. And so we know from other things that we're taught that that could be... I mean, it's crazy, right? 'Cause we look at... I always called it Chinese face mapping but, or regular face mapping. And you taught this in school to aestheticians and there is validity to it. And so when we're looking at... Let's review some of the causes. Forehead, if we're looking at Chinese mapping, we have the forehead was dairy, and I think it was liver and something else. And then the nasolabial fold and chin, hormones. And then that area right around the nose was digestive and cheeks. And then something that I actually noticed in that vein, having that base understanding, that very basic understanding of the... What we call Chinese face mapping, I would notice that clients who had this little tiny breakouts just past their ear, right under their cheekbone usually was happening when they were ovulating. So that wasn't on the face mapping, but that was something I put together because I was getting it too there and then...
0:27:24.2 MS: That's interesting.
0:27:25.3 EC: I was getting it and I was noticing people were getting it. And I'm like, "Where are you at in your cycle?" Bada-bing, wouldn't ya know? Dropping eggs. [chuckle]
0:27:35.0 MS: Yeah, yes, totally. And also, I think there was something about if you are ovulating on one side, you might notice breakout. If you break out on the body, you might notice breakouts are on that side of your back or to that side of your chest, for instance. So there's always a correlation too if it's one ovary versus another.
0:27:54.4 EC: Yeah, that's amazing to me. The body is fascinating. So we know that just by simply classifying skin as acne with oily or acne/oily or acne/oily combination... [chuckle] The industry is really missing a mark on potential relief of symptoms. And so that being said, it is my unpopular opinion that not all acne is an oil problem, and also that the comedogenic scale's wack. Maggie, what's your opinion?
0:28:22.5 MS: I think after this discussion, Ella, I'll have to agree with you that acne is a dry skin problem, it's a hormone problem, it's potentially a digestive problem. Unfortunately, aestheticians are not doctors, they don't diagnose, but I think it's important for them to understand the root cause of the issue.
0:28:41.3 EC: Absolutely. Well said. So what about you listeners, what's your opinion? Based on your experience, how do you feel about the way the industry currently classifies acne and acne/oily? Please let us know your thoughts on Instagram, Facebook, Twitter, or by emailing, getconnected@ascpskincare. On behalf of myself and for Maggie, we wanna thank you for listening and for more information on this episode, or ways to connect with Maggie, myself, or to learn more about ASCP, check out the show notes. And stay tuned for the next episode of ASCP Esty Talk.
0:29:18.3 EC: 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 aestheticians that includes professional liability insurance, education, industry insights, and an opportunity to spotlight your sick skills, join at ascpskincare.com. Only $259 per year for all this goodness. ASCP knows, it's all about you.