When you treat a patient with a chemical peel, and they come back to you and say, “your treatment didn’t work, because I didn’t peel….” how do you explain this? When patients hear the word “peel” they have many different thoughts as to what the actual outcome will be, and it is the clinician’s responsibility to explain treatment outcomes and why they may vary. Patient expectations must be discussed during the initial consultation.
Visible exfoliation does not determine the efficacy of the treatment. For example, if there is a lot of visible exfoliation after the first treatment, and less for the second, this does not mean the first treatment worked better than the second. The function of the ingredients used in the treatments is the same from treatment to treatment – kojic acid will suppress hyperpigmentation; vitamin C will function as an antioxidant, suppress hyperpigmentation and increase epidermal thickening – regardless of the amount of visible flaking. There are also other factors involved:
1. Many times the same patient won’t have the same experience with each treatment. The amount of visible exfoliation can depend on the current state of the skin combined with atmospheric conditions; for example, humidity may cause flakes to adhere to the skin more so than in dry climates.
2. Someone who has been treated with peels monthly for the past ten years may not have as much visible exfoliation as someone who has never or rarely gets treatments, as these patients will have more build-up.
3. Some patients are so impacted that it can take two or three peels to really loosen those cells and allow them to shed. Typically, these patients will see little or no peeling initially, and then get a very good sloughing after several treatments.
4. We shed microscopically, continuously, throughout the month, rather than in one big slough every 28 days. The accurate way of explaining this would be that in some circumstances our natural desquamation process is interrupted because of an impaired barrier function and our stratum corneum does not shed off appropriately, even though our cells are turning over beneath the surface. In this circumstance, using one of our peels may induce more flaking than if we were desquamating correctly.
5. Healthy skin has less visible exfoliation.
PCA SKIN® peels deliver excellent, visible results whether or not actual visible peeling occurs. Frequently, exfoliation is at a cellular level and not apparent to the naked eye; however, our peels will create a tighter and firmer complexion and appearance. PCA SKIN professional treatments are formulated to preserve, promote and protect healthy skin, regardless of whether the patient sees visible exfoliation following treatment. In today’s busy society this progressive, rather than aggressive, approach is advantageous, as patients will experience minimal downtime yet still have outstanding results.