Modified Jessners Peel
- Combination Peel– Lactic Acid, Salicylic Acid and Glycolic Acid in full (14%) and light (7%) strength Non-buffered Modified Jessner’s solution is very effective for a wide range of patients, with particularly positive benefits for those with:
- Acne prone/oily skin
- Active acne
- Photo damage
- Fine to medium wrinkling
- The Modified Jessner’s peeling solution is recognized as a superficial to medium peeling agent. The solution is comprised for three active ingredients in an ethanol base:
- Lactic Acid is a normal metabolic product. Human skin has all the enzymes necessary to utilize it. There is no toxicity form the Lactic Acid. On normal skin, Lactic Acid is partially responsible for maintaining the acid mantle of the skin at a pH of 5.5 to 6. Several studies have shown that lactic acid has a natural moisturizing effect on the skin.
- Salicylic Acid provides powerful exfoliation due to the high lipid(oil)solubility. It concentrates exfoliation on the lipid-rich outer layers of the skin, where the rate of exfoliation reduces with aging, thus causing a buildup of dull, dry skin.
- Glycolic Acid is an alpha hydroxy acid that exerts specific effects on the dermis and epidermis. At the epidermal level the acid works at the level of stratum granulosum by dissolving the “sticky” dead cells, allowing them to shed. At the dermal level histology shows that there is an increase in the deposition of collagen and glycosaminoglycans, thus leading to a thickening of the dermis. This increase in volume may create a reduction in the wrinkles.
Normal to oily or acne-prone skin
Modified Jessner’s 1.66
Light Modified Jessner’s 2.25
Lactic Acid, Salicylic Acid and Glycolic Acid, U.S.P. in concentration
SD Alcohol 40B
- Improves tone and texture
- Removes fine lines and wrinkles
- Improves hyperpigmented areas
- Corrects sun damage
- Improves mild scarring
- Controls oiliness and slough comedones
- Severe milk, sugar cane, strawberries and aspirin allergies.
Excessive absorption may increase risk of Salicylism, not to be used over 20% body’s surface area at one time.
SENSITIVE SKIN CONSIDERATIONS:
There is more risk for patients determined to have sensitive skin.
- Tretinoin or retinoic creams and/or acids will heighten the skin’s sensitivity to any type of peeling agent and should be left out of patient’s regimen 48-72 hours prior and post treatment.
- Most physicians recommend 6 months post-Accutane before even moderate treatments are performed.
Oily to acne prone skin types; normal skin types can have spot treatments for problem areas; desiring moderately aggressive treatment.
- Determine what type of treatment patient desires and that moderate peeling will not be an inconvenience at this time;
- Patient has not had a treatment in less than 7–10 days;
- Avoid broken or severely irritated skin except for those comedones still intact; refer to drug interactions.
Test spot near ear or on inner arm; spot treatment on specific blemishes provide a good test because flaring will occur immediately. Also, Light Modified Jessner’s is suggested to use first, moving to Modified Jessner’s after layers of the Light treatment have been successfully tolerated.
This combination is self–neutralizing because of the Salicylic, therefore, frosting is almost always apparent and can be monitored more closely with a Wood’s lamp. Peeling cannot really be stopped if unintended areas are treated or patient is uncomfortable, 10% Sodium Bicarbonate or distilled water can somewhat slow the action.
APPLICATION OF ACIDS:
Try to achieve one even pass by quickly making one pass and going back over the area to assure the peel is even.
APPLICATION OF PRESSURE:
Crucial with this acid, controls the depth of peel, acid can be applied with light pressure one pass and if deeper peeling is desired more pressure can be applied to area without using more acid. Applying excessive pressure can cause deeper peeling and irritation.
No more than three layers should be applied in one treatment. Each layer must be allowed to dry and frost before the next layer is applied. Secondary and tertiary layers may only be desired in specific areas.
Not necessary because it is self-neutralized, rinsing is not necessary. However, it is recommended that skin be rinsed with distilled water to ensure patients’ comfort.
POST TREATMENT CONSIDERATIONS:
- Follow treatment with Skin Perfect Skin Recovery Hydrator. Then apply a thin layer of a broad-spectrum sunscreen.
- Patients can expect skin sensitivity for 24-48 hours, tightening of skin for up to 72 hours, moderate flaking for 2-5 days especially in areas treated with more pressure and layers.
- Discuss the importance of maintaining the treatment results with the appropriate Skin Perfect skin care protocol as maintenance for skin.
- Record complete patient skin history.
Note: Retin-A treatments must be stopped 4-7 days prior to any acid treatment. DO NOT treat patients who have been treated with Accutane within 12 months prior.
- Discuss procedure thoroughly with patient. Patient must sign consent form prior to procedure.
- Perform patch test on patient’s upper arm.
Note: Patients with sensitivity to aspirin will likely have sensitivity to Jessner’s and Lite Jessner’s, due to the salicylic acid in the solution.
- Secure patient’s hair with headband.
- Cleanse areas to be treated with Skin Perfect Perfect Cleanser. Pat dry.
- Instruct patient to lie in a relaxed supine position, with eyes closed for the entire procedure.
- Apply 1-3 passes of ONE Peel Prep. Peel Preps remove any debris remaining on skin after cleansing, open pores and lower pH of skin to enhance effectiveness of the peel solution.
- Thoroughly shake solution.
- Apply acid to thickest areas of skin first.
- Apply in single strokes, in the following order:
Across forehead at hairline – moving to brow area
Down sides of face (continuing onto neck, if applicable)
Across upper lip
- Do not allow solution to drip. Try to achieve one even pass but some overlapping is not detrimental with this acid. Patient may experience a stinging sensation. Stinging may be somewhat relieved with the use of a 6” fan.
Note: Under no circumstances should patient open eyes. If acid makes contact with eyes, flush with water for 15 minutes, occasionally lifting upper/lower lids, until no evidence of chemical remains. Continue flushing with normal saline until pH has returned to normal (30-60 minutes). Get medical attention immediately.
- Allow solution to dry. Expect to see some white frosting as the solution dries.
- Apply successive layers and allow to dry to control the depth of the peel. Each layer should dry in 2-4 minutes.
- Total treatment time should be 7-10 minutes. Solution is self-neutralizing so it will cease working around 10 minutes after application. No addition layers should be applied after 10 minutes from the start of the treatment.
- Stinging sensation should subside with the use of a fan as the peel solution neutralizes itself.
- Apply Skin Perfect Skin Recovery Hydrator and SPF 30 Sunscreen before client leaves treatment. These products are recommended for post treatment home care: Skin Recovery Cleanser and Skin Recovery Hydrator for three days post treatment.