Introduction
Advances in cosmetology have led to the development of novel ways of dealing with skin issues such as acne, scarring, solar lentigines and wrinkling. Chemoexfoliation (chemical peeling) is the directed cutaneous ablation produced by precise caustic agents (Soleymani, Lanoue and Rahman, 2018). Conversely, microneedling is a dermaroller procedure that alleviates skin problems through the stimulation of collagen production (Singh and Yadav, 2016). This paper reports of the correct protocols for the application of superficial chemical peels for the face (client A) and body microneedling (client D).
Appropriate Peel and Needling Protocols
Client A
The chosen protocol is an initial two sessions of highly superficial peeling with 30% mandelic acid to prep the skin, 3 phases of superficial peels with 20% salicylic acid (SA) to visualise the results and final maintenance treatment with 40% mandelic acid. SA is preferred in chemical peels for active acne because it exhibits strong comedolytic and sebostatic upshots (Araviiskaia and Dréno, 2016). Additionally, SA can dissipate intercellular bonds, thus decreasing corneocyte connection.
Justification
A superficial chemical peel is preferable because the patient’s indicators, for example, acne vulgaris, scarring and papules, as well as aesthetic needs, are relevant to this technique. The patient’s skin matches point two on the Fitzpatrick scale, which makes her an ideal candidate for a superficial chemical peel. Furthermore, studies show that superficial peels are appropriate in comedonal and papulopustular acne (Kontochristopoulos and Platsidaki, 2017). The integrity of her skin is good because there is no evidence of inflammatory pustules.
Client D
The appropriate needling protocol for client D is microneedling with M.Pen, 0.75 needle depth and two ampules of Mesoestetic c.prof 223 Skinmark Solution for the first two sessions. The subsequent two treatments should each use two ampules of c.prof 223 Skinmark Solution with M.Pen, 1.0 needle depth, whereas the last two treatments need to use two ampules of Mesoestetic c.prof 222 Body Firming Solution with M.Pen, 1.0 needle depth (Keys to the microneedling technique, 2017).
Justification
Client D has striae on her thighs and has a history of substantial weight gain, which is associated with the condition. Her previous reaction to vitamin E and peptides indicates that products containing these active ingredients should not be attempted. Mesoestetic c.prof 223 Skinmark Solution ampules were selected because they contain X-DNA, organic silicon, Chlorella Vulgaris extract and Darutoside for the reactivation of cell repair and renewal, restructuring, enhanced collagen synthesis and regular tissue regeneration, respectively. Conversely, c.prof 222 Body Firming Solution ampules were chosen because of the active ingredients sodium pyruvate, organic silicon, hydroxyproline and DMAE, whose functions promote the synthesis of amino acids, fibroblast proliferation and firming up the skin to minimise the appearance of stretch marks.
Benefits
Client A will benefit from the peel protocol through the resolution of acne and reduction of scarring. SA and mandelic acid reduce the secretion of sebum, thereby putting forth comedolytic effects (Jecan et al., 2017). They also cause keratolysis and prevent the formation of acne because of their anti-inflammatory and antibacterial properties. Multiple sessions of SA peels reduce inflammatory and noninflammatory acne lacerations. Studies show that combined chemical peels yield better outcomes in the treatment of acne vulgaris compared to single peels (Nofal et al., 2018; Abdel Hay et al., 2019). Additional benefits include an enhanced look and feel of the skin. Using SA in superficial chemical peels also minimises the probability of hyper or hypopigmentation post-treatment. The benefits of microneedling with the c.prof 223 Skinmark Solution to client D include enhanced hydration, elasticity and skin firmness, which will diminish the appearance of stretch marks on her thighs. The solution will also trigger cell repair within the dermis. The benefits of c.prof 222 Body Firming Solution encompass the stimulation of collagen synthesis and firming up of the rejuvenated skin.
Application
The application of a chemical peel entails prepping the skin by massaging with a purifying mousse, removing oils with a cleanser and protecting the eyes, nostrils and lips. A cotton ball is then used to apply the SA or mandelic acid solution for a maximum of 5 minutes, followed by neutralisation of the peel. The skin is soothed and hydrated with a mask followed by rebalancing with a gel pore sealing cream. The process is concluded by applying sun protection SPF50+.
The application of the microneedling treatment involves skin preparation for 5 minutes by cleansing with Hydramilk or Hydratonic. The next step is the application of the meso.prof solution alongside cold treatment to minimise discomfort without anaesthesia. The dermaroller should then be rolled over the affected area while applying the meso.prof solution over the treated area (Mesoprof procedure, 2020). The area is massaged, followed by the application of protective sunscreen.
Effects
The side effects associated with SA and mandelic peels include dryness, erythema and a burning feeling (Lee, Daniels and Roth, 2016). Certain skin types, such as dark ones, are prone to the development of fleeting or lasting colour alterations after chemical peels. The likelihood of skin colour changes is increased in females on birth control pills and people with a family history of brownish tinting on the face. However, such scarring can be treated effectively. Individuals with a history of herpes flares often run the risk of re-triggering cold sores. The effects of photoaging treatment include slight erythema, skin tautness and oedema.
Clinical Endpoints
When performing a chemical peel with the selected solutions, the clinical endpoint is erythema for mandelic acid (Lee et al., 2019) and a pseudofrost for SA (Haney, 2020). In the treatment of active acne, the clinical goal is to reduce inflammation, decrease the area with obvious lesions and enhance the overall texture of the skin. Conversely, the clinical endpoint in microneedling is uniform pinpoint bleeding (Alster and Graham, 2018). This sign indicates that the process should stop.
Client Tolerance Levels Expected
The discomfort associated with superficial chemical peels is usually tolerated well by most patients. The reaction experienced is usually similar to that observed when sunburn occurs. The skin reddens after the procedure, followed by scaling that subsides in 3 to 7 days post-treatment. For skin needling, most clients tolerate penetration levels between 0.25 and 0.5 mm with optimal outcomes (Cook et al., 2020). However, numbing through cold treatment enables deeper penetrations to be tolerated.
Treatment Protocol Frequency
The most effective treatment for acne and its scars entails six sessions. The first two sessions are prep peels, whereas the subsequent three peels enable the visualisation of outcomes. The final peel is a maintenance treatment. A duration of two weeks is allowed between each session to ensure that the skin is completely healed. Similarly, for body microneedling, a total of 6 sessions every fortnight is sufficient to observe the maximum effect of the serum (Ramaut et al., 2018). Nonetheless, visible improvements can be seen from the initial treatment.
Pre and Post Home Care Recommendations
Pre-home care recommendations for client A include stopping the usage of over-the-counter preparations, which could be medications such as glycolic acid, Retin-A or Retinova for at least six months before the procedure (Kontochristopoulos and Platsidaki, 2017). Post-home care suggestions include cleansing the skin with a purifying mousse and applying treatments such as Acne One, Imperfection Control and Pure Renewing Masks. SPF50+ should be used throughout the treatment. Pre-home care endorsements for client D entail avoiding Retin-A products, auto-immune drugs and protracted sun exposure 24 hours before the procedure. Post-home care recommendations for microneedling is the use of body lotion with SPF30 thrice a day throughout the treatment duration.
Adaptations Required as the Treatment Course Progresses
The skin may exhibit increased sensitivity to the sun following a chemical peel. Therefore, the patient is advised to put on sunscreen every day for protection against harmful ultraviolet rays. A broad-spectrum sunscreen of more than SPF50 (Mesoestetic Antiageing Veil SPF50+) is recommended due to its ability to block UVA and UVB rays. The client needs to minimise their time in the sun, particularly when the sun is very hot from 10 am to 2 pm. A wide-brimmed hat can be worn in the sun to reduce exposure.
After the microneedling process, patient D should avoid taking inflammatory medications for at least two weeks. Furthermore, the patient should protect against UV rays by using Mesoestetic sun protective lotion (SPF30) thrice a day and decrease her exposure to the sun (Iosifidis and Goutos, 2019). Intense exercise, swimming and active skincare ingredients such as alpha and beta-hydroxy acids and vitamins A and C should be avoided during the recovery period. She should also massage her skin gently with Mesoestetic Collagen 360 essence.
Conclusion
The success of chemical peels and microneedling treatments depends on their suitability for different skin types and the selection of products according to clients’ aesthetic requirements. The most appropriate treatment for client A was a superficial peel with mandelic acid and SA, whereas client D required microneedling with c.prof 223 Skinmark Solution and c.prof 222 Body Firming Solution. Following proper pre-care and aftercare procedures based on scientific evidence and product manufacturers’ recommendations is necessary to facilitate timely healing, avoid complications and obtain optimal outcomes.
Reference List
Abdel Hay, R. et al. (2019) ‘Clinical and dermoscopic evaluation of combined (salicylic acid 20% and azelaic acid 20%) versus trichloroacetic acid 25% chemical peel in acne: an RCT’, Journal of Dermatological Treatment, 30(6), pp. 572-577.
Alster, T.S. and Graham, P.M. (2018) ‘Microneedling: a review and practical guide’, Dermatologic Surgery, 44(3), pp. 397-404.
Araviiskaia, E. and Dréno, B. (2016) ‘The role of topical dermocosmetics in acne vulgaris’, Journal of the European Academy of Dermatology and Venereology, 30(6), pp. 926-935.
Cook, J. et al. (2020) ‘Fractional radiofrequency microneedling for skin rejuvenation’, Dermatological Reviews, 1(1), pp. 16-19.
Haney, B. (2020) ‘Superficial chemical peels’, in Da Costa, A. (ed.) Aesthetic procedures: nurse practitioner’s guide to cosmetic dermatology. New York: Springer, pp. 67-72.
Iosifidis, C. and Goutos, I. (2019) ‘Percutaneous collagen induction (microneedling) for the management of non-atrophic scars: literature review’, Scars, Burns & Healing, 5, pp. 1-11.
Jecan, R.C. et al. (2017) ‘Use of trichloroacetic acid in treating facial hyperpigmentation’, Materiale Plastice, 54(1), pp. 88-90.
Keys to the microneedling technique (2017).
Kontochristopoulos, G. and Platsidaki, E. (2017) ‘Chemical peels in active acne and acne scars’, Clinics in Dermatology, 35(2), pp. 179-182.
Lee, J.C., Daniels, M.A. and Roth, M.Z. (2016) ‘Mesotherapy, microneedling, and chemical peels’, Clinics in Plastic Surgery, 43(3), pp. 583-595.
Lee, K.C. et al. (2019) ‘Basic chemical peeling: superficial and medium-depth peels’, Journal of the American Academy of Dermatology, 81(2), pp. 313-324.
Mesoprof procedure (2020).
Nofal, E. et al. (2018) ‘Combination chemical peels are more effective than single chemical peel in treatment of mild‐to‐moderate acne vulgaris: a split face comparative clinical trial’, Journal of Cosmetic Dermatology, 17(5), pp. 802-810.
Ramaut, L. et al. (2018) ‘Microneedling: where do we stand now? A systematic review of the literature’, Journal of Plastic, Reconstructive & Aesthetic Surgery, 71(1), pp. 1-14.
Singh, A. and Yadav, S. (2016) ‘Microneedling: advances and widening horizons’, Indian Dermatology Online Journal, 7(4), pp. 244-254.
Soleymani, T., Lanoue, J. and Rahman, Z. (2018) ‘A practical approach to chemical peels: a review of fundamentals and step-by-step algorithmic protocol for treatment’, Journal of Clinical and Aesthetic Dermatology, 11(8), pp. 21–28.
Appendices
- Contraindications
- Client A
- None for superficial chemical peel
- Client D
- None for microneedling
- Contra-actions
- Client A
- None for chemical peel
- Client D
- None for microneedling
- Mesoestetic Homecare Advice
- Client A
- Cleansing with a purifying mousse
- Applying treatments such as:
- Acne One
- Imperfection Control
- Pure Renewing Masks
- Use SPF50+ all through.
- Client D
- Body lotion with SPF30 thrice a day throughout the treatment duration.
- Regular massage with Mesoestetic Collagen 360 essence
Log Sheet