Replies to This Discussion

Permalink Reply by Lisa VanBockern on March 26, 2013 at 11:06am

Hi Lisa:  Honestly, I feel you should start from the beginning of the protocol, work through it, and use the associated homecare products.  I have had people jump to week 4 and they don't see the results that we might see when you start from beginning to end.  Also, if you have been doing peels in the past, but aren't seeing the results, maybe there are other reasons why.  E.g., the client who has tried Obaji but didn't get results, or she has done numerous 35% TCA peels, or medical-grade peels and is still looking for more results.  Instead of peeling the skin more and more and more, consider the root cause such as hormonal issues, sun exposure, shortened dendrites, before considering more peels.  My thought is if the skin hasn't responded in the past to peels, a different hammer (peel) may not be the best answer.  If you'd like to talk further on the phone about the history of your client please call me at 480-543-1121.  Thanks!

Permalink Reply by Brigitte McDonald on March 26, 2013 at 12:07pm

Hi Lisa:

I have been using your TCA protocol on a client who has a lot of melasma around her eyes and cheeks.  Has had it for years, but very regularly uses sunscreen.  We have started the protocol from the beginning using the homecare and have done the glycolic peels.  Everything seems to be going fine until recently after the lactic.  She started to peel around her cheeks and under her eyes (I did not put the peel under her eyes for obvious reasons and I had warned her she might flake).  Her skin was extremely dry in that area when she returned and she complained she would rather have the spots than "look older"...lol  I opted to do a hydrating treatment on her that week instead of the TCA and sent her home with some samples for help.  Her skin looked good when she left, however now the timing is off a bit for the TCA peel.  I felt like her skin needed to balance before we did the TCA.  Is this typical of the series?  Did I offer the right "fix" or do you have any other advice?  Also, her melasma is just slightly starting to lift, though she is not noticing it, what should I expect?  Does this sound like a correct result at this stage in the game? 

Permalink Reply by Lisa VanBockern on March 26, 2013 at 12:48pm

Hi Brigitte:

Everyone responds differently to peels and that's why we take this protocol one week at a time.  When someone has a reaction to something (excess peeling), you want to let the skin rest (as you mentioned above), make a note of the sensitive area and treat that area gentle on future peels. Yes, she would look older (kind of like a football) as the skin has dried, and will now begin the shedding process (we are doing peels here).  I agree with you above to put an extra week in before the TCA.  When you apply Week 4, I suggest only 1 layer of TCA and a very light layer towards the cheek that was sensitive to the lactic.  It sounds like you are seeing good results that the melasma is starting to lift at this point.  Ensure she is using the glycolic/retinol pads twice a day (or as often as can be tolerated) on the pigment.  Proceed with the series after the skin has healed from the lactic.  Proceed with 1 layer of TCA for Tx4.  See how she does with that 1 layer and make your decision on the final TCA peel of how to proceed (based on her 1 layer of TCA).

It's difficult to sit in an office and write protocols as I know very well that each client responds differently; it's up to you, the aesthetician, to adjust the protocol timing to accommodate for sensitivies, peeling, yet yielding the results you are looking for.  Keep going!

Permalink Reply by Lisa Fulton on March 26, 2013 at 8:28pm

Hi Lisa. Thank you for your reply.  Client has melasma all over her face and had it for many many years and she even tried laser in the past (it came back).  I have been treating her with glycolic peels, herbal peels with light therapy in the past and shown improvement but I would like to do more for her.  I hear some good things about SS products so I ordered SS line hoping I can offer better result to my clients.  Melasma is much lighter than when she first started treatment with me and her face looks much brighter.  She is asian in late 40s and she hopes in the future she does not have to wear thick make up to cover her face up.  She uses vitamin C serum, thyrosinase reduction serum, nourishing cream during the day, night cream which contains glycolic and hyaluronic acid, spf30 primer, sunforgettable loose powder at the moment.  I know it's hard but I really want to help her get rid of her melasma. 

Permalink Reply by Lisa VanBockern on March 26, 2013 at 9:24pm

Hi Lisa:  It sounds like a tough case.  I believe laser can remove melasma, but it comes back in full force because we have inflammed the melanocyte (this is my personal opinion as I have melasma myself and I treated me and all my clients in the med spa the same way).  I also tried the medical-grade chemical peels, also with great results, on me and my clients, but it still comes back in full force.  My thoughts turn to mild peels to exfoliate and suppress the melanocyte and keep the melasma at bay until we can find the culprit and remove it .  For me, it was birth control.  Once I went off BCP, it took approximately 2 years for the melasma to wear off.  If it doesn't wear off after removing the offending factor (BCP, HRT or pregnancy), then I think we need to consider other things such as a shortened dentrite, or a misplaced melanocyte.

I have had cases where I cannot find the offending factor that is stimulating the tyrosinase enzyme.  It could be a hormonal imbalance. 

Once we have tried everything, my thoughts turn to treating the skin gently with lemon enzymes and lactic peels (and some natural lighteners for homecare).  Find a nice mineral makeup that you can cameflauge the pigment and create an even skin tone.  I use Youngblood mineral makeup with a small eyeshadow brush to cameflauge the pigment, then dusted the rest of the face with a big brush of minerals to create flawless complexion.

I realize this may not be the answer you are looking for to create that flawless complexion without makeup, but I also realize there are sometimes that we cannot find the hidden clue that is creating that melasma.  I talk to my clients realistically about options with dermatologists (normally they have already been through that route), and then talk about good makeup without comegenic issues that can cover pigment to create a flawless complexion.

Permalink Reply by Lisa Fulton on March 27, 2013 at 12:23am

Thank you so much for your reply. Much appreciated!

Permalink Reply by Cindy Greenwood on March 27, 2013 at 10:04am

People tend to forget that HEAT, not just UV rays, can also trigger the melanocyte to spit out more melanin. I had one client a few years ago(massage client not a skincare client - so I was not treating her) who attended her kids outside sporting events all the time, she also did pretty heavy duty workouts...so she was hot and sweaty all the time!  She was being treated with Hydroquinone from her derm.

Good point about the hormonal component.

In my limited experience, the clients that received laser to treat their melasma also all had it return. The woman above was one.

So - why not take a more gentle approach?  Agressive, heavy-duty treatments are not always called for - especially when dealing with inflammation.

Permalink Reply by Lisa Fulton on March 27, 2013 at 11:02am

Lisa, why do you do glycolic peel the second week of TCA 8week peel protocol?  Can you do lactic peel instead?