TIA contains a plethora of information on products you can purchase for home use, and we are constantly seeking out the next best thing available on the market. There is also a bit of information on professional-grade treatments, including microdermabrasion and Pellevé as well as some discussion on advanced treatments. I’d like to provide  further insight into professional-grade treatments, not generally known outside of the esthetics profession. I’ve heard too many horror stories from clients who have suffered under the hands of an inexperienced or untrained esthetician (it’s even happened to me). Knowing what to expect and how a treatment should be performed safely will likely help to avert any skin disasters at the spa.

You might be wondering what the tangible benefits of having professional treatments are - and perhaps thinking that I am writing this only because I’m a licensed esthetician. For those who don’t suffer from severe or chronic (repetitive) skin conditions, home care is fine and I encourage maintaining a home-care regimen even if you go to the spa. There’s no point in paying for professional treatments if you don’t continue to practice good skin care at home in order to prolong the treatment results. However, for those who find they are not seeing the desired results at home, professional treatments can aid in accelerating the process for more rapid results. Generally speaking, estheticians treat the epidermis (outermost layer of skin), while doctors can treat down to the dermis level (skin layer under the epidermis). Thus, a good esthetician will tell you when to seek out a dermatologist for certain skin conditions, such as cystic acne.

An esthetician should always perform a skin analysis, examining your skin under a large magnifying glass (I like to use a Wood’s lamp as well). If you are not asked to fill out what is known as an intake form, walk out. The form is critical to the consultation process, which should be performed for every new client. Estheticians often use medical-grade ingredients and it’s important that they are aware of a client’s medications, allergies, and home care before treatment. These are known as contraindications and are important in determining whether you are a good candidate for a particular treatment. If you are allergic to milk and receive a peel containing even the smallest amount of lactic acid, you may experience severe side effects. Moreover, pregnant women should never have a chemical peel as peels penetrate down to the cellular level. It’s similar to avoiding certain foods during pregnancy. Intake forms vary by spa and cannot cover absolutely everything so I always ask if there's generally anything else that I should know. It's surprising  how often I discover useful information with that general question. I would advise you to offer any relevant information that's not included on the intake form.

Good estheticians will start a file on each client, noting skin type, products used, treatments performed, as well as any particulars noted (e.g. “sensitivity on chin - do not microderm”). If you return to the same spa and another esthetician works on you, she can review your file and know your skin well enough to treat you without asking you to repeat information already given. However, you should be asked if any conditions have changed from your last visit (e.g., you started a new medication). Moreover, just because you are scheduled for a certain treatment doesn’t mean the esthetician should perform it, even if you’ve had the treatment before. Skin conditions change and if skin is not in ideal shape for a particular treatment, the esthetician should offer alternative treatments - this does not happen often enough. I recommend going to the spa before hitting the gym or waiting at least a couple of hours after sweating it out at the gym before your spa visit.

Exfoliation is fundamental to healthy skin care and requisite to maintaining a youthful complexion - it is often the focus of spa treatments. There are two types of exfoliation: manual (scrubs/microdermabrasion) and chemical (acids/peels).

Microdermabrasion is a common exfoliating treatment often incorporated into a facial. A machine sprays crystals onto skin or a diamond tip head abrades skin directly, the latter being the more aggressive type of exfoliation. While microdermabrasion is commonly performed, it should not be taken lightly. I have heard horror stories from clients. Skin should be dry and should not be steamed prior to the procedure. Ideally, a toner is used after cleansing because it evaporates quickly and removes any cleanser residue left on skin. The head of the diamond tip or crystal dispenser should glide along the skin and not be pressed into it, which will only lead to red, inflamed skin. Some feel a pinching sensation during microdermabrasion, usually on loose skin. This can be avoided if each area of skin is gently stretched out by hand during the procedure. If you experience anything more than slight discomfort, the strength is too high. Ideally, the esthetician should first test the strength on the back of her gloved hand, and then perform a test stroke on the face to determine level of comfort. Microdermabrasion should be quick and painless and you should walk out with soft, smooth skin.

Chemical exfoliation penetrates deeper into skin and exfoliates via high concentrations of AHA/BHA acids. The acids loosen the bonds between skin cells, allowing them to shed quicker than they normally would. Spas can use concentrations containing anywhere from 10% to 30% (depending on which state you live in). While peels can provide rapid results, it’s very important that the esthetician determine what strength is best to use. While peels do cause a tingling sensation, it should be neutralized before the tingling turns into a burning sensation. Everyone has a different tolerance for peels and that tolerance tends to grow with every use. If you are new to a spa, it’s best to start at a lower concentration, even if you’ve had a professional peel before. It’s unlikely that the spa is using the same type of peel; a 15% peel at one spa can feel like a 30% peel at another spa. This is because the pH varies, causing the acid to penetrate at different levels, even if the concentration is the same. The esthetician should closely monitor the progress of the peel and should not leave the room while acid is on your face (it always amazes me when I hear that). At most, your skin may be red and slightly inflamed after a peel; however, this should subside by the next day. Like microdermabrasion, spa-grade peels should result in little or no downtime if performed correctly.

SPF should always be applied at the end of any facial. This is especially important post-peel as the procedure sensitizes skin to the sun. Remember, peels work at the cellular level and are still working long after you’ve left the spa. Moreover, the esthetician should inform you of what you can and cannot do at home. For example, if you’ve just had a peel, going home and using a cleansing scrub is ill-advised.

Lastly, I have previously stated that many people have a tendency to over-exfoliate, which is detrimental to skin health. Often, clients see impressive results from a peel or microdermabrasion and think that more is better. There have been many times that I’ve kindly discouraged a client who wants microdermabrasion every week! Unfortunately, there are spas that will perform treatments as often as requested. Personally, I’ve had remarkable results with professional-grade treatments, and Marta has monthly treatments. It’s important to find a licensed, skilled professional and to maintain a balance between home care and spa treatments.