Facials a prescription for your face and it is true. For years, Michelle Palmer, a lawyer in Manhattan, bounced from aesthetician to aesthetician having her skin cleaned, assessed and exfoliated, simply because she had always heard that facials were the best way to get glowing skin. “I never did a ton of research to figure out what those products were doing, or whether or not I could get results at home, or whether I was better off going to see a dermatologist — this is what single women in the city did,” said Ms. Palmer, 36, who paid anywhere from $100 to $250 per session. Aestheticians and spas have long promoted such routine facials as required maintenance for radiant skin. But dermatologists don’t necessarily agree.
Today’s bloated and breathless spa menus promise more than a mere facial can deliver, dermatologists say, and have people thinking that monthly facials can be their first line of defense against wrinkles. “People will say, ‘I’ve had facial after facial and I still have wrinkles,’ ” said Dr. Amy Derick, a board-certified dermatologist from Barrington, Ill. “They have unrealistic expectations of what facials can do.” Meanwhile, aestheticians say that some doctors downplay how effective their treatments are because they don’t want their patients consulting the facialist down the street.
“They’re bad-mouthing us because they want our business to go to them,” said Wendei Spale, an aesthetician of 14 years and the owner of Peace of Mind Skin & Body Care in the Studio City neighborhood of Los Angeles. “If my clients go to them, they’re going to talk them into fillers, Botox or a super strong peel they don’t need.” Facials, a pillar of the $10.9-billion spa industry, are the third most popular service at spas nationwide, after massages and nail care, according to the International Spa Association. Some facials are marketed as massages for the face, relaxation pure and simple. But most spas and aestheticians also offer a dizzying array of results-oriented facials that claim to do far more.
Aestheticians say that so-called oxygen facials can plump skin, produce collagen and regenerate new cells. A company called Intraceuticals has its technology in 300 spas, resorts and doctors’ offices nationwide. It uses pressurized oxygen to deliver modified hyaluronic acid to the face, but doesn’t have any research to back its machine, said Deirdre Burke, the director of sales and education. Still, the company believes in its efficacy, she said, adding, “If you have had a treatment, you’re a believer.” But without scientific evidence, many dermatologists remain unconvinced. “Show me the data that oxygen facials make the skin better,” said Dr. Jeffrey Dover, a director of SkinCare Physicians, a comprehensive dermatology practice in Chestnut Hill, Mass. Exhale spa, with outposts in Dallas and in Santa Monica, Calif., promotes a $195 “non-surgical face lift” on their Web site that entails using “sub-sensory microcurrent waves to tone and lift facial muscles.” And the Manhattan flagship store of Dr. Nicholas Perricone, a board-certified dermatologist, offers an electro-stim lifting facial, which his site says is a “non-invasive ‘face lift’ ” that will “stimulate facial muscles to perform more youthfully….” Dr. Derick, who isn’t familiar with these two particular facials, suggests that massaging of the skin alone can cause temporary swelling, which may be responsible for that lifting effect after a facial. What then can consumers expect from deep cleansing, microdermabrasion and other staples of today’s facials?
To rid oneself of some of the outermost dead-cell layers, old-fashioned exfoliation, microdermabrasion or a glycolic peel will do the trick, many dermatologists say. A salicylic peel may help diminish sun spots, they say, and acne sufferers may benefit from a meticulous extraction of clogged pores. More and more dermatologists are hiring aestheticians to perform such services. Ms. Palmer, now married, found her facialist of three years, Rowena Woo, at her dermatologist’s office, Tribeca Skin Center in Manhattan. “If client wants an ‘anti-aging’ facial, we don’t have that,” said Ms. Woo, who sticks to basics like cleaning, extraction and exfoliation. Dr. Arielle Kauvar, the director of New York Laser & Skin Care in Manhattan, doesn’t offer facials per se, but she does offer microdermabrasion as well as glycolic and salicylic peels. “From a pure budgetary standpoint, facials can add up,” she said. She’ll advise patients who dislike their frown lines or crow’s-feet and spend hundreds of dollars on anti-aging facials to consider Botox. “The same amount of money would at least erase those wrinkles,” she said. (Temporarily, of course.) Dr. Leslie Baumann, a dermatology professor at University of Miami, ignited a firestorm recently when she wrote on her Skin Guru blog for Yahoo that facials are a waste of money. Outraged aestheticians and their followers made up a lot of the 1,453 commenters. Two criticisms were particularly sharp: that aestheticians “often don’t know which products are right for the skin of each client” and that facials cause breakouts most of the time. Dr. Baumann has since said that aestheticians play a vital role advising clientele about home care and the wearing of sunscreen.
However, she is astonished that some of her new patients “throw facials in at the level of sunscreen.” Dr. Baumann said: “Getting a facial is a great cost to cut,” because, unlike sunscreen, “it’s not doing anything preventative or anything long term for your skin.” Some aestheticians and their satisfied clients wouldn’t agree. Nancy Girten, a 50-year-old geologist from Los Angeles, used to have sun spots on her face, but since she started getting lactic acid peels 12 years ago from Ms. Spale, she is convinced that her skin tone has evened out significantly. Dermatologists are also wary of facials that aren’t customized. “If you drop into a hotel, they do a similar thing to everybody,” said Dr. Dover, who has had aestheticians on staff since 2000, and is the co-author of “The Youth Equation.” “It’s a recipe.” Such one-fits-all recipes where the aesthetician may not even do an initial skin assessment can backfire. Take the case of Dr. Dover’s wife, who is also a dermatologist. “She’s gone for spa facials where they put things on her skin that should never be put on,” he said. “Then they do a massage, and she breaks out in deep tender pimples.” Now she gives to others any gift certificate she receives for a facial. “The standard in the industry has to include a complete analysis of the skin,” said An G. Hinds, the president of Catherine Hinds Institute of Esthetics in Woburn, Mass. “Every aesthetician should know this.” But often the consumer is the one to guess which facial might work. Dermatology Partners, a practice with three aestheticians in Wellesley, Mass., circumvents this by only booking the hour, not the service, said Milena Turok, the director of aesthetics. “We analyze,” she said. “It’s dangerous for a patient to pick a treatment.” Demand customization, advised Celeste Hilling, the founder of Skin Authority, a product line used at 62 resorts and 37 doctors’ offices nationwide. “At the end of the day whether you’re spending $40 or $400,” she said, “if that facial doesn’t have active ingredients for what you want, it’s not worth it.”