Ep 220 - Chemical Peels for Ethnic Skin with Pamela Springer

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0:02:03.7 Maggie Staszcuk: Hello and welcome to ASCP's Esty Talk. I'm your host today, Maggie Staszcuk and ASCP's Education Program Manager. I'm very excited to be joined by Pamela Springer. Pamela is considered a subject matter expert in ethnic skin care. She is the author of several books and provides master courses in skin of color for practitioners to develop a more inclusive approach to the treatment needs of different ethnicities. She is also a licensed esthetician, esthetics instructor and founded Global Skin Solutions and the Skin and Makeup Institute of Arizona. I'm so happy to have you on the podcast, Pamela. 

0:02:41.5 Pamela Springer: I am so happy to be here, thank you. 

0:02:45.0 MS: You are so welcome. One of the most misunderstood concepts in esthetics is chemical peeling, regardless of your Fitzpatrick and when it comes to ethnic skin this becomes even more confused, I think. Should you peel, not peel? How do you prep the skin?  

0:03:02.5 PS: Well, it is the... As we know in this industry people like to peel, they just love it. And I really, really wanna stress the importance of peeling and when to peel and what you need to know to use a chemical peel. First of all, most people aren't trained in what a chemical peel is. We know what it does to the skin, but you don't understand the pH and the percentage. And most people think the percentage is the strength, whereas the pH. So let's go to ethnic skin. We know that it can be, and I use the word volatile, and I use that strongly because of the pigment and what happens when something's hot or something goes deep and what is happening is the stimulation of those melanocytes. With that stimulation, it's a pigment that is being brought to the surface of the irritation or the inflammation. With that, a week or two later, we have post-inflammatory hyperpigmentation. 

0:04:10.7 PS: So let's talk about Fitzpatrick 1 and 2, the same thing. You're gonna put on the chemical peel and it's gonna tingle, it might sting, and there's so much redness. That redness is our post-inflammatory hyperpigmentation. You're not gonna see the same thing that you see because the canvas naturally is different. So it's important to understand the pH, which is the strength, and the percentage, which is the actual concentration. So when I say that, if it's a 30% salicylic, that means 30% in that bottle is salicylic and the rest, ethanol. If it's a pH of 1.2, that is so caustic that it is going to travel deep into the dermis and cause probably a second-degree burn on not only skin of color, but also on Caucasian skin. 

0:05:10.8 PS: My favorite pH level for ethnic skin is 2.5 to 3. Remember the pigment is disturbed if you traumatize it, if there's irritation or inflammation. So I'd like to say you have to sneak up on it. So you're gonna use a higher pH that will allow the penetration to be slow and not disturb those melanocytes to produce the pigment. Also, the skin needs to be prepped. You need to actually have the skin prepped. The minimum is two weeks if it's a superficial, I should say a very superficial peel. Now, I even prep Caucasian skin because a lot of people don't know that they're mixed. They're just finding out with Ancestry.com. So they don't know and I wanna be cautious. But also the prepping will allow them with a more even peel. 

0:06:13.6 MS: So let me ask you, let's go back a little bit. How are you selecting the right peeling agent? So you're saying that pH should be within a specific range, but would that be for any peel or are there certain peels you are choosing to eliminate or you have your favorites for ethnic skin types?  

0:06:35.7 PS: Well, again, it's how it's formulated. I like all my peels to be a 2.5 or higher, okay? There's some peels like a TCA that isn't formulated like that. That's why we only use a 10 or 20. I prefer if you're gonna use a TCA on a darker skin, it'll be 10%. And I recommend that you only do one layer, not two or three layers like you can with a Jessner or a modified Jessner. And it also depends on the skin and what you're trying to accomplish. All peels are not alike. All manufacturers actually formulate peels differently. So it's important to understand what you're actually putting on that skin. And prepping helps it because it allows, when it comes to a skin of color, to suppress the action of the melanocyte to produce pigment. And if it's prepped well the tyrosinase and tyrosine that it takes to actually, I can say marry to have the baby melanin or melanosomes doesn't happen. They do not connect. And that's what you want on a pigmented skin. 

0:07:47.9 PS: Now, I really still, like I said, prep the skin on all skins. Because again, today we really don't know for sure our ethnic background, our ancestral makeup and I'd rather be cautious than take a chance. 

0:08:08.5 MS: Hold that thought. We'll be right back. 

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0:10:00.1 MS: Okay, here we go. Let's get back to the podcast. So you have estheticians out there who are peeling any and all skin, whether they're prepping and not prepping. And then I think you also have the camp who is saying three plus or four plus on the Fitzpatrick scale, I'm not going there. What's your feeling about these two groups?  

0:10:19.7 PS: Well, I like they say they're not going there because it tells me they don't know what to do. So it's very important to get the education. It is something, especially on darker skins, is more resistant. So you're gonna have skin conditions that you are not going to be able to use with just enzymes or your retinols or any of the other, like, mandelic, you know, the brightness and all of that. The thing is you just have to learn what peel is best, not only for what skin, but also for what condition. So once you understand that... Plus people don't do the patch tests anymore because even if it's right for that condition and that skin type, they may be on a certain medication they shouldn't have, or you don't know that the doctor has put them on that week on another... You guys, you really have to learn to ask the questions. You really have to do a skin analysis every time that client comes in. You have to say, "Has anything changed since your last appointment?" Because with that, I personally had them sign every time they came in that nothing had changed from the previous service. So you have to watch your back and cover all of the bases. And that's why liability insurance is so important to me. And I really, really encourage everyone to make sure that they have it because you can prevent a lot of the things that are happening today if you know what you're doing. 

0:12:01.6 PS: And it's telling me you don't. So chemical peels is a hot commodity right now. And chemical peels you have to understand what peels are best for what skin, what peel is best for what skin condition, and what is the right percentage or pH that that skin can handle. And most of it is superficial peels or even very superficial peels. Everyone wants to get the big guns out and it's not necessary. Plus my belief, I don't peel a skin until I see them maybe the fifth, sixth or seventh time because I know that condition is where it might be a little deeper than whatever I am doing in my pro treatment. And it's being very resistant. So now I go to my toolbox and get the big guns and try to blow it up. 

0:13:00.4 PS: So I've been very successful unless it was really in the dermis. It was deep into the dermis. If it's only in the first layer of the dermis, I can still get results. But again, you guys have to understand that. And most of you don't. You just take that bottle, read the direction and boom. But guess what? At the end it's gonna be bam. 

0:13:21.5 MS: Yeah. What are some of the clinical implications that can happen on the surface of the skin when they're just going straight to the big guns and not prepping or working with their client to reach the point when they're ready for that?  

0:13:37.1 PS: The complications. 

0:13:39.2 MS: Yeah. 

0:13:39.3 PS: Your first degree, second degree, and unfortunately, some have gotten third degree. And on a skin of color, losing your pigment, not being able to gain that pigment back. And I preach all the time. I said, our face is our billboard. And when we walk into a room that's the first thing you notice. And if it's all scarred up from someone who has done a service that's gone wrong, they're not listening to you. You might have so much to say, but they're not. They're trying to figure out what the hell happened to your face. So I don't understand how estheticians will take that chance knowing that they don't know. I asked an esthetician a question, and I asked her, "With the knowledge you have would you go and put your face on someone's facial bed with that same knowledge?" And she thought about it and ended up saying no. 

0:14:38.3 MS: Oh. 

0:14:38.3 PS: So why would you do that to somebody else? I know none of it is intentional, but people today are trying to get to that six-figure thing. It takes time, and guess what gets you there? The knowledge of knowing, giving treatments that people really continue to come back. They don't call and cancel your appointments. They tell their friends about you. They tell the community. Anybody that ask about their skin, they recommend you. That's how you get to the six figures. And in my case, I was able to get to seven. So I know, and it took time to get there. And I think today estheticians are so anxious to make that money, and it blows my mind when I hear what they do for a service. They'll do a dermaplaning, microdermabrasion, all in one service in a non-chemical peel. And I think that... I haven't found the answer to why, but in my head I think they're just adding on services to make more money and not really understanding what the outcome is gonna be, because I'm sure it's not intentional. 

0:15:52.4 MS: That concludes our show for today, and we thank you for listening. For more information on this episode or for ways to connect with Pamela Springer or to learn more about ASCP, check out the show notes.