Text copyright by The International Dermal Institute. No part of this text may be reproduced in any way without written permission from The

Transcription

1 Text copyright by The International Dermal Institute. No part of this text may be reproduced in any way without written permission from The International Dermal Institute

2 1. Consultation (15 minutes) 2. Cleanse eyes and lips (2 minutes) 3. Cleanse 2x (8 minutes) 4. Skin analysis (5 minutes) 5. Exfoliation (5-10 minutes) 6. Extractions (5-10 minutes) 7. Massage (15-20 minutes) 8. Complex (1 minute) 9. Masque (10-40 minutes) 10. Tone (1 minute) 11. Moisturize (1 minute) 12. Sunscreen (1 minute) 13. Homecare (10-15 minutes) 2

3 For Skin Therapists, the skin is the most important organ in the body. The study of the skin is essential in making a correct diagnosis, thus enabling the appropriate treatment to be given. Next to the brain, the skin is the most complex organ of the body. The skin has 6 functions in the body: 1. Sensation Because the skin contains so many tactile nerve endings, the brain can be made aware of the stimuli of pain, heat, and cold in any part of the body. 2. Heat Regulation Controls our body temperature so that it maintains our internal heat regardless of environmental climate. It does this through the excretion of sweat from the sudoriferous glands, and the dilation of the blood vessels in the dermis. 3. Absorption The skin is able to absorb some oil or fat-based substances on a topical level, but deeper penetration is confined to either medication or application of a water-based substance by means of galvanic current. Penetration of cosmetic preparations is restricted to the epidermal layers only. 4. Protection Through the fat cells in the subcutaneous tissue the skin protects the body against blows and falls. The Stratum Corneum acts as a barrier against bacterial invasion. The Stratum Germinativum produces melanin pigment as a natural protection from ultraviolet light. 5. Excretion The eccrine and apocrine glands excrete perspiration and sweat for temperature regulation. 6. Secretion Sebum is secreted by the sebaceous glands, and is a complex mixture of lipids and fatty acids. Adult sebum is fungicidal and germicidal and inhibits the growth of skin surface bacteria. Sebum plays an important part in maintaining the surface of the skin intact. 3

4 Notes: (1) The Epidermis consists of keratinized surface layers. (2) The Dermis is made up primarily of collagen (80%) & elastin (3%) (connective tissue) with sebaceous glands, apocrine glands, eccrine glands and hair follicles; ground substance, nerves, blood supply - living layer because anything that penetrates the dermis is absorbed into the blood and lymph supply. (3) The Hypodermis or Subcutaneous Tissue is made up of loose connective tissue mostly adipose (fat) & blood vessels. 4

5 Produces keratinocyte and melanocyte cells. Keratinocytes transport cholesterol to the stratum corneum to form a part of the Natural Moisturizing Factor. 1 in 10 cells is a melanocyte. Skin renews at the rate of 1 million cells per minute in youth. This is the layer involved in basal cell carcinoma. These are cells with 'tonofibrils' extending from the membrane, hence the layer is referred to as the 'filamentosum. This is the first epidermal layer involved in allergic response, blistering and squamous cell carcinoma. Cells contain granules of 'keratohyalin, which hardens to form keratin protein. Nuclei is broken down by lamellar bodies within the cell, which then breaks down to form lipids. Lipids pass through the membrane along with the lamellar bodies, to form the Natural Moisturizing Factor. Translucent and flat cells which are present only in the palms and soles. Cells are filled with densely packed filaments called 'eleidin' (the horny pads). Cells are almost devoid of water (6%-9%). Made up of hard 'corneocytes. Lamellar bodies' function to regulate the Natural Moisturizing Factor and cell thickness, thus regulating absorption in the epidermis. The outer few 'shell' layers of dead epidermal cells. This is the layer we exfoliate. The journey from the Stratum Germinativum to the Stratum Corneum during puberty takes between days, mid-life days, and up to 90 days at maturity. The ph of the environment is controlled in part by the acid mantle which is now referred to as the hydrolipid film. The hydrolipid film has a ph of 4-6 (in healthy people) and supports the formation and maturation of epidermal lipids; it is often said that it helps maintain the barrier function of the skin. It also provides indirect protection against invasion by microorganisms and provides direct protection against alkaline substances with its alkali neutralizing capacity. If the hydrolipid film becomes disrupted, damaged, or loses its acidity, the skin is more prone to damage and infection. In essence, the ph gradient in the SC has a multitude of benefits that help maintain the epidermis in optimal condition. 5

6 1. Corneocyte Bricks Surface Deep 4. Cell Envelope 3. NMF 2. Lipid Mortar Our objective as Skin Therapists is to focus on optimum health of the skin; this involves a deeper understanding of the skin and we can improve on certain imbalances. One of the most common skin conditions is dehydration. There are many factors involved in this imbalance one of those being connected with the corneocyte cells and the mortar that supports them. The above diagram shows how the Stratum corneum is organized: the corneocytes or bricks (1) are embedded in a lipid matrix (2) also known as the mortar. NMF (3) or natural moisturizing factor - There are many proteins involved in developing the skin into an organized, layered structure. These degrade into amino acids and other end products. These breakdown products are what results in the NMF, or natural moisturizing factor. Contrary to what past text books may have said, we now know that the NMF resides within the cell and does not leave the cell and move into the intercellular space. The NMF combined with the intercellular lipids in the intercellular space to help the skin retain its water content and barrier function. The cell envelope (4) also helps the cells retain their moisture. Therefore we have three structures responsible for helping to maintain water content and barrier function of the Stratum Corneum. (1) the cell envelope (2) the intercellular lipids that make up the barrier layer; and (3)the NMF within the cells. 6

7 Natural Moisturizing Factors: Lipids: 7

8 The dermal layer of the skin has been called the "action" layer and is regarded as the "true" skin. The Dermis is made up of connective tissue proteins namely collagen and elastin, which lend support to the epidermis and give the skin both its moisture retaining properties and its elastic quality. It is in this layer that the skins major aging processes take place. Being a condensed connective tissue, the dermis is unstable and undergoes changes, breakdown and renewal. The Dermis also contains blood vessels, lymphatics, nerves, tactile corpuscles, sebaceous glands, sudoriferous glands, and hair follicles. The Dermis has a superficial papillary layer, and a deep reticular layer. For growth the skin requires amino acids, vitamins, trace elements, and essential fatty acids. Mitosis (cell renewal) in the Stratum Germinativum gets the necessary energy from the nutrition supplied by the blood supply in the Dermis. Action in the Dermis will ultimately affect the appearance of the epidermis either obviously, as in a blush due to capillary dilation, or progressively, such as over or under activity of the primary glands. The sudoriferous or sweat glands, secrete a weak salt solution that varies in amount according to our activity and body temperature. They consist of a coiled base and a tube- like duct which opens on the surface of the skin, forming a pore. There are two types of sudoriferous glands; apocrine glands, connected with hair follicles and stimulated by emotions, and eccrine glands, situated all over the body and stimulated by heat. The sebaceous glands are sac-like glands attached to hair follicles. These glands are 2-3 times more numerous around vellus hairs (facial area, upper chest and back). The sebaceous glands manufacture sebum and it travels upward through the hair follicles to the surface of the skin opening in an ostea (not a pore). Sebum, which is a complex secretion with a high percentage of fatty acids and lipids, then mixes with the perspiration from the eccrine glands and forms the skins "acid Mantle. It is this layer of oil and water, together with the N.M.F., that keeps the epidermis smooth and prevents bacterial invasion. The subcutaneous tissue is a deeper layer of connective tissue and separates the dermis from the underlying muscle. An ample supply of blood and lymph vessels, nerve endings, and fat cells are found here. The fat cells act as a storage depot and helps reduce heat loss, and also as a shock absorber to protect the bones and internal organs. The adipose fat cells contain carotene, a yellowish pigment, which lends a "buttery" look to the human fat cell. It is in the adipose fatty tissue of the subcutaneous layer that we also find the toxic stubborn cellulite tissue. 8

9 The choice of treatment and product will be based on a thorough skin analysis and consultation. If only the overall condition is noted, the diagnosis will be incomplete, as this usually relies only on the sebaceous activity. Carefully record all the following observations, which will then show a common denominator and allow the Skin Therapist to make a simple professional plan. 1. Client Perception: Ask the client if they have any particular concerns. Check overall skin condition/appearance. 2. Exfliation History: Look for previous exfoliation procedures or treatments, like chemical peels, microdermabrasion, laserbrasion, when they had the procedure, and the invasive depth (ie did the skin peel? how much redness was experienced? 3. Moisture Hydration: Look for lines, flaking, tautness, and possible causes of dehydration (caffeine, alcohol intake, laxatives and diuretics). 4. Capillary Activity: Observe how red or blotchy the skin is likely to become. Look for dilated capillaries or couperose. Feel the warmth of the skin. 5. Oil Secretion: Evaluate how quickly the skin is producing oil and check for oily shine. Assess the size of the follicles, feel for congestion and look for comedones, papules and pustules. 6. Nerve Activity: Check how sensitive the client is to pressure, heat, cold and pain. Ask if the client suffers from claustrophobia and discuss history of skin allergies. 7. Female Clients Only Pregnancy will contraindicate detoxifying treatments. 8. Male Clients Only May experience problems with ingrown hairs from back waxing. 9. Questions to discuss every visit Make sure that each time the client comes in for a treatment, the consultation card is checked and signed. 9

10 Due to the advances in the skin care profession, it is essential that a detailed skin analysis be conducted for every client. First time client analysis should take 15 minutes, and a follow-up consultation should be given every time she/he returns. This is important if we are to prescribe treatments for her/him that will give positive results, not merely superficial cosmetic application. Apart from the obvious areas that we cover with our clients, there are more specific questions that we should be aware of before any treatment commences. Also, modern analysis techniques may be employed, such as Woods Lamp analysis and ph testing, if an even greater depth of knowledge is to be obtained. The Skin Treatment begins with an in-depth consultation that will not only reveal any contraindications to your planned course of treatment, but will also give you a glimpse into the client s current regimen and expectations of your services. Keeping your consultation cards up-to-date will therefore, not only allow you to chart your clients progress, but will also be a vital legal record of whether or not each client has accurately disclosed related medical conditions. The consultation card is divided into the following key sections: Your Health This portion gives you valuable insight into your client s general health, including any medical issues that might contraindicate a particular service or product, as well as general lifestyle habits that might prove useful in troubleshooting skin problems. The numbers below correspond to the questions on the consultation card. 1. If your client has been under a physician's care in the past year, you should pay particular attention to the following questions #3 through #5. It is important to ascertain whether or not the underlying medical reason will affect your treatment choice. Should the client answer "yes" to being under a Dermatologist's care in the past year, it is advisable to contact the Doctor if you are at all unsure of the suitability of your treatment. 2. Areas of recent surgery should not be massaged for at least three months (facial area) or six months (body), possibly more if very invasive surgery was performed. Gentle lymph drainage can assist in recovery over scarred areas, but only if the site is completely healed. 3. If your client has experienced any of the following health problems in the past or present, your treatment should be modified in the following manner: Cancer - Do not perform lymph drainage. If skin cancer, check with the Doctor prior to treating the affected area. Diabetes - Diabetics have poor healing. Avoid waxing or extractions. Epilepsy - Do not use electrical current, as it may provoke a seizure. Avoid tightly wrapping the client. Heart Problems - Avoid body massage, electrical current, hot or very detoxifying wraps as they can all increase heart rate. Hormonal Imbalance - Can be the cause of acne breakouts, very dry skin, excess hair growth and dramatic weight fluctuations. Spinal Injury - Don't move the neck, and avoid scalp massage. 10

11 Hysterectomy - May experience skin breakouts and/or dryness. Thyroid Condition - An overactive thyroid usually results in oilier skin, and possible breakouts, under-active thyroid in dry skin. Varicose Veins - Do not massage over the area to reduce the risk of dislodging a blood clot. Systemic Disease - May make the client more prone to bruising and increase healing time. You should wear gloves during the treatment, if the disease is communicable. 4. Your client s medications and vitamins can also have a dramatic effect on their skin. Note: For detailed information on skin reactions to medications, refer to Consumers Guide to Prescription and Non-Prescription Drug by H. Winter Griffith M.D., Published by HP Books. 5. Smoking depletes Vitamin C in the body and restricts oxygen to the skin. It impairs healing, and also causes a yellow, sallow look to the skin. May cause comedones and fine wrinkles. 6. Regular exercise usually improves skin condition by assisting in stress reduction, as well as the stimulation of circulation and elimination. Lack of exercise calls for a more detoxifying, stimulation course of treatment. 7. If a client is on a highly-restricted diet or fasting, breakouts can occur as part of the detoxification process. Extremely low-fat diets can result in dry skin. Long-term fasting can stimulate breakout activity and hormonal imbalance. 8. Use extreme caution around the eye area of people wearing contact lenses. Do not apply pressure on or around the eyelid, or ask if they would prefer to remove them prior to the treatment. 9. Metal implants and pacemakers contraindicate the use of electrical current in any form. Use caution when using electrical currents around areas of piercing. 10. Rating stress levels on a scale of 1 to 4 (1= low stress, 4=high stress) gives the Body Therapist an improved understanding of degree of stress impact. 11. Asking whether the client has any special skin problems pertaining to the face or body enables the Skin Therapist to further customize the treatment. 12. Establish what skin products are currently being used on the face or body, as these may be contributing to the problem or not achieving the desired result. 11

12 Exfoliation History A full understanding of the client's exfoliation history is vital to performing a safe and effective treatment. With the number of highly-invasive exfoliation techniques, such as chemical peels and dermabrasion on the market, you must ensure that the client's skin has returned to normal health and thickness before recommending your own exfoliation course. 13. After any of these types of treatments, the skin can be dramatically thinned. Follow the less" rule, avoiding any steps that may over-stimulate the skin. Perform extractions very carefully, avoid all exfoliation, and ensure that client has sun protection on at all times during the healing process. 14. Do not exfoliate or wax the area treated by any prescription, or topical acne treatment product for at least three months after the client has stopped using it. Use of prescription acne medications, including those mentioned previously in the Your Health section, may contraindicate waxing, exfoliation, the use of Benzoyl Peroxide, heat and/or firm massage over the affected areas. 15. One of the most prevalent problems experienced by clients is over-exfoliation, which can result in dry, over-sensitized skin and in premature aging. Carefully check their existing exfoliation regimen, and recommend that they discontinue these products before beginning an exfoliation regimen. Moisture Hydration 16. Drinking two liters of water daily is vital for a healthy body. Many skin conditions can be improved with increased water intake. 17. Consumption of more than eight alcoholic beverages per week can contribute to skin dryness and bodily dehydration. 18. Clients experiencing flakiness, tightness or obvious dryness should increase their water intake, adjust to a richer moisturizer and use a moisturizing masque at least three times a week. 19. All client s should use an SPF15 sunscreen over the face daily to prevent incidental sun damage. A sunblock should be applied to the body if sun exposure is anticipated, and the hands should always be protected by an SPF15 if they are exposed while driving in sunlight. 20. Check whether the client uses sun beds or tans regularly, as this may be the cause of significant sun damage. Capillary Activity Both your client s answers and your own analysis of capillary activity can indicate possible early stages of rosacea, skin sensitivity and/or environmentally sensitized skin. If a client answers "yes" to any of the questions, chances are good that the skin is very easily sensitized, and should be treated with care. 12

13 25. Oily shine may indicate overuse of exfoliants, dehydration and/or overactive sebaceous glands. Focus on home care products that can regulate oil production without stripping the skin's natural moisture barrier. 26. For clients experiencing breakouts, check for comedogenic ingredients in their current skin and hair care regimens, as well as their make-up. The answers from the "Your Health" section will indicate possible causes. Knowing more about your client's nerve activity will help you to ensure that the client has the best possible treatment experience. 27. High levels of caffeine can increase skin sensitivity and blood circulation, reduce skin moisture levels and make the client anxious during prolonged treatments. The client will also have a lower pain threshold. 28. If the client experiences burning or itching on the skin, you should be very concerned about cosmetic allergies. We recommend doing a patch-test on the inside arm with the exfoliating product you were planning to use, and allowing them to try some samples at home, before undergoing a full treatment. 29. The client's pain threshold will determine how firm you can be with massage and extractions, and indicates their response to waxing. 30. Clients who experience claustrophobia should never be wrapped tightly, or have their arms wrapped. Never leave claustrophobic clients unattended during a treatment. 31. Indicates the preferred massage pressure. 32. Allergic reactions to the following may contraindicate treatment and/or specific home care products. If you are in doubt about a client s suitability for treatment, perform a patch test on the inside arm and re-schedule the appointment if no reaction occurs within 24 hours. Cosmetics - Educate the client about comedogenic make-up and products. if the client marked yes to any of the following, it will indicate heightened skin sensitivity: medicine - if topical medication, do not treat affected area pollen food animals Iodine - Avoid full body seaweed wraps containing large amounts of iodine. Hydroxy Acids - Avoid al products containing hydroxy acids. Fragrance - Counsel against products, especially personal fragrances and skin care products containing artificial fragrances. Sunscreens - Recommend the use of physical sunblocks. 13

14 Sometimes a consultation may not be straight forward, there may be instances that alter the direction of your treatment. Diabetes Heart problem Epilepsy Cancer Thyroid Sinus conditions Hormonal imbalance Menstruation/ pregnancy Braces & dental work Laxatives & diuretics Dietary considerations Medications Stress level Products currently used Bruises 1. Less 2. Less 3. Less 4. Less 14

15 There can be many contraindications to a complete or part of a skin treatment. A contraindication means a reason why the treatment cannot take place because it can cause the skin condition to get worse, spread an infection, or be harmful to the client. Recognition of skin disorders is very important, as they may prohibit or limit the treatment planned. Common sense and a sound knowledge of skin diseases, disorders and pigmentation will guide the therapist in their decisions for the client s skin care. If in doubt, always refer to a doctor before proceeding with a treatment. An allergic reaction is seen as an abnormal response to a specific substance, brought about by antibodies in the blood. Dermatitis means sensitization of the skin, often red, itchy or burning, an irritation rather than a disease. Contact or Allergic Dermatitis is the most common form due to an allergic reaction to an ingredient coming into contact with the skin s surface. These include cosmetics, laundry detergents, jewelry, clothing dyes or fabrics, even plants like poison ivy. Avoid treatment until this clears up. It is necessary for the therapist to be cautious in their product applications on an individual who has a history of previous allergies. This is the most serious form of skin cancer. It is a cancerous lesion frequently occurring on sun exposed sites. Classic findings are discolored patches on the skin surface with variations in color, brown, red, tan, irregular border and irregular surface. The Skin Therapist should always refer to a Dermatologist even if the lesion does not manifest all of the above markings. Areas affected by cuts, bruises or open skin should be avoided as it may be uncomfortable and there is a risk of infection. 15

16 There can be many contraindications to a complete or part of a skin treatment. A contraindication means a reason why the treatment cannot take place because it can cause the skin condition to get worse, spread an infection, or be harmful to the client. Recognition of skin disorders is very important, as they may prohibit or limit the treatment planned. Common sense and a sound knowledge of skin diseases, disorders and pigmentation will guide the therapist in their decisions for the client s skin care. If in doubt, always refer to a doctor before proceeding with a treatment. Features are seborrhoea (giving skin an oily appearance), comedones (blackheads), papules, pustules, nodules and cysts. There are different grades of acne (degrees of severity). A mild acne condition with comedones and one or two papules or pustules can be treated in the skin treatment center. However a more severe acne vulgaris or cystic acne with many comedones, papules, pustules, nodules and cysts may need medical treatment prescribed by a doctor or dermatologist. The Skin Therapist can still treat the inflammation and remove comedones and provide homecare advice. Caused by a viral infection, therefore it is highly contagious. It is characterized by erythema, pustules and vesicles (watery blisters) often grouped in a cluster around the mouth (herpes labialis). It is a recurring disease, and the skin treatment should be postponed until the condition recesses and two weeks after the lesions have disappeared. Can be spread to the fingers (herpes whitlow), eyes (corneal herpes) or genitals. This is a spreading staphylococcal or streptococcal infection of the skin presenting a thin blister or oozing erosion which grows over several days into a honey colored crust. It is common in children and often spreads from the nostrils, which form a reservoir of bacteria for infection. Scratching and personal contact can spread the infection, and other members of the family are frequently affected. The condition is common during the summer months. In tropical countries lesions may be widespread and severe epidemics occur. It clears rapidly with antibiotic ointment. 16

17 How to recognize skin types and conditions It is important to understand the difference between a skin condition and a skin type in order to carry out an effective analysis. There are certain things we look for when diagnosing the skin and certain steps must be taken in order for this process to be effective. A common mistake made by both client and therapist is not knowing the difference between skin type and skin condition. These are two different things and must be determined by the professional. A skin type is determined genetically by our parents and can be directly measured by the amount of oil secretion in the skin. Over active sebaceous activity will produce an oily skin, and under-active sebaceous glands will produce a dry skin. Skin Types Skin Conditions Other factors that contribute to a skin condition can be surgery, medication, stress and illness. The Skin Therapist can successfully address different skin conditions that the client may experience. These conditions affect all skin types and will regularly change, possibly from day-to-day. It is important to assess the skin before every professional treatment to find out what conditions the client is experiencing, and to address this in the treatment and product recommendation. Appearance: Cause: Woods Lamp: Soft, moist and plump. Healthy glow and color, fine texture, no open pores, fine lines, little wrinkling Genetic Blue/White 17

18 Any good treatment starts out with a thorough consultation, from the consultation we start to understand more about the client and have an idea about what we will see on the skin. We then cleanse the skin and begin the skin analysis, reiterating the consultation card with the client ensuring them that we see the areas of concern. For many, the Skin Therapist asking questions or speaking to the client during the treatment is quite worrisome. However, during the five minutes of skin analysis, it is recommended that we have a brief conversation with the client again letting them know that we understand their concerns, explain how we will address these within the treatment, and then we gently make an product recommendation for a home care regimen that will help their skin concerns. Once we have a better idea about the skin, we are then able to perform a customized treatment, and finish the treatment by recommending home care. Now once all of these things fall into place, rebooking the client will be easy because they will have their concerns addressed and they will be getting the results they are looking for. In conclusion, a through skin analysis can be the determining factor for a client to return or not! Therefore, it has to be great! Skin analysis is always the key to giving a successful customized treatment and a professional and accurate prescription. Skin analysis is the link between consultation and prescription. If you miss this vital step in your skin treatment, it will be very difficult to retail to your client. There are certain steps to follow and obviously a way in which we pass on this information to our clients. Skin analysis is personal and a client may well have been oblivious to the conditions you are suddenly pointing out. Diplomacy is essential, however you do need to disclose the information to the client in order to enter into a partnership with them and work to achieve optimum skin health. With the correct treatment and the right recommendations, the client will see a dramatic difference in their skin. That client will then not seek another professional. You will be the person they refer to for advice and further product suggestions. 1. Consultation 2. Skin Analysis 5. Re-booking 3. Skin Treatment 4. Prescription Retailing 18

19 One of the many reasons we lose clients is that they do not receive a skin analysis, or thorough explanation of their skin condition. If an analysis is Bypassed, a Skin Therapist cannot devise the correct treatment or give a correct prescription or home care. There are 3 ways to carry out an analysis: Look From the moment the client walks through the door you should be observing their skin and noticing things about them; personality type, general stress levels, color of skin, breakouts, amount of make up, body language etc. This will help with your general impression and then will be backed up when you look through the magnifying lamp and skin scanner. Touch Touch the client as soon as you can. This is the start of your relationship and helps the client to feel comfortable. Touch an arm or shoulder to guide, or shake their hand when saying hello. Touching the skin through analysis is essential, you will feel under the surface congestion, hair growth, excess oiliness, milia, dryness, etc. You will detect excess heat or cold that is sometimes not visible with the naked eye. Listen When we have a new client in for a skin treatment we have to believe they are there for a good reason. Most people are longing for the correct advice on their skins. Recent survey suggests that out of 100 people that went for first time treatment 80% wanted advice on their skin and only a staggering 3% received this. Think of all the potential prescription retailing that could come from that simple art of listening and really finding out what it is that your client wants or needs. Develop your listening skills. Give the client the opportunity to express what it is they would change about their skin, or what it is that is truly a problem to them. Steps to Follow: Tools: 19

20 This is an advanced form of skin analysis accomplished by the "Woods Lamp." This examination instrument is fitted with a magnifying lens and produces long-wave ultra-violet black light. This is in no way harmful to the eyes of either the client or operator. In Dermatology, it is used as a diagnostic instrument, to analyze skin types through their different shades, characteristics and peculiarities. The lamp must be used in a totally dark room, and blemishes that are barely visible to the naked eye can be seen under the rays. The Woods Lamp is very useful in showing areas of sun damage in the skin, not yet visible to the eye. Damaged areas will appear as pigmented patches on the skin. The otherwise flawless skin, will appear patchy and pigmented, thus showing the sun damaged areas, that have not yet become visible, but will in the coming years. It normally takes around 10 years for the damage to show. This is a great incentive for the client to begin using sun protection, and to understand that sun damage can take several years to show. Up to 80% of our sun damage occurs before the age of 18! The benefits of having a Woods Lamp or Skin Scanner are enormous. Instead of just verbalizing information, the client has visual back up. If the client can see the hard evidence they are normally in shock and more inclined to purchase home care that you prescribe. Many Skin Treatment Centers that use Skin Scanners and Woods Lamps on a regular basis notice a huge increase in sales, both in treatments and retail. The Skin Scanner This works on a similar principal to the Woods Lamp. It uses the same Ultra Violet black light but allows the client to see his/her own skin by way of a mirror. The client sits one side with the Skin Therapist on the other. This is a great tool to have in a reception area. Clients that come into the center can be encouraged to have an analysis, followed by a prescription. The skin scanner is very accurate and provides visual proof of current skin condition - this helps in the retail procedure. Make up does not have to be removed, and if the therapist is knowledgeable about reading the different colors the analysis need only take a few minutes. 20

21 Thick stratum corneum Dead skin cells Normal/healthy skin Dehydrated, thin skin Easily stimulated, tender skin Dry skin, lacking oil Hydrated skin Oily areas/comedones Pigmentation 21

22 22

23 Normal Oily Combination Dry/Alipoid Acne Sensitive Dehydrated Sensitized Aging Pigmentation Congestion/ Breakout Other 23

24 When you consider the fact that we produce a great amount of sebum, sweat and around one million cells every 40 minutes, the skin naturally gets dirty! Then add to this our exposure to outdoor pollution, like soot and dust. What we put on our skin like more occlusive types of formulas like waterproof long-lasting make up and sunscreens that are designed to adhere to the skin s surface, the result is going to be a very dirty skin. Also clients under twenty-five years of age tend to over-cleanse and under-moisturize - obviously, this tendency is precipitated by the need to remove excess oil from the skin's surface. As you might expect, individuals over twenty-five tend to under-cleanse and over-moisturize. Therefore we have to be more thorough in our cleansing and we have to teach our clients to double cleanse their skin. The basis of skin perfection is cleansing. With the selection of products and equipment available, it is possible to deep cleanse the skin extremely thoroughly without over stimulation, or disturbing the hydrolipid film. The usual skin care routines used in many skin treatment centers do not attach enough importance to the cleansing of the skin, often encouraging the overuse of nourishing products, rather than the freeing from the surface of adhesions and waste products. Use of the correct movements during the manual cleansing routine adds greatly to the effectiveness of this section of the treatment, and avoids over stimulation of the skin. Electrical methods of skin cleansing are popular, and if well applied, provide a fast, professional method of skin cleansing. They do lack the personal touch of a manual method, but should be considered when an electrically based skin treatment is to be given and designed to accomplish a result, rather than relax the client. 1. Specialty: Pre Cleansing Oil- Exfoliating - 2. Gel based : Foaming Gel - 3. Clay based - Medicated Gel - 4. Milky/creamy based - 5. Gel/cream based - 6. Bars - 24

25 The International Dermal Institute's Method of Work: 1. Prepare client correctly with headband and bonnet, and cleanse the eyes and lips. 2. Apply the cleansing product with flowing, effleurage movements, performed with even pressure, and in a rhythmical fashion. 3. Cleansing product should be applied to all areas of the face, throat and upper chest, in a spreading movement to distribute the product evenly. The pressure should be applied gently with care not to over-stimulate or presensitize the skin. 4. The cleansing routine is continued with careful roll patting strokes, attention being given to thoroughly remove all traces of cosmetics. The center of the forehead, the nose and the chin all require more repetitions of the cleansing strokes, due to frequent blockages that occur in these areas. This is due to the more numerous sebaceous glands being present. 5. A successful cleansing routine must release all preparations from the surface of the skin, remove dead cellular matter, and should gently stimulate the lymph network of the skin, resulting in improved tissue cleansing internally. Eye and Lip Cleanse: Take 3 pieces of cotton, dampen down with water. Apply a pea size amount of a gel based eye makeup remover to one pad and gently transfer to the other 2. Take 2 cotton pads and place them on the eyes. Cleanse the lips by supporting the side with the fingers and wipe across in one direction with the 3 rd pad. Continue the eyes with right hand take cotton pad and wipe out towards temple. Take cotton pad and wipe down over the lashes three times finishing by coming in underneath the lashes towards the nose and wipe out across the lashes ending at the temple. Repeat 3 times. On third time wipe out over the eyebrow. Repeat on left eye. 25

26 (Repeat twice, 4 minutes each) 1. Spreading movement from the chest, below collarbone, up on throat, over chin, scissor mouth, between eyes, circle 1-2-3, temple and back to shoulder. Repeat 3 times. 2. Roll patting across throat. 3 times. 3. Circular pressure across jaw, from one ear across to the other. Trailing hand pressing back to ear. Across 3 times. 4. Chin frictions. Include upper lip. 5. Outside cheek cleansing, chin to temple. 6 times. Repeat other side. 6. Inner cheek cleansing. Both hands circle simultaneously. 6 times. 7. Cross thumbs over nose, lift off fingers. Thumb frictions. 8. Thumb frictions up center nose, between eyes to hairline. 9. Finger frictions over entire forehead to temples. 10. Temple frictions. Pressure and lift off. 11. Sponge off, following cleansing pattern. 12. Repeat total routine. 26

27 An exfoliant is any agent that removes dead skin cells from the surface stratum corneum to reveal the newer, smoother skin underneath. When we exfoliate, we automatically cause skin renewal as the stratum germinativum is stimulated to push new cells upward towards the surface of the skin. Exfoliation has many benefits: it gives a smoother, softer skin texture; it removes dry, flaky patches resulting in a finer more translucent skin; it helps to clear congestion; and it creates a moist healthy glow to the skin. It is a cosmetic process based on abrasive, biological, enzymatic or acidic products which removes dead surface cells. Clients using topical or oral medications that thin the skin such as, Accutane, Adapalene or Retin-A, should not receive exfoliation treatments. Also check to see if recent chemical peeling procedures have been performed. Thickness or turgor of the skin must be assessed. 27

28 This is simply a guideline as to what The International Dermal Institute regards as the most important items necessary to provide skin care services of the highest standard. 1. A comfortable client couch, sheets and towels. 2. A sturdy white metal trolley for supplies and water bowls. 3. A 5-diopter magnifying lamp. 4. An ultraviolet sanitizer, and germicide for wet sterilization of implements, germicidal wipes and an antimicrobial skin wash for hands. A sanitizing gel is also recommended to have on the trolley. 5. Headbands, bonnets, eye pads, tissues, gauze squares, cotton swabs, cotton in 2 squares, water bowls, masque bowls and brushes, spatulas, hook neck bottle, water pitcher, distilled water for steamer. 6. Client gowns, robes and slippers preferably in a locker with client s name. 7. Both latex and vinyl gloves to wear for extractions. 8. A reliable and well-built steamer. Check carefully for easy movement, no spitting and easy filling, with no risk for burns. 9. Pressure spray toning, electric brushes and vacuum are extremely useful if you can budget for them. It may be more economical to purchase a multi-use unit that combines several functions on one piece. 10. High Frequency machine, Galvanic machine, and Dr. Lucas Pulverizer are options that may be considered in the future. 11. A hot towel cabinet. Many of you will be working on your own, or may be sharing space with other Skin Therapists. Either way, it is absolutely vital that you clean up meticulously as you work. Sloppiness or laziness is inexcusable in a professional skin treatment center, so always keep standards high! 1. Remove all used laundry and replace with fresh linens. 2. Sterilize any reusable items that have come into contact with the skin, such as brushes. Wipe off bottles and equipment with sanitizing solution. Replace any empty or low product containers. 3. Refill steamer and Dr. Lucas Pulverizer with distilled water, if necessary. 4. At the end of the day, empty all waste bins, and make sure treatment room cleanliness, and check that all the fresh supplies are ready for the next day.

29 Once you have completed the treatment, you may either take your client back to the changing area or have them change in the room. It is important that you are waiting for the client in the prescription area when they arrive. Have them take a seat and have a beverage waiting for them. It is important to for the client to take a seat before they get to the cash register, as they have a different mindset with the wanting to pay, leave and complete their next errand, etc. Make sure that you have the completed the analysis / prescription sheet that you used during the treatment. Ensure that the display or tester of the products that you are going to recommend are ready. Ask the client how their skin feels and if they enjoyed the treatment. Let them know that you are going to spend a few minutes completing their service with some professional recommendations for their skin. Discuss your findings, mentioning why they came and how their skin looks now, show them in a hand mirror. Advise them on your recommendations starting with their problem and then the solution. Firstly, clarify what the client s concern were and the findings from the consultation card. Discuss the findings during the skin analysis. Offer solutions in the form of products. Go through each product in turn and let them try the product on their hand, encourage them to smell and feel the product on their skin. Let them know why they need to use it and how their skin will look and feel. Refer to your findings on their personalized skin analysis chart. At this stage, it s advisable to talk specific product names. Remember that there has to be a valid reason to purchase. That reason should relate to the concerns raised and seen on the client s skin. Clients will expect great treatments, but what they will remember most is how well they were taken care of; it is this that makes them a loyal client. Greet the client - Ask client to complete consultation card and discuss - Take them to changing room and give clear instructions - Explain what you intend to do and why- Make client comfortable on treatment couch - Customize the entire treatment - Guide through homecare Homestudy: 29

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31 Steaming the skin should be regarded as part of the cleansing process and is a natural way of activating the circulation, thus softening the skin, relaxing and dilating the follicles. It may also induce slight perspiration by stimulating sudoriferous glands, which has a cleansing action on the skin and assists in the elimination of waste. The warmth and moisture facilitates the use of the water- soluble cleansing products and leaves the skin hydrated. - Easily stimulated skin conditions - Rosacea - Sunburn or extreme UV exposure - Skin irritation, abrasions, etc. 1. Check water level. Fill with distilled water. Overfilling will cause spitting. 2. Make sure skin is cleansed or being cleansed. 3. If using alone, ensure eye pads are on and sensitive areas are protected. 4. Make sure steam reaches entire face. Check from below and from the side. 5. Use for 7-10 minutes. Not more than 20 minutes. 6. Distance at 22" from the skin. 31

32 Electrical brush cleansing may be used as an alternative to manual methods for use with a foaming cleanser and/or scrub, or combined with manual methods. A manual initial cleanse may be given, and the second cleanse may be by an electrical method as it will facilitate a deeper cleanse and light exfoliation. 1. A water-based cleanser is applied to the face, throat and upper chest manually, and the selected brush head is moistened with water. 2. A range of brushes can be used, from soft tapered bristles to more abrasive firm bristles, to achieve desired effect. A variable speed motor powers the brushes, which can be set according to the skin condition. 3. The client should be advised to keep her eyes closed during the procedure, in case of any splattering of product. 4. The routine of work should follow that of a manual method, beginning on the upper chest, and working upwards. The brush should be contoured to the area under treatment, and bony and sensitive sections treated with a reduced pressure and speed, with the minimum number of strokes possible to accomplish complete removal. 5. Damp sponges or a warm steam towel should be utilized to remove the cleansing product. 32

33 The use of pressure sprays for toner and liquid applications during the skin treatment is popular due to the fineness of application. The spray is directed onto the face under pressure and forms a very fine penetrating film which readily hydrates the superficial tissues. A solution of 3 parts distilled water to 1 part toner should be used due to the increased stimulation of the product when under pressure. The pressure spray toning can be used throughout the skin treatment whenever tonification is required. Some of the models are equipped with an adjustable spray, which enables a constant stream of liquid to be emitted. This is extremely useful in aiding masque removal, particularly the clay based setting type masques. Attached to vacuum suction machine. Cover hole on vacuum bottle to release a fine mist spray. Refillable spray bottle with a propellant canister. Gives a very thorough spray. Manual spray bottles make toner application more economical and hygienic with no wasted cotton. 33

34 This is a great method of pulverizing or atomizing solutions onto the skin for a deeply hydrating and calming result. Because the temperature is tepid, it allows the therapist to treat even the most delicate skin conditions without over stimulation. It may be used at several different times during the treatment. It can be used for rinsing any cleanser or masque residue, and loosening up clay based masque for easier removal. It is one of the best treatments for dehydration and/or sensitivity and is used to pulverize concentrates (mixed with distilled water), water soluble botanical extracts and fruit infusions. 1. Check water level in inner chamber. Fill to ¾ level with distilled water (overfilling causes spitting) 2. Fill beaker nearest handle with desired solution 3. Switch on Dr. Lucas Pulverizer (takes 5 minutes) 4. Protect eyes, ears and hair properly 5. Spray from behind the head, moving spray evenly over the skin 6. Use a sponge to catch any dripping; blot skin after use 34

35 This ph scale is a good tool to use to help to demonstrate why most soaps are bad for the skin, even the soaps that claim to be gentle. When people have oily skin, their natural instinct is to use a drying agent (alkaline) but by doing this, they just compound the problem encouraging growth of bacteria on the skin surface. Alkaline products will dry out and irritate the skin, stripping it of its protective coat the hydrolipid film. It is therefore, important for products to be graded as acidbalanced to the skin on the ph scale at 4-6 as ph levels can vary considerably. If the ph is low, it means that there is a LOW concentration of Hydrogen ions (ACID ph) and if the ph is high it means that there is very HIGH concentration of Hydrogen ions (ALKALINE ph). NOTES: 35

36 There is often the misconception between oil-dry skin vs. dehydrated skin among our clients. They will complain that they are dry when really they are experiencing dehydration. Often incorrect use and sometimes recommendation of products that deliver oil, not water is the problem. Dry Lacking oil Skin type Flaking / uneven Wrinkles / deep lines Systemic Hereditary / illness /medication Dehydrated Lacking water Skin condition Peeling / tight Fine superficial lines Exposed areas Environment / lifestyle Appearance: Visible dryness, tightness, tight pores, prone to wrinkles, poor skin tone Cause: Woods Lamp: Genetic Deep purple hue if skin is very keratinized, and white flakes if also dehydrated Appearance: Cause: Woods Lamp: Flaky, tight on surface, very fine lines, oil/comedones can be present Lack of moisture, incorrect product use, diet, environment, medications White flakes, light violet hue 36

37 1. Consultation 2. Cleanse eyes and lips Steam 3. Cleanse 2x 4. Skin analysis 5. Exfoliation Cleanser /Scrub / Electric Brushes 6. Massage Indirect High Frequency 7. Complex Iontophoresis 8. Masque 9. Tone Dr. Lucas Pulverizer 10. Moisturize 11. Sunscreen 12. Homecare 37

38 Skin: Dry skin Action: Nourishing and softening Skin: Dehydrated skin Action: Hydrating and protecting Key Modalities: Steam Exfoliation Stimulating massage - Indirect High Frequency Key Products: Milky, creamy cleanser Mechanical scrub exfoliant Enzyme based exfoliant Oil / cream based masque Hydrating toner Oil / cream based moisturizer Silicone protection barrier Oil based sun protection Key Modalities: Steam Exfoliation Product penetration - Iontophoresis Key Products: Gel based cleanser Lactic Acid based exfoliant Hydrating gel based masque Hydrating toner Humectant based complex/booster Humectant based moisturizer Silicone protection barrier Oil based sun protection 38

39 The International Dermal Institute massage is an excellent method of introducing the client to the benefits of skin care, as well as being a healthy and relaxing procedure. There are many benefits to an International Dermal Institute Massage: 1. It increase supply of oxygen and nutrients to skin and muscles 2. It stimulates removal of waste products from the tissues 3. It stimulates glandular activity of the skin 4. It improves cellular activity 5. It improves the texture of the skin 6. It relieves tension and fatigue 7. It promotes total relaxation Light, even stroking movements which prepare the tissue for deeper massage and link up other movements in the skin care sequence. It stimulates the superficial circulation causing a slight increase in skin temperature. It is an aid to desquamation and loosening of surface adhesions. Relaxation will be induced with a feeling of total body wellness. Compression (pressure) movements, using either the whole of the palmar surface of the hand or just the pads of the thumbs and fingers. Kneading, knuckling, rolling and squeezing of the muscles are examples of petrissage movements. There is an increase in blood and lymph flow, the muscles are relaxed and toned, skin desquamated appears smooth, clear and fresh as a result. Thumb kneading to the trapezius helps to release the knotted fibers by breaking up the tension nodules and increasing the supply of blood to the muscle. Percussion movements such as tapping, hacking and cupping, stimulate superficial nerve endings. This causes temporary toning and tightening of the skin and improved blood flow resulting from alternate constriction and relaxation of blood vessels. There is also a removal of static lymph from the tissues. Small circles with thumbs, fingers or palms to increase blood flow in a small area. Can help sebum congestion. 39

40 1. Sensitized skins, prone to allergic reaction 2. Extremely vascular skin conditions 3. Skin infection, irritation or evidence of sepsis 4. Excessively loose skin 5. Inflammation, bites, stings, etc.

41 Application of Essential Oil Application of Massage Cream - décolleté, upper arms, throat, chin, cheeks Spreading (x3) from elbows, décolleté, shoulder, up on throat, over chin, scissor mouth, between eyes, circle 1-2-3, temples 1-2-3, back to shoulder 7 minutes upper body, upper arm, around elbows, chest & décolleté, around deltoid, neck, using thumbs and knuckles, kneading areas of tension end at temples 1 Spread to link.. 1. Right hand pumping circle down from temple to right axillary ridge (armpit), work across chest to left axillary ridge, round deltoid, back of trapezius muscle behind ears (x6) to temple.right hand slides across forehead, Repeat with left hand. (x2 each hand). Return to temples. 2. Roll patting across throat from shoulder (x3). 3. Jaw Pulls - start from chin, pull all way back to ears and massage lobe and spine of ears. Slide under jaw with thumb back to chin (x6). 4. Thumb lifts at side of mouth (x6). 5. Full cheek lifts with palmer pad frictions - lattice fingers and lift cheeks. (x6), complete with fingers in between the eyes. Return to temples. 6. Butterfly (x3) Return to temples. 7. Circle eyes - acupressure under inside brow line and slide over eyebrows then round and under the eyes (x6) Return to temples. 8. Slide right hand to meet left eye - S movements inwards, under eye. Circle back out. Repeat - Slide across forehead, repeat under right eye. Return to temples. 9. Temple frictions (x9). 10. S movements across forehead (x3). Return to temples. 11. Right hand Heel press to center forehead, swivel right hand to meet left hand, gentle alternate lifts across to right temple. Return to temples. Repeat with left hand (x3). Return to temples. 12. Say goodbye to the body with full spreading movement (x3). 13. Grand Butterfly pause. 14. Temple frictions.(x12). Pressure and lift off slowly and laterally. Total Time: 20 minutes 41

42 Essential Oils Aromatic essential oils are the pure living elements of plants, herbs and flowers. They are classified as vegetable hormones, and have the ability to detoxinate, hydrate and oxygenate the tissues. Pure essential oils are processed and sold in a pure form to blenders, who then blend the pure extracts into a vegetable oil base or hydroessentials-essential oils in a water base for cosmetic use. The base is usually hazelnut, avocado or rose hip oil if in an oil base, or can be in a floral water base using technology known as hydroessentials. The percentage of essential oils in each blend will vary according to manufacturer and for what purpose it is to be used. At The International Dermal Institute we use strengths varying between 10% to 20% on the face, and higher strengths on the body. These same oils are used during an Aromatherapy treatment, but then they are used in combination with working specific reflex points on the entire body, which is a specialized treatment in itself. During skin treatments, The International Dermal Institute uses the essential oils before the International massage, under the massage cream if oil base essential oils are chosen, or under an oil-free massage fluid if water-base essential oils are chosen. Never rub the oils directly, heat them, or try to dilute them. Your instructor will teach you the proper method in which to use the oils. Each essential oil has the three qualities mentioned, and in addition, possesses other specific qualities (i.e. lavender is very antiseptic and calming, and it is important to know which blend of oils is best for each client). All oils used at The International Dermal Institute are carefully blended by The Institute of Clinical Aromatherapy in London, England and are blends of several oils in combination, for a more therapeutic effect. In order to have a basic understanding of the different actions of each oil, below are common essential oils and their actions on the skin: Lavender - antiseptic, calming Sandalwood - calming, sedating Geranium - anti-inflammatory, soothing Eucalyptus - respiratory stimulant Lemongrass - invigorating, antiseptic Ylang Ylang - antiseptic, detoxifying Rose - hydrating, warming Jasmine - revitalizing, hydrating 42

43 Hydroessential Oils Massage Cream Indirect High Frequency 43

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45 Appearance: Cause: Woods Lamp: Wrinkles, loose skin, pigmentation, poor circulation, oil dry Genetics, sun, stress, free radicals, smoking White hue, brown, burgundy marks Ingredients to look for: Safflower Oil, Hops & Rosemary to nourish, Pinecone to increase blood flow, Horsetail extract for firming, tightening action. Corralina Officinalis for firming tissues. Anti-oxidants, A, C, E, Vitamin A, normalize skin cell renewal rate, Vitamin C antioxidant, stimulates collagen synthesis, Vitamin E to nourish & Gingko Biloba Anti-enzyme agents - hydrocotyl, grapeseed, coneflower. Phytonutrients like wild yam. Squalane to moisturize and protect. Phospholipids & Shea Butter to nourish. Butchersbroom, maintains skin elasticity. Peptides specifically for an aging skin will stimulate collagen collagen synthesis Appearance: Cause: Woods Lamp: Brown or white markings Sun, trauma, medications, stress, hormonal, fragrance Dark brown irregular patches, many freckles Ingredients to look for: Lactic acid for 5 %, salicylic acid, Vitamin A for increasing cell renewal rate, Vitamin C for lightening and antioxidant properties, Camellia Sinensis (White Tea) Extract an antioxidant; helps accelerate skin brightening. Ferula Foetida (Giant Fennel) Root Extract slows enzyme activity inhibiting melanin formation Glycyrrhiza Glabra (Licorice) Root Extract / Dipotassium Glycyrrizhate an antioxidant; helps scavenge free radicals and fight melanin formation. 45

46 1. Consultation 2. Cleanse eyes and lips Specialty cleanser / Steam 3. Cleanse 2x 4. Skin analysis 5. Exfoliation Microfoliant 6. Massage Indirect High Frequency 7. Complex Iontophoresis 8. Masque 9. Tone Dr. Lucas Pulverizer / Pressure Spray 10. Moisturize 11. Sunscreen 12. Homecare 46

47 International skin treatments ALWAYS feature a masque preparation at some stage of the treatment, usually as one of the concluding applications. Masques are blended to have a concentrated and specific effect on the skin, and different ingredients and formulations give the Skin Therapist hundreds of alternatives. Masques are also recommended to the client to use at home on a twice-weekly basis, and are an important step in everyone's skin care regime. Depending on their different formulations, masques have very different effects, and if the skin is varied in its needs, we often use more than one masque on each client. This would mean applying a different masque to various areas of the face and throat, depending on the different skin conditions across the face. Every product manufacturer has several different masques in their lines, and your product manufacturer will teach you the specific actions of each line that you carry in the skin treatment center. However, masques fall into one of three categories, and it is important to understand the general actions of each type: 1. Clay ( oily skin) - 1. Gel ( dehydrated skin) - 2. Cream ( dry skin) - 3. Cream ( sensitized skin) - 1. Thermal - 2. Peel-off - 3. Paraffin Wax - 4. Setting Vacuum - 5. Collagen Sheet - 6. Oatmeal - 7. Antibacterial / Medicated - 47

48 Skin: Photo-damaged Action: Brightening & protecting Skin: Aging Action: Hydrating and protecting Key Modalities: Iontophoresis (+) Key Products: Exfoliating specialty cleanser Hydroxy acid exfoliant Vitamin based masque Cream based masque Hydrating toner Regenerating booster/serum Emollient daily moisturizer with spf Firming eye complex Key Modalities: Iontophoresis (+) Indirect High Frequency Key Products: Exfoliating specialty cleanser Vitamin/ hydroxy acid combination exfoliant Vitamin based masque Hydrating toner Potent treatment moisturizer Emollient daily moisturizer with spf Firming eye complex Hydroxy acid booster/serum Pigmentation treatment cream Eye cream with SPF15 48

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50 Acne is a medical catch phrase that includes everything from the smallest blackhead to the deepest cyst. The Skin Therapist will need to define and recognize both the non-inflammatory and the inflammatory lesions, in order to determine whether the client can be treated in the skin treatment center or needs to be referred to a Dermatologist. This will depend on the severity of the acne condition. Appearance: Cause: Oily shine, open pores, or coarse skin texture, little wrinkling. Possible comedones, breakouts Genetic Woods Lamp: Orange dots for comedones orange hue over oily areas. (combination - orange hue on T panel only) Appearance: Cause: Oily with comedones, papules, pustules. Often red and sensitized Genetic Woods Lamp: Orange fluorescent dots and deep purple if sensitized Appearance: Cause: Woods Lamp: Open & closed comedones, under surface congestion. Possible inflammation and pustular breakouts and papules Hormonal imbalance, comedogenic ingredients, smoking, pollution, friction Orange dots, if inflamed, dark purple 50

51 1. This is the smallest form of a blackhead, felt rather than seen. 2. Commonly known as milia - where an impaction in the hair follicle has a hardened overcap of the stratum corneum cells. There are two types: 1. Hard Closed Comedones - commonly found around the eye area 2. Soft Closed Comedones - due to comedogenic ingredients in products or makeup. 3. Non-inflamed impaction of dead skin cells, sebum, and bacteria, exposed to the air (blackhead). 4. High break in the follicle wall, empties impaction into the dermis, white blood cells attack and a sore red lesion is felt. 5. Papule develops and as white blood cells attack, pus is produced, yellow cap of pus is visible on the surface of skin. 6. A deep break in follicle wall, empties impaction into the lower dermis thus infects adjoining follicles. 7. A membrane forms around the lesion in the dermis, and traps it as a soft fluid filled lump - this has to be incised and treated by doctor or dermatologist. 51

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53 1. Consultation 2. Cleanse eyes and lips Steam 3. Cleanse 2x 4. Skin analysis 5. Exfoliation Hydroxy acids / Microfoliant 6. Massage Specialty, medicated masque 7. Complex Desincrustation Vacuum Suction Direct High Frequency 8. Masque 9. Tone Dr. Lucas Pulverizer / Pressure Spray / Eco Spray 10. Moisturize 11. Sunscreen 12. Homecare 53

54 Softens the skin and dilates the follicle Prepares skin for extractions Effects of: Alkaline reaction Softens the tissues Dilates the follicles Increases blood flow Increases sensitivity Emulsifies sebum A treatment used to infuse water soluble substances deep into the skin Effects of: Acid reaction Tightens and firms tissues Constricts the follicles Decreases blood flow Decreases sensitivity Reduces edema 54

55 The lymphatic system is a network of blind-ended vessels, which contain valves to keep the lymph fluid moving forward throughout the body, not allowing it to seep backwards. Along the course of the lymph system are fluid filled nodules, known as LYMPH NODES. These nodes act as filters to prevent the spread of infection by pathogenic bacteria. They manufacture bacteria fighting cells, called LYMPHOCYTES, which help fight infection. The superficial lymphatic vessels lie in the connective tissue membrane of the dermis. When the superficial vessels become inflamed, redness appears on the skin and the nodes swell. Two main large ducts drain the lymph from the lymphatic vessels and open into the blood supply at the base of the throat (called the TERMINUS). Important groups of lymph nodes are gathered together at points on the body. It is necessary to consider the relevant lymph nodes and the areas they drain into when attempting to treat the system in the skin treatment center. Lymph is a clear fluid formed from the tissues, which has seeped from the cells and connective tissue fluid. It contains water, salts and eliminated toxins. The function of the lymph is to carry away the products of metabolism and chemical change from the tissues such as; carbon dioxide, lactic acids, bacteria and mobilized fats from digestion. The flow of lymph depends on respiration and general exercise. Inactivity, rest and sedentary occupations affect it. Tissue fluids collect when the flow of lymph is retarded. Whether you are dealing with lactic acid, debris or intestinal toxins, it is important to realize that these actually block full metabolism. Wastes that are not reconverted into sugar pass through the fine filtration system of the lymph. Inside the nodes, the lymph is pumped through screening devices to filter impurities. Once trapped inside the nodes, the toxins stimulate the production of lymphocyte cells, which destroy similar bacteria throughout the body. In 24 hours, four pints of lymphatic fluid are circulated through the body. Since it has no heart, the system depends on the natural massage - like movements of surrounding muscles to speed its flow. Manual massage can be used to literally press wastes through the lymphatic system, and stimulate its drainage. 55

56 Second to manual massage, vacuum treatments must be one of the oldest treatments known to medicine. The vacuum massage is a mechanical method to stimulate lymph circulation. The treatment may be applied in 1 of 2 ways. Indications for Use: Full face vacuum massage treatment - for Lymph stimulation and deeper cleansing purposes. An oil based precleansing medium or a milky creamy cleanser is applied all over face, neck and décolleté to act as a form of slip and glide while draining towards lymph nodes. After manual cleansing or steaming - The direction of the lymphatic vessels is followed with straight strokes, applied in a light, gliding manner. This treatment will stimulate a dry, dehydrated skin, promoting cellular function, biological activity and increase the elimination process via the lymphatic vessels of the face and neck. The vacuum massage application may take up to minutes. For Pre-extraction treatment:- congested areas only. After galvanic desincustation - to increase loosening and removal of skin blockages, comedones and sebaceous matter. Here, the flat bell shaped glass ventouse and small round ventouse will be applied over a desincrustation solution for slip and glide. The direction of lymph flow is followed with straight strokes, applied in a light, gliding manner over the desincrustation solution. This is most effective after steaming or galvanic desincrustation (-). This vacuum suction application may take up to 3-5 minutes prior to manual extractions. Contraindications for Use: 1. Delicate, sensitized skins, due to over-stimulation and possible capillary damage. 2. Infected acne conditions, where secondary infection of the follicle is present, due both to the risk of infection and discomfort. 56

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58 Proper extractions should be restricted to non-inflamed, non-infected microcomedones, closed comedones and open comedones. Only Skin Therapists with clinical acne experience, or who are working with a physician should attempt any pustule extractions. Whenever extractions are done work only with the hands and lancets, or tools that are disposable afterwards. Never allow a contaminated instrument to come in contact with different clients. 1. Wash the hands thoroughly in a surgical scrub. Latex gloves may be used, wrap your fingers in tissue. 2. Examine the skin under the 5-diopter magnifying lamp, and locate the non-inflamed lesions. 3. Working under the lamp, stretch the skin taught to bring the lesion nearer the surface. 4. If the lesion is closed (like a milia), gently insert the tip of a sterilized lancet, to break the dead skin tissue covering the lesion. Be very gentle, and work in a very shallow depth. You should not be so deep as to draw blood. 5. Once you have opened the lesion, gently wiggle and move the skin to bring up the impaction. Work smoothly and repeatedly until the impaction slides out. Do not hold your fingers too close together, as this will make the skin indent, and will not roll out the impaction. 6. Once you have completed extractions, apply anti-bacterial solution or a weak benzoyl peroxide solution over the area. 7. For pustular breakouts, do not attempt extractions. Go over the area with 5 minutes of Direct High Frequency, and apply a 5% benzoyl peroxide solution. Extractions are made easier if you precede them with at least 15 minutes of warm steaming, a mild exfoliation treatment and a softening solution before starting. Ask your product manufacturer if they have specific products that can make this easier for you. Galvanic current on the negative polarity with a softening solution can also help ease extractions by having an alkaline, softening effect and dilating the follicles. This is known as "desincrustation. *Check the regulations in your state regarding the use of lancets before use. 58

59 The TESLA current is an alternating radio wave which uses the surface of the skin for transmission. It does not effect muscle stimulation or chemical changes in the tissues. A series of gas filled electrodes are inserted into the conductor handle of the unit. The electrode is filled with either ARGON gas (glows violet), which gives a "sparking" stronger reaction, or NEON gas (glows orange), which is milder. Both gases have similar effects, but argon is used on acne-type lesions, where neon is used on general oily-type skins or to create warmth in a localized area for improved product penetration. The TESLA current is conducted to the gas where it ignites. The gas is inert, and in a vacuum so it is quite safe and stable. Once the gas ignites, light energy is given off which forms electricity around the glass electrode. When the oxygen, naturally present in the air around the electrode, is electrified it forms ozone gas. Simply, high frequency forms ozone gas close to the skin surface, which has a germicidal, healing and drying effect. The more oxygen that surrounds the electrode, the more ozone is formed, and the greater the effect. Therefore, when the electrode is lifted away from the skin surface, and more oxygen surrounds it, a more intense drying and healing action occurs. This method is called "sparking" and uses an argon gas electrode on acne-type lesions. We achieve a "spark gap" by laying layers of dry, cotton gauze over the skin, thus creating a narrow space between the skin and the electrode for ozone to form in. Never create a gap of more than ¼", as tissue destruction can occur and the skin will heal leaving brownish marks. 1. Acne-type lesions using argon gas electrode for a "sparking" treatment. 2. Oily skins with overall congestion using neon gas electrode for drying and germicidal effects. 3. To aid penetration of a treatment cream/ampule by increasing blood flow in certain areas where infrared or massage would stimulate the entire face. 4. To assist in massage for an aging skin using the indirect method. 59

60 Epileptics 2. Diabetics 3. Asthmatics 4. Excessive fillings 5. High blood pressure 6. Pregnancy 7. Metal implants - pacemaker 8. Highly nervous clients 1. Apply dry gauze and eye pads to the skin 2. Hold electrode in working hand and make contact with finger prior to placing on skin. 3. Increase intensity and move in small circles. 4. Do not lift electrode more than ¼ inch above skin. 5. Work for maximum 5 minutes over skin. 6. Place finger on electrode, remove from skin, and switch off. Sterilize electrode. 60

61 These are all names given to highly concentrated solutions of active ingredients which are applied to the skin to give an immediate and dramatic result. Packaged to avoid contamination from the hands or environment, and are applied in very small amounts due to their high concentration. Concentrates are highly active ingredients that penetrate more actively into the skin than a cream type formulation moisturizer, due to their aqueous solution. More modern packaging uses economical dropper bottles, with a valve closure. An old fashioned method of packaging is the standard glass vial, or ampoule. These ampoules are expensive to use, usually wasteful (they contain 5ml. where you only need 2 ml.) and can be dangerous, glass slivers often get broken into the liquid as the neck of the ampoule is opened Concentrates are either in a water or oil base, and are composed of hundreds of active ingredients. They may be plant or animal based, or comprised of sea algae s, placental extracts or synthetic fatty acids, all depending on the individual product manufacturer and the skin it is to be used on. Concentrates are applied with five to six drops on a perfectly cleansed skin, generally after a masque and toning. They are pressed over the skin, and sealed in with a moisturizer. Concentrates can also be penetrated with galvanic current, or pulverized onto the skin with the Dr. Lucas Pulverizer. Some manufacturers also recommend that they can be used under the masque to increase the intensity of the masque treatment. Although each product line has its own choices for ingredients, the basic action that you need to have covered in a collection of concentrates would be one for each of the following skin conditions: 1. Refining and purifying action for oily/acne type skin. 2. Stimulating collagen and elastin synthesis for an aging skin. 3. Reduce pigment, regenerating and firming action for a photo-damaged skin. 4. Soothing, calming and protecting action for sensitive skin Skin Condition Ingredient Action Oily, Acne Premature aging Photo-damaged & pigmented Sensitized Salicylic Acid, Horse Chestnut, Zinc Arginine Peptides Soybean Wheat Protein White Tea Green Tea Vitamin C & Licorice Fumitory Extract Lemon Extract Coneflower Exfoliates the follicle and reduces sebum Stimulates collagen and elastin synthesis Potent antioxidant Firming properties Inhibits enzyme activity Reduces pigmentation Antioxidants Protects Soothes Anti-Itch 61

62 Moisturizers are applied at the end of the skin treatment to protect the skin against pollution, sunlight and grime. They also help seal in the moisture of the skin, and help prevent dryness and dehydration caused by evaporation. Be careful not to apply too much moisturizer after a skin treatment, as most clients do not want to leave the skin treatment center feeling at all sticky or greasy. Apply a very small amount over the damp skin, and for oilier skin types use only an oil free formula and apply it with damp fingertips for a dewy, lightweight finish. Dehydration of the skin is one of the most common skin problems. Moisture is lost from the skin through evaporation from the deeper layers of the epidermis. When the surface is moisturized, the formula helps the skin cells bind together, and form a more even protective barrier against this moisture loss. The skin's moisture cannot pass through this barrier easily, and the skin appears smoother and more moist and supple. If the skin is naturally oilier, then the natural sebum will also act to prevent some moisture loss. It follows that the oilier the skin is, naturally, the lighter moisturizing protection it needs. We therefore, recommend light oil-free and oil controlling lotions for the oilier skins, and slightly richer and oilier creams to the more naturally dry skins. Even if the skin has oil being produced, it still needs sun protection and light hydration (moisture), remember water is not the same as oil! But be sure and keep the oily skin clients protection very light so that they do not feel it is too heavy and rich for them. For severe dehydration, always use the Dr. Lucas Pulverizer in the treatment (see notes on Dr. Lucas Pulverizer). Moisturizers have become more sophisticated over the years and there are now many types, such as oil-free, oil-based, oil controlling, exfoliating, anhydrous, occlusive and humectant. Always make sure that the moisturizer is applied to a damp skin, so toner and concentrate should be sprayed first before the moisturizer. This gives a much better rehydration effect. The SPF represents the ability of a sunscreen to delay sun-induced burning or erythema. It is important to realize that an SPF is only a measure of how much UVB protection a product provides. Unfortunately, a similar system of denoting sunscreen protection from UVA radiation has not been universally recognized. Types 1. Oil-controlling - 2. Oil-free - 3. Lightweight & SPF - 4. Humectant - 5. Oil-based - 6. Anhydrous - 7. Occlusive - 62

63 Sunscreens work by two mechanisms: Chemical Sunscreens absorb UV Rays lowering the energy level and releasing energy as heat. Examples: Physical Sunscreens reflect or scatter the energy rays. They are non-chemical and therefore less irritating. Examples: Skin: Oily, sluggish, congested skin Action: Deep cleansing and softening Key Modalities: Steam Ultra Sonic and or vacuum suction Desincrustation Key Products: Clay based cleanser Enzyme based exfoliant Hydroxy acid exfoliant/abrasive scrub Softening/ Desincrustation solution Clay based masque Hydrating toner Hydroxy acid serum Oil absorbing moisturizer Sal acid based overnight gel Anti bacterial wipes Skin: Inflamed pustules and papules Action: Kill bacteria decrease inflammation, expedite healing Key Modalities: Direct High Frequency Iontophoresis Key Products: Anti bacterial cleanser Salicylic based exfoliant Sebum and bacterial controlling serum Soothing and anti-inflammatory masque Spot treatment Oil-absorbing moisturizer Eye gel Antiseptic wipes 63

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65 Rosacea is a progressive, inflammatory vascular disorder that is characterized by four subtypes. It primarily affects the central part of the face and is recognized by facial flushing/blushing, facial erythema, papules, pustules, and telangiectasia. Skin changes are gradual in the early stages and the disorder is often mistaken for sunburn or acne. Many of our clients (men in particular) are often unaware of having Rosacea and do not seek help, often they treat their skin with acne type products which can dramatically worsen the condition. The sensitive and continually sensitized skin may also be prone to Rosacea. Appearance: Thin, delicate, often showing freckles and blood capillaries. Easily stimulated through touch or heat. Impaired barrier function. Cause: Genetic Woods Lamp: Dark burgundy/red Appearance: Cause: Can be hard to visibly see. Red, inflamed, skin irritable to; heat, products, friction. Stress, friction, incorrect product usage, medication, sun, pollution Woods Lamp: Dark burgundy/red Appearance: Cause: Woods Lamp: Red, inflamed, skin irritable to; heat, products, friction. Flushing and blushing characterized by 4 stages. Heredity, sensitized skin, continual irritation, stress, friction, incorrect product usage, Dark burgundy/red predominantly the central part of the face 65

66 1. Consultation 2. Cleanse eyes and lips Specialty cleanser / NO Steam 3. Cleanse 2x 4. Skin analysis 5. Exfoliation Microfoliant 6. Massage Pressure Point / Chinese Acupressure / MLD 7. Complex Iontophoresis 8. Masque Speciallty oatmeal or vitamin 9. Tone Dr. Lucas Pulverizer / Pressure Spray / Eco Spray 10. Moisturize 11. Sunscreen 12. Homecare 66

67 Skin: Sensitive & sensitized Skin: Rosacea Action: Calming, soothing & protecting Action: Calming, soothing & protecting Reduce triggers Key Modalities: Cold stones Iontophoresis Key Products: Gel / Cream based cleanser Microexfoliant Oatmeal based masque Soothing and anti-inflammatory toner Silicone based moisturizer Vitamin based treatment Key Modalities: Cold stones Iontophoresis Key Products: Gel / Cream based cleanser Microexfoliant Oatmeal based masque Soothing and anti-inflammatory toner Silicone based moisturizer Vitamin based treatment 67

68 To get to know your client and the skin concerns To ascertain medical background To review client s current skin care regimen To prescribe effective skin treatment and home care Prepare 3 cotton pads Rinse with damp sponges or warm steam towel Manual Cleanse Mix scrub with cleanser for power cleanse Electric brushes 5 diopter magnifying lamp Woods lamp Skin Scanner Medical grade headset Abrasive scrub Micro exfoliant Enzyme Hydroxy Acids Hydroxy Acid/vitamin combination Steam Desincrustation Solution Desincrustation - Galvanic (-) Vacuum Suction Direct High Frequency Essential Oils Massage Cream Hydroessential Oils International Dermal Institute Technique Indirect High Frequency Manual Lymph Drainage Chinese Acupressure Aromatherapy Pressure Point 68

69 Oily/Acne Salicylic Acid, Horse Chestnut, Zinc Aging Skin Arginine, Peptides, Soybean, Wheat Protein Photo damaged And Pigmented Green Tea, Vitamin C, Licorice Sensitized Skin Fumitory Extract, Lemon Extract, Coneflower Setting - clay Non- Setting - cream or gel Specialty - thermal, peel-off, paraffin wax, vacuum setting masque, collagen sheet, oatmeal Pressure spray Spritz (manual) Eco Spray Dr. Lucas Pulverizer Concentrate Complex Booster Serum Ampule Oil-free Oil-based Oil-controlling Exfoliating Anhydrous Occlusive Humectant Physical Chemical Tinted Camouflage 69

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71 1. Consultation Student Notes page number Skin Type: 17 Skin Conditions: 2. Cleanse eyes and lips 3. Cleansing (2x) Skin analysis 5. Exfoliation Extractions (optional) Massage 42/43 71

72 Student Notes page number 8. Complex / Concentrate Masque Toner 33/ Moisturizer Sunscreen Homecare Prescription 29 72

73 Normal Oily Combination Dry/Alipoid Acne Sensitive Dehydrated Sensitized Aging Pigmentation Congestion/ Breakout Other 73

74 Gain clients Retain clients Increase services per client Increase retail sales per client Direct mail Network with other businesses Insanely great treatments = great referrals Editorial and PR Word of mouth Creative displays Community Events Educational Evenings Existing Client Referral Programs Who are your top 10 clients? Why did they choose your skin therapy center? Why do they continue to come back to you? What do they like most about their visits with you? What do you like most about them? What do they most like about you? 74

75 Expanding a higher level of service Increase the value, add small luxuries Rebooking incentives Prescribing home therapy Establishing product loyalty Recognizing VIP clients Providing insanely great treatments Delivering educational events Offering monthly specials Mailings and monthly promotions Exfoliation & moisturizer events Girl scout events Teen night evenings Simplify your menu Monthly promotions Therapists thank you cards/phone calls Piggyback product promotion Service coupling Holiday promotions Birthday cards and specials Postcards to clients Monthly teen night programs 75

76 2fer specials: receive 2 treatments for the price of one Schedule 2 appointments at the same time, receive a discount on both Well trained, knowledgeable staff Educated and experienced therapists Sampling product Tester / product displays Skin scanner events Eye level is buy level Link selling Effective sampling Merchandise material GWP (gift with purchase) Punch cards Re-merchandise Notes: 76

77 94% of dissatisfied customers do not complain directly 31% told friends and family about the negative experience 33% definitely not or probably not return 48% of consumers avoided a store based on someone else s bad experience 46% with a problem expect they would definitely or probably experience the same problem in the future 24% complained it took too long for someone to serve them 33% complained it took too long to pay Going beyond what is expected Doing ordinary things extraordinarily well Identify customer s needs Being at your best with every customer Discovering new ways to delight those you serve Handle difficult customers with care! Adding value and integrity to every interaction Taking care of your customer the same way you would take care of your grandmother Maintain an attitude of service excellence Identify customers needs Use customer-friendly body language and words Practice excellent service at every customer contact point! Handle difficult customers with care! Exceed customer s expectations 77

78 The sensory experience is key Excellent amenities with added touches Allow clients to smell, touch, see and hear the experience Added touches create memories and separate the rest from the best What business am I in? What business should I be in? What is my vision? What is my advantage over other therapists? What is my next step? 78

79 Once the client has received a prescription skin treatment, it is imperative that the Skin Therapist advises regarding a home-care routine. The results of the treatment can only be maintained if the client is using the correct products in the correct way at home. Ideally a prescription sheet should be completed and the recommended products shown to the client explaining how to use them at the end of the skin treatment. The products should then be wrapped in tissue and placed in a retail bag. A product brochure and any relevant literature concerning the skin should be also placed in the bag. If appropriate a sample in a sampler envelope can also be handed to the client. Customer Service is paramount. In many Skin Treatment Centers, an extra 15 minutes is added to the appointment time for a first time client, so that the Therapist can sit down with the client at the end of the treatment to recommend home care products. 79