Acne Cure: The Esthetician’s Approach

Estheticians are trained, licensed beauty professionals (skin therapists) who work in salons and spas. (Others have private practices and make house calls.) Estheticians perform facials and other skin-care treatments, many of which are designed to help acne sufferers. They often work in concert with physicians—sometimes actually in the physician’s office—so acne can be managed with a two-pronged approach.

“Skin therapists who have received comprehensive training are able to treat acne; however, they cannot remove inflamed lesions—only non-inflamed lesions like comedones,” says Annet King, a licensed esthetician who serves as training and development manager for the Torrance, California-based International Dermal Institute (IDI), through which she oversees a global staff and curriculum in 40 countries. “Breaking or piercing the skin is illegal in most U.S. states under a skin-care license. The only time there is really an exception to this rule is when a skin therapist works in a doctor’s office and is covered by the doctor’s insurance. The reason for this is that the risk of permanent scarring is much higher if bleeding takes place.

“Basically, we can treat all grades of acne. But for acne vulgaris and cystic acne, we would refer to a dermatologist, as systemic drugs or topical drugs may be necessary. Someone with acne vulgaris or cystic acne could still receive skin treatments to address the inflammation, keratinization and sebaceous activity, but to achieve more positive and faster results, a more comprehensive approach may be indicated.”

What to Expect

“Before actually getting a facial, first-timers should have a consultation with the esthetician to discuss their specific skin-care issues,” says Nona George Cohen, owner of The Body Clinic Day Spa, with two locations in Los Angeles. Established in 1986, The Body Clinic is a full-service professional skin- and body-care salon that provides an array of services in a tranquil setting that draws many celebrities, including Usher, Vivica A. Fox, Vanessa Bell Calloway and Miss America 1993/TV personality Leanza Cornett.

What happens during a typical appointment? The initial consultation allows the esthetician or facialist to custom-tailor the facial and overall skin-care regimen to the client’s individual needs, Cohen says. It also lets the esthetician provide specific recommendations for products that should be used at home.

“You will normally be asked to come in a little earlier than your appointment time to be able to complete a consultation card,” Annet King explains. “After a full written consultation—where you will check off or answer different questions about medication, habits, caffeine consumption, etc.—you should receive a thorough skin analysis or mapping of your skin. The skin-care professional will ask you a lot of questions and point out different observations about your skin—both positive and the areas of concern. You should be educated about your skin condition, and the skin treatment should be designed around your concerns and what the skin therapist discovers about your skin. You should then receive home-care advice, together with any nutritional or lifestyle suggestions, from the skin therapist. Preferably, you shouldn't leave without an appointment for your follow-up treatment. You should come away feeling good—not like you want to hide!”

Newbies should get a facial every four to six weeks, Cohen says.

“A typical facial process for acne sufferers includes cleansing, massage, steaming, extractions and a finishing mask,” Cohen says. “The Body Clinic's Acne Facial includes a deep pore cleansing, surface exfoliation and skin softeners to aid in the extraction of impurities. Pressure-point massage to the face calms the oil-producing sebaceous glands and boosts the healing abilities of the skin. An antibacterial mask soothes and calms inflamed skin, and an oil-free moisturizer provides hydration.

“In addition, clients should practice a good skin-care regimen at home, based on the advice of the facialist. Seeking the advice of a dermatologist as part of the skin-care regimen is also recommended. Everybody’s skin is different, but it is not uncommon for a person to see subtle changes after the first facial.”

Steam, however, can sometimes exacerbate your acne. During the Vietnam War, many soldiers developed acne that was eventually termed “tropical acne.” Exposure to jungle humidity caused their follicles to swell, and excess sebum plugged their pores. While home facial steamers and salon facials that incorporate steam are often used to unplug pores, the humidity generated may aggravate acne for some sufferers. You will need to determine whether these treatments prove to be beneficial or detrimental, as every patient experiences a different effect.

But even extractions can be controversial. Facialists perform extractions as a normal part of the facial process, and many dermatologists have nurses or estheticians in their offices who remove comedones. This has been done for decades, and many dermatologists find that it effectively unclogs pores. Other dermatologists, however, believe extractions are a waste of time. Instead, they will prescribe a topical retinoid, which will eliminate the plug in the pore (blackhead) within three to four months—without the trauma to the skin and ongoing expense.

For mild acne, there’s nothing wrong with going to an esthetician for a consultation. If you have a major case of cystic acne, however, it’s probably wise to visit a dermatologist first. While most estheticians are well trained and capable, they cannot write prescriptions, and they haven’t spent eight years in medical school.

Choosing an Esthetician

“State requirements are generally not very adequate, as most skin therapists have only received very minimal training: around 300 to 600 hours,” King says. “This helps them to get their license after they have passed a very basic exam, but doesn’t mean that they will be a great skin therapist. Look for someone who has taken postgraduate education—preferably with their postgraduate diploma from IDI, which involves 100 hours of education. This shows that they are committed to education and passionate about skin care.

“Experience doesn't necessarily mean you will get a better treatment,” King adds. “Often, it’s the new skin therapist who is the most passionate and skilled. Look for those certificates on the wall, and ask if they do a formal consultation and design the treatment for you.”

Nothing beats a referral from someone who is pleased with her esthetician—and whose skin looks great, says spa owner Susie Galvez.

“If that is not possible, visit the location,” she recommends. “Look at the surroundings. Does it look clean? Does the treatment room look inviting and relaxing?”

Galvez urges potential clients to ask the salon staff—or the esthetician herself—a few questions about types of treatments provided, skin-care philosophy and recommendations for acne management.

“Listen to the answers,” she advises, “and see how they interact with you. A good esthetician should welcome the idea of showing you around the location. The best estheticians love to look at the skin and decide how best to treat the condition. In fact, if there is more than one esthetician available, usually the group consults to help determine the best treatment.”

Some readers, however, may feel too embarrassed to seek help, worrying that their acne is too severe to be inspected “up close and personal.” Don’t fall into this trap, Galvez urges. Estheticians want to help.

“You needn't be embarrassed at all,” she emphasizes. “Estheticians love treating the skin and improving its condition. In fact, I actually get excited when I see a ‘tough’ case, as I know that I can help this person. I can help him or her see positive results with the right treatment program.”

The Team Concept

In the best of all worlds, dermatologists, naturopaths and estheticians work together to help cure their patients’/clients’ acne.

“I have worked with plastic surgeons in the past, and we referred patients to dermatologists quite frequently for evaluation,” says Connie Traugh, a Tidewater, Virginia-based esthetician with more than 20 years experience. “Dermatologists have referred patients for microdermabrasion, chemical peels and product education, while I, in return, would refer patients to the ‘derm’ for anything outside my scope of practice. Dermatologists would prescribe tretinoin or antibiotics, to be administered in conjunction with at-home skin-care products.”