What makes a chemical peel “medical”? Is it the results it yields, the depth it penetrates, or extremely effective marketing? “I just want to peel, like a snake, to shed all these wrinkles, age spots, and dull, lackluster skin!” We have all heard this (and maybe we think this) but is it true? Is sheet peeling the only indication of positive changes in the skin? Or is it a sign of too much exfoliation? Join Ella and Maggie as they discuss their (unpopular) opinions on medical peels, managing client expectations, and evaluating when too much is . . . too much!
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 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.
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0:00:00.2 Ella Cressman: Are you an esthetician that has felt unsupported or underrepresented in the industry? Have you felt 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 Multicultural 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 EC: 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. Hello and welcome to ASCP Esty Talk. I'm your host, Ella Cressman, licensed esthetician, certified organic formulator, and owner of the HHP Collective. I'm excited to be joined once again by the amazing Maggie Staszcuk, and we're gonna address an unpopular opinion, medical peels. I know we both have some pretty strong opinions on this subject, and because there are so many layers, pun intended, of peeling, we took to the streets, the virtual streets, and compiled a list of questions that are either commonly asked or commonly misconceived. Hey, Maggie.
0:01:38.7 Maggie Staszcuk: Hi, Ella. How are you doing?
0:01:40.3 EC: I'm good. I'm excited to talk about this subject because I think it's important one. I see all the time... I do a lot of my research on Facebook, [chuckle] I see a lot of times estheticians posting, "I just want a deeper peel, and I want a medical peel. Where can I get one?" Or even some clients, "I want a deep peel. I want a medical peel." What does that mean? Let's talk about what makes a chemical peel medical.
0:02:05.8 MS: Yeah, I think that you ask a really good question. And some of the things that make a peel a peel in general, not even necessarily a medical peel, is what's the percentage, what's the pH, how's that peel being applied to the skin, and I think both consumer as well as esthetician has their own idea of what is a good peel, what's a deep peel. And you brought a percentage in pH, I think that's a big debate in aesthetics, and we can touch on that in a minute. When we're talking about the client or the consumer coming in for a chemical peel, they have their own preconceived ideas and they're wanting multiple layers, they're wanting really high percentages, and sometimes that's even out of scope for the esthetician, unless maybe it is "Medical," and does that mean they're working for a physician, they're doing multiple layers, the client is getting deep, deep peeling or epidermal slides, and so I don't really know that there is a right answer.
0:03:09.6 EC: I think too. I mean, you hit the nail on the head there where you talked about percentage and pHs, and a lot of times, do those be lined out by your licensing board, they will have those guidelines for you and anything within that scope of practice as an esthetician, you can work on, and then anything out of that may be considered medical by a State standard. Something else that we should also talk about is medical peel versus aesthetic peel based on a marketing decision for the companies, the skincare companies, 'cause there are those out there too, I think of one, in particular, that's very well known, has made a decision, even though it's a TCA peel, maybe a certain color, I don't know, blue, [chuckle] that that peel is a certain percentage of TCA by some State standards, would fall under an esthetician's scope of practice, but that company has made the decision to market only to medical professionals, so that's something else to keep in mind too. I guess all of that, and you kinda touched on this too, when we're looking at skin response, what do we want to have happen in the skin, we have to ask what is more important in effective peeling, the percentage of the peel or the pH?
0:04:26.7 MS: Well, we have a couple of things because what is an effective peeling, first of all? 'Cause in my opinion, you could apply a chemical peel or even just like an acid-based toner and still get a positive outcome, which is you're increasing cell turnover, there's maybe a little flushing in the skin, if you're not necessarily peeling, and I think that's still a good exfoliation. You're still creating inflammation in the skin, which is anti-aging, right? We talk about that a lot in esthetics, creating inflammation to anti-age, but as far as pH and percentage, and I think going back and touching on your point, Ella, a lot of it has to do with the manufacturer as well. Some manufacturers are not open about their product and pH versus percentage, and a lot of it's philosophy too.
0:05:17.2 MS: We all know and we learn this in aesthetic school, if you're dropping the pH of the skin low enough, you are creating exfoliation, you're going to slough the skin and that's a positive peel, that's a good peel, and maybe even "Medical peeling," if you're going low enough. I think one of the biggest issues I had with rules and regulations when I was a practicing esthetician, sometimes those rules and regulations don't match, so to say that you can't go below a pH of three and a percentage that's above, say 30%. A lot of those manufacturers aren't meeting those guidelines. And I think also too, you can find almost any chemical peel you want off of Amazon, for instance. So you have people that are going and buying something crazy, like 70% glycolic and people are just applying that to their own skin, the consumer, for instance, and creating a lot of damage, is that medical because it's 70%, maybe it has a high pH and it kind of neutralizes itself, so to speak. You know what I mean? Voids the effectiveness.
0:06:18.8 EC: Oh, when I first got out of school, this is a long time ago, [chuckle] but it was Neiman Marcus or Nordstrom, you'll probably remember, they had a 70% glycolic toner or 70%. They were calling it a peel, an at-home peel, 70% glycolic acid. Which at the time, glycolic acid was a peel, that's what peeled you. And we should say that peeling, it's more initiating of cell turnover. But we refer to it as peeling, because when it started in the 1980s, we would apply a solution, and our skin would slough off in sheets like snake peeling, right? So that's why it's peeling, but as you mentioned, from a toner, you can get that inspiration, that initiation of increasing cell turnover, 'cause that's what we're trying to do. You can get that from many different substances to where you're encouraging youthful function of the skin, which is the goal, right? In the '80s, '90s, early 2000s, we wanted to turn it, we want it to burn it.
0:07:20.9 EC: And what we learned in doing that, that inflammation... It's 'cause it's a controlled wound, the inflammation that we were initiating was... In an attempt to anti-age was actually pro-aging, so there's this delicate balance of just... Goldilocks feature of just enough, just enough initiation without... That's gonna stimulate but not overdo it. So anyways, there was this stuff, Nordstrom, Neiman Marcus, pH 70. And we're in school, so we are some thirsty little students. And so I bought it. And the pH was 5.75 or 6... Something like... It was mid-range, it was basic, it was basic. [chuckle] It was pretty near basic in that it wasn't going to pass to the acid mantle, which we know is 4.5 to 5.5. In order to penetrate the skin, it's... It needs to be below that. So the percentage, out the door, who cares? You have... I think there's a delicate balance of pH and percentage to be able to drop to get to the layer of skin that you need at a certain percentage to provide just enough initiation, whatever that is.
0:08:32.9 EC: And then you also have to consider the acid. Is it alpha-hydroxy, beta-hydroxy, all of which are carboxylic acids, which is a fun, new word, because there's a new carboxylic acid movement out there, or are you doing these other chemical peels like TCA and Jessner's, which are... Or Yessner's as Tom referred to it, which are tried and true? And in that case, how many layers are you doing, what are the layer dependents? Because an institution can do a Jessner's as a medical office can do a Jessner's. But I think that goes into wherever you are, this is kind of a thorn in my side when I hear either practitioners or clients alike saying, "I just wanna peel. I wanna peel real good. I need a medical peel." "Why do you need a medical peel?" "'Cause I wanna sheet-peel, I wanna slough, I wanna snake-peel. I want all these things to happen," but why? When you were a practicing esthetician, what were your thoughts on that Maggie?
0:09:28.1 MS: Yeah, for me, I have always had the opinion that there's too much exfoliation happening in the industry, that less is more. And like I said earlier in the podcast, you can get a little bit of inflammation, achieve anti-aging without having to peel it to the bone and get that peeling like a snake and sheets coming off. And there were those clients that would come in and say, like you're saying, Ella, that they want more layers, it's not burning, it must not be working, no pain, no gain kind of a thing. And I disagreed with it then, I disagree with it now. There's a time and a place for those hardcore chemical peels, but it's not consistently needed every single month to achieve positive results. And I think you were mentioning too that eventually you get to pro-aging as opposed to anti-aging when you have those clients, or estheticians for that matter, that are always abiding by the client, giving them what they want and doing these aggressive treatments rather than allowing the skin to have moisture and nutrients and just be in a state of healing.
0:10:37.8 EC: Say that again!
0:10:40.0 EC: One more time, who's in charge?
0:10:43.7 MS: Be in a state of healing. Yeah, exactly, exactly. The client doesn't always know. Their these days watching TikTok or YouTube or whatever, I don't know. And seeing these outlandish pictures with potentially positive end results that may even be altered, and that's not really what you get when you apply these crazy chemical peels to the skin, that's like a one-and-done. When you're wanting to get rid of terrible pigmentation and really deep wrinkling, but it's not something you come in every single month for.
0:11:17.7 EC: Can I just say, "Yes, because that is so true." And it... You mentioned... I don't have TikTok, but I understand it kind of. And Maggie nailed it, one-and-done, right? So that would be like going to the gym once, and then coming out like, "Yes, I did it. Phew, that was great." That's not what happens. So skin is... You think of the skin as a muscle group or as your body... It's an organ, and you have to work it out, it has to be strong in order to sustain things. So when I see people wanting to rush in to a treatment in any setting, an ideology or subscribing to this ideology that somehow deeper is better, higher percentage is better, more peeling is better, I like to give the analogy of working out. So here we have... Or I guess we could call it a marathon. So when I get those clients, I say, "Would you run the X Marathon tomorrow?"
0:12:21.1 EC: There's a Boulder Boulder race we have here. I say, "Would you run the Bolder Boulder tomorrow?" 'Cause it's an easy point of reference, and they know that there's a lot of terrain changes, they know how long it is, they know it's arduous. And I often get, "No." "Well, why not? "Because I'm not in shape." And I say, "That's exactly why we can't peel you like that today, because your skin is not in shape. It takes time to get it strong and healthy enough to stimulate a cell turnover like that. If not, if you ran the Boulder Boulder tomorrow, if you ran the Boston Marathon or the New York Marathon tomorrow, what would happen?" And they're like, "Well, I'd probably die." "Well, you wouldn't die, but you might be injured, right? That's the same thing that would happen if we did this to your skin today, we could injure you, which is professionally irresponsible of me, so I can't do that. But what we can do is work out a plan to get your skin strong.
0:13:16.4 EC: Hey guys stop. Let's take a quick break.
0:13:20.2 EC: 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 skincare products.
0:14:00.2 EC: Let's get back to the conversation. The other thing that I wanna talk about is, Maggie, do you remember when we were in school, we learned peel series, like a series of peel?
0:14:12.1 MS: Yeah, totally.
0:14:12.6 EC: And when we were learning it was a peel six, a series of six, usually the same acid, so a peel series of six glycolic or a peel series of six salicylic, whatever was appropriate. And we did that at about a two week interval for six weeks. So it's three months. That's not the case anymore, either. Because there is this relationship between at home management in clinic where I see, oh I call it clinic but a studio, whatever you wanna say in office visits where I see, I like to see my clients once a month, for about a year. I don't peel them once a month, but we're doing some kind of a service, whether it's a facial, an enzyme, sometimes micro needling, sometimes dermaplaning, and then we can move into something a little more aggressive when their skin is strong enough. But the reason I do that is because it's also an opportunity to check back with their home care, because here's what's up is I'm seeing them once a month, maybe every six weeks when they get to a point where I don't have to see them as often maybe every eight weeks, but they're seeing their skin once, hopefully twice. But we'll, you know, we'll be good with once a day. [chuckle] And so there's the opportunity to strengthen it's like coming to see a personal trainer, doing a whole gym routine, and then going home and eating right and doing your home exercises. What are your thoughts on that?
0:15:43.8 MS: Yeah, no I totally agree. And I think for those clients that are choosing to do a chemical peel or a series of peels, that home regimen also changes and the care that they have to give for their skin is going to increase. So that client that comes in that says I want this aggressive peel or this aggressive medical peel now to your point, well it's not gonna happen now. Let's talk about what is your new regimen going to be at home to help support and boost the skin and what is it going to be once we get to the point we decide that you're ready for the peel and after to care for your skin now that we have made a change in the skin.
0:16:23.8 EC: And when that trust comes, word of mouth advertising and I gotta tell you that is worth more than any Facebook ad, any direct mailings that you can send out, this word of mouth is so much more powerful than... And I've tried a lot of things as long as I've been in business I've tried a lot of different marketing, I don't even know, avenues I guess you would say but my... I don't anymore. I don't. I don't do it. I don't... When they call about this neighborhood magazine or a Facebook ad or even Groupon. I don't because my marketing comes from my clients. And it's because we've had this time to really get to know each other I take into account their lifestyle. If they're not routine people will they do well with a four step routine or should I try to simplify it into a two stepper? Do they love nine steps? [chuckle] You know, I'll say taking pictures so you can see progress, especially when you're in something as separated as my program and that's because they can't see the results as well. Every day the changes but when they're coming in once a month, and they can see that measurable progress. I had this client this summer, she started with me in late May. And she has come now four times and her skin she walks different, she's so much more confident because she had some really, really problem skin that had cofactors which was acne and pigment.
0:17:52.4 EC: And she's at that age where she's starting to get wrinkles at the same time. So we have this relationship, we have this rapport now where we're joking around 'cause she's also always late [chuckle] so I know that and so I tell... Tease her that I'm gonna tell her appointment's 15 minutes before it really is and we have this rapport where... When she came in last week, she... Her shoulders were further back. She stood taller, she was smiling brighter. She said, "How you doing?' She just feels better. And it's that confidence that other people are noticing. And I got three calls from her last week just telling people about me.
0:18:27.1 MS: It's very gratifying to be able to make that change in people's skin and in their lives for sure.
0:18:31.8 EC: I know, it's... That's why we got in this business.
0:18:34.0 MS: I have a question for you. What about those clients that are not willing to adopt your philosophies and your protocols and that client that comes in and says, "I don't wanna wait and prep the skin and I want this aggressive treatment now." What do you say to them?
0:18:50.5 EC: It was nice to meet you.
0:18:51.8 MS: We're done.
0:18:53.3 EC: I wish you the best that is, you know, if you seek ye shall find. [chuckle] But it's not happening here. Because that... You've got... I have to remember 'cause I've had that pressure before. And I felt that pressure. And I have ignored my intuition. And I instead just went with it. And guess what, that's when oopsies happened. That's when we burn clients. That's when we have to call our insurance providers and let them know that we've got an unhappy client and that word of mouth does not pay the bills. And so I have no problem... And it is still a little awkward, I'm not gonna lie, but I have no problem saying no, that's... I mean, in a very kind way, like, "I don't think I'm the right person for you. I wish you the best and I'm happy to give you... " I'm not even happy to give a referral because I think it's professionally unethical but there's a lot of really great estheticians in the city and I'm sure you'll find one that you you better mesh with.
0:19:49.9 EC: And usually those are the clients that are like, "What do you mean, I can't get in with you?" [chuckle] "What do you mean you won't do it?' I'm like, "I'm not gonna, it's not in your best interest. It's not." And so sometimes, I would say probably about 70% of the time that... I mean, I probably get four of those a year. It's not... It doesn't happen that much. I'm the authority. I went to school. I do continuing education every year to make sure that I'm up on the latest and greatest, and I have these years of anecdotal experience, practical application experience, so I'm the authority in this. They're the authority in their skin, so they have to have the freedom to decide, of course, but I... If I'm not comfortable doing it, I'm not gonna do it. What would you do? I'm sure you had that happen to you.
0:20:37.0 MS: Yeah, and I agree with you, there is a little level of discomfort because sometimes, did you get those clients that are very, very pushy, and I can remember many times people coming in who would want these treatments and they've got a big event that's tomorrow or later that afternoon, and it baffles me that they think now is the best time to come and get this aggressive chemical peel. But I'm the same as you, I have the education, the training, the authority, and I'm sorry, but that treatment is not happening today.
0:21:09.3 EC: I'm sorry, but I'm not sorry. [chuckle]
0:21:11.2 MS: Exactly. [chuckle]
0:21:11.2 EC: It's not happening.
0:21:13.0 MS: Yeah.
0:21:14.4 EC: Thanks. Good day. [laughter]
0:21:16.7 MS: Yeah.
0:21:17.4 EC: And it's... Remember that episode of Sex and the City when Samantha went to Carrie's book signing party and she got a chemical peel that day.
0:21:23.3 MS: Yeah, yeah.
0:21:23.4 EC: That's what I think of. And I'll reference back to that too, show them pictures of the... Sometimes they're young. They don't remember that. Like, oh, let me tell you. But, you never know too, sometimes I'd even told a client no, a prospect, no, and they still send me people.
0:21:42.8 MS: Well, they probably respected your decision and your authority to say, I'm not gonna just take your money, and this is what's up, this is why.
0:21:53.1 EC: Yeah, I hope. I mean it doesn't happen all the time, but like I hope that that's the case, that that's... That's where I wanna be in, in that space where you know, right, I let them down gracefully, gracefully enough that they feel so good about it, they don't feel judged that any... You know, that they feel that was the professional decision, but... Now you worked in the medical field and you worked in a laser spa?
0:22:17.8 MS: Yeah, I worked for a doctor and he had lasers but I wouldn't say it was laser spa.
0:22:22.2 EC: Oh, did you use the lasers? Do you feel that peels... What do you feel the relationship between peel versus lasers are? What's your... What's your take on that?
0:22:36.4 MS: There is a place in the industry for both of them. I think that a lot of people are moving away from peels and opting to go right into laser, but I think chemical peels can be used as a great prep for laser treatment. And that's where you're seeing kind of a shift in the medical industry, in my opinion. But to some degree, I think chemical peels in some environments are kind of going away a little bit. People are getting caught up in the technology and they can get greater results with things like laser and other devices, and not have to go through, like we were talking about, series of six, every two weeks, and go through the pain and the sloughing and all that kind of thing, when they can go in for a couple of laser procedures and be done with it.
0:23:28.7 EC: Why do you... Let me... I have two questions for you. Why do you think a client would opt in for laser versus chemical peel, you think it's because of the rapid change?
0:23:38.6 MS: Yeah, I think just immediate gratification, faster results. That would be my decision to do it, but certainly it comes at a cost.
0:23:49.2 EC: That's what I was gonna ask the next question. I have had several clients who had Fraxel laser, CO2 Fraxel, and you can still see the grid lines.
0:24:00.6 MS: Oh!
0:24:01.4 EC: Some of them it's been five years or six years and they're almost like hypo-pigmentation grid lines.
0:24:06.4 MS: Yeah, see it... That's not good. That's, I think, where they moved into the procedure too quick, didn't prepare the skin, didn't exercise, take their skin to the gym and give it all the nutrients and support it needed, [chuckle] before having the procedure.
0:24:20.1 EC: Yeah, they just went straight to the marathon.
0:24:21.4 MS: They went straight to the marathon, yeah. And maybe too it's that it could be many factors, but maybe they didn't use proper after care, sunscreen or maybe it had nothing to do with the client, maybe it was the esthetician and the device was not set at the proper parameters for their Fitzpatrick. Who knows, it could be a lot of things.
0:24:41.7 EC: Well, I think we covered quite a bit of landscape here on medical peels. Now, listeners, we wanna hear from you, what are your thoughts on medical chemical peels? What is your preference? Has your opinion changed over the years? Let us know on social media, Twitter, Instagram, Facebook, or by emailing, email@example.com. We wanna know all the details. In the meantime, on behalf of Maggie and myself, we wanna thank you for listening to ASCP Esty Talk. 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.
0:25:24.4 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 estheticians that includes professional liability insurance, education, industry insights, and an opportunity to spot light your six skills, join @ascpskincare.com. Only 259 per year for all this goodness. ASCP knows, it's all about you.