MILADY

STANDARD ESTHETICS

ADVANCED 2nd Edition

MILADY STANDARD ESTHETICS
EDITORIAL CONTRIBUTOR
Judith Culp
CONTRIBUTING AUTHORS 2nd EDITION
Efrain Arroyave, M.D. Sallie Deitz Anne Miller
Anne Beauchamp Ramona Moody French Peter T. Pugliese, M.D.
Linda Bertaut Pamela Hill, R.N. Melanie Sachs
Helen Bickmore Mark Lees Cynthia Shaw
Judith Culp Natalia Michalun Laura Todd
Michelle D’Allaird M. Varinia Michalun David Vidra and Kris La Chance

ADVANCED Australia Brazil Japan Korea Mexico Singapore Spain United Kingdom
2nd Edition

United States
 Milady Standard Esthetics
Advanced, 2e
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Contents at a Glance
ORIENTATION / 1
1 Changes in Esthetics / 2
GENERAL SCIENCES / 17
2 Infection Control / 18
3 Advanced Histology of the Cell and
the Skin / 61
4 Hormones / 100
5 Anatomy and Physiology: Muscles and
Nerves / 122
6 Anatomy and Physiology: The Cardiovascular
and Lymphatic Systems / 144
7 Chemistry and Biochemistry / 163
8 Laser, Light Energy, and Radiofrequency
Therapy / 184
SKIN SCIENCES / 215
9 Wellness Management / 216
10 Advanced Skin Disorders: Skin in
Distress / 230
11 Skin Typing and Aging Analysis / 272
12 Skin Care Products: Chemistry, Ingredients,
and Selection / 288
13 Botanicals and Aromatherapy / 323
14 Ingredients and Products for Skin Issues / 349
15 Pharmacology for Estheticians / 366
ADVANCED
ESTHETICS / 393
16 Advanced Facial Techniques / 394
17 Advanced Skin Care Massage / 445
18 Advanced Facial Devices / 492
19 Advanced Hair Removal / 561
20 Advanced Makeup / 602
SPA AND ALTERNATIVE
THERAPIES / 651
21 Spa Treatments / 652
22 Complementary Wellness Therapies / 697
23 Ayurveda Theory and Treatments / 726
MEDICAL SCIENCES / 764
24 Working in a Medical Setting / 765
25 Medical Terminology / 780
26 Medical Intervention / 795
27 Plastic Surgery Procedures / 819
28 The Esthetician’s Role in Pre- and Post-Medical
Treatments / 844
BUSINESS SKILLS / 857
29 Financial Business Skills / 858
30 Marketing / 874
References and Resources / 891
Glossary/Index / 900
Contents
Procedures at a Glance / x Proteins of the Dermis—The Extracellular Matrix
(ECM) / 76
Preface / xi The Cell Cycle / 78
About the Authors / xvi An Introduction to Embryology—The Stem Cell / 80
The Major Tissues in the Body / 82
Acknowledgments / xxiii The Basic Immune System / 82
The Mechanism of Exfoliation—The Desmosomes / 84
Skin Penetration and Permeation / 86
PART 1 ORIENTATION / 1 Sensory Nerves and Perception in the Skin / 88

1 CHANGES IN ESTHETICS / 2 4 HORMONES / 100

The Global Evolution of Spas and Spa Treatments / 4
Advanced Education and Employment
Opportunities / 7
Developing Critical-Thinking Skills / 10
Enhancing Soft Skills / 12
Privacy Laws / 13
Professional Organizations and Publications / 14
What Are Hormones? / 103
The Endocrine Glands / 103
Other Hormonal Disorders That Affect the Skin / 105
Hormones Produced by the Ovaries and Testes / 108
The Hormonal Phases of Life / 109
Hirsutism / 118
Obesity, Anorexia, and Hormones / 118

5 ANATOMY AND PHYSIOLOGY: MUSCLES

AND NERVES / 122
PART 2 GENERAL SCIENCES / 17 Muscle Types / 125
2 INFECTION CONTROL / 18 Function of Skeletal Muscles / 127
Rules and Regulations Governing Workplace Muscles of the Head and Face / 128
Safety / 20 Muscles of the Neck / 131
Hepatitis / 23 Facial Nerve Patterns / 132
Human Immunodeficiency Virus (HIV) / 25 Muscles of the Arms and Shoulders / 133
Tuberculosis / 25 Muscles of the Torso / 135
Community-Acquired MRSA / 26 Muscles of the Legs / 137
The Principles of Infection Control / 28
Gloves / 35 6 ANATOMY AND PHYSIOLOGY: THE
Cleaning, Decontaminating, and Sterilizing Reusable CARDIOVASCULAR AND LYMPHATIC
Equipment / 39 SYSTEMS / 144
Potential Hazards for an Esthetician / 47 The Cardiovascular System / 146
Basic Safety Guidelines / 49 Blood / 146
OSHA Inspections / 50 The Heart / 149
Heart Disease / 152
3 ADVANCED HISTOLOGY OF THE CELL The Arterial System / 152
AND THE SKIN / 61 The Venous System / 155
Cellular Structure and Function / 65 The Lymphatic System / 158
A Brief Overview of Skin Structure and Function / 68
The Cells of the Epidermis / 69 7 CHEMISTRY AND BIOCHEMISTRY / 163
Major Cells in the Dermis / 72 Reference Tools / 165
How Keratinocytes Replace the Stratum Corneum / 74 Principles of Chemistry / 165

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 Chemical Reactions / 169 12 SKIN CARE PRODUCTS: CHEMISTRY,
Understanding Chemistry Notation / 170 INGREDIENTS, AND SELECTION / 288
Chemicals Found in the Skin and Body / 171 Why People Use Performance Skin Care
Chemical Terms Estheticians Should Know / 173 Cosmetics / 291
Botanical Chemistry / 174 Cosmetic Ingredient Categories / 291
Essential Oil Chemistry / 177 Product Penetration / 293
Alpha Hydroxy Acids / 294
8 LASER, LIGHT ENERGY, AND Beta Hydroxy Acids / 306
RADIOFREQUENCY THERAPY / 184 Retinoids and Retinoid Derivatives / 307
The History of Light and Energy Devices / 186 Free Radicals / 308
Physics / 187 Sunscreens / 310
Safety Governmental Agencies / 193 Antioxidants / 313
Safety / 196 Moisturizers—The Essential Need for Skin
Laser Therapy / 201 Hydration / 316
Intense Pulsed Light (IPL) / 205 Botanicals / 317
Radiofrequency Devices / 208 Understanding Organic / 318
Light-Emitting Diodes (LEDs) and Low-Level Light Nanotechnology / 318
Therapy / 210
Conclusion / 211
13 BOTANICALS AND AROMATHERAPY / 323
What Are Botanical Ingredients? / 325
PART 3 SKIN SCIENCES / 215 Plant Compounds and Extracts / 326
Methods of Botanical Extraction / 326
9 WELLNESS MANAGEMENT / 216 Eleven Botanicals for Skin Care / 328
Nutrients and Diet / 218 Aromatherapy and Essential Oils / 332
Nutrition and Aging / 222 What Essential Oils Can Do / 333
Effects of Stress on the Body / 225 Essential Oil Chemistry / 334
Becoming Proactive in Stress Management / 227 Contraindications / 337
Thirteen Essential Oils / 338
10 ADVANCED SKIN DISORDERS: SKIN IN Application of Essential Oils / 342
DISTRESS / 230 Recipes for Skin and Spa / 344
The Inflammation Cascade / 232 The Aromatherapy and Botanical Practice / 344
Wound Healing / 233 Holistic Consultation / 345
Injuries from Laser and Other Treatment Therapies / 240 Legal Considerations / 345
Short-Term Sun Damage / 241
Long-Term Photo-Aging / 244
14 INGREDIENTS AND PRODUCTS FOR
Skin Cancers / 245
SKIN ISSUES / 349
Other Sun-Related Skin Growths / 249
Products for a Successful Home Care
Acne / 251 Regimen / 352
Rosacea / 262 Line Selection for Designing a Successful Home Care
When to Refer a Client for Medical Evaluation / 267 Regimen / 358
How Products Are Developed / 361
11 SKIN TYPING AND AGING ANALYSIS / 272
Fitzpatrick Skin Typing / 274
Other Skin Typing Systems / 277 15 PHARMACOLOGY FOR
The Aging Analysis / 279 ESTHETICIANS / 366
The Glogau Scale / 279 Initial Consultation / 369
Rubin Classification / 280 The FDA and Drugs / 370
Oriental Reflex Zones of the Face / 281 Prescription Drugs / 370
Hormonal Balance and Skin Identification / 284 Drug Classifications / 371
Skin Categories / 286 Over-the-Counter (OTC) Drugs / 372

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PART 4 ADVANCED Speed Waxing and Body Techniques / 580
Advanced Male Waxing / 586
ESTHETICS / 393 Electrolysis / 589
Hair Removal and Plastic Surgery / 593
16 ADVANCED FACIAL TECHNIQUES / 394
Treatment Variations / 396
20 ADVANCED MAKEUP / 602
Rosacea and Sensitive Skin Treatments / 401
Mineral Makeup / 604
Clinic Exfoliation Treatments / 403
Minerals for Camouflage / 609
Mask Therapies / 416
Airbrush Makeup and Spray Tanning / 614
Eyelash Perming / 624
17 ADVANCED SKIN CARE MASSAGE / 445 Semipermanent Eyelash Extensions / 625
Massage Contraindications / 447 Permanent Cosmetics / 631
Advanced Facial Movements / 448
Selecting and Incorporating Advanced Movements / 449
Advanced Neck and Décolletage Movements / 451
Advanced Back Movements / 455 PART 5 SPA AND ALTERNATIVE
Shiatsu Massage for the Face / 456 THERAPIES / 651
Reflexology / 457
Stone Massage Techniques / 458 21 SPA TREATMENTS / 652
Lymphatic Massage for the Face and Neck / 460 Understanding Spas and Their Services / 654
Machine-Aided Facial Lymphatic Massage / 465 Topics to Consider When Performing Body
Treatments / 656
Post-Massage Care / 465
Preparing the Client / 661
The Popularity of Body Wraps and Masks / 664
18 ADVANCED FACIAL DEVICES / 492 Types of Body Wraps / 665
The Purchasing Process / 494
Hydrotherapy and Other Specialty Treatments / 674
Skin Analysis Devices / 497
IPL Facial Rejuvenation / 497 22 COMPLEMENTARY WELLNESS
Laser and IPL Hair Removal / 502 THERAPIES / 697
Laser Hair Removal Treatment / 508 Complementary Wellness / 699
Light-Emitting Diodes (LEDs) / 513 Energy Basics / 700
Photodynamic Therapy (PDT) / 514 Energy Management / 702
Machine-Aided Microdermabrasion / 515 The Chakra System / 705
Ultrasonic Technology / 518 Reiki Hands-On Healing / 708
Microcurrent Technology / 519 Energy Therapies / 710
Electrodesiccation Devices (Radiofrequency) / 522 Crystals and Gemstones / 711
Dermaplaning / 523 Introducing Energy-Balancing Treatments
Skin Needling / 523 to Clients / 718
Management of Complications / 523
23 AYURVEDA THEORY AND
19 ADVANCED HAIR REMOVAL / 561 TREATMENTS / 726
Safety and Disinfection First / 563 What Are Ayurvedic Treatments? / 728
Hirsutism and Hypertrichosis / 564 What Makes a Spa Treatment Ayurvedic? / 729
Threading / 566 Five Ayurvedic Principles to Apply to Treatments / 729
Sugaring / 568 The Three Doshas / 730
Hard Wax / 574 Vata Body-Mind Characteristics / 734
Soft Wax / 574 Pitta Body-Mind Characteristics / 735
Product Evaluation / 576 Kapha Body-Mind Characteristics / 736
Advanced Facial Waxing / 576 Ayurvedic Skin Care Treatments / 737

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PART 6 MEDICAL SCIENCES / 764
24 WORKING IN A MEDICAL SETTING / 765
Medical Esthetics / 767
How Estheticians Work with Physicians / 768
Scope of Practice / 769
The Medical Esthetic Practice / 770
Training and Education / 771
Interfacing with Medical Professionals / 773
25 MEDICAL TERMINOLOGY / 780
How Medical Terminology Works / 782
The History of Medical Terminology / 783
The Basics of Medical Terminology / 783
Root Words / 785
Prefixes / 786
Suffixes / 791
Pronunciation / 792
26 MEDICAL INTERVENTION / 795
Medical Intervention Defined / 797
Introduction to Botox Cosmetic / 800
Introduction to Dysport / 800
Introduction to Dermal Fillers / 803
Introduction to Sclerotherapy / 811
Introduction to Medical Peels / 812
27 PLASTIC SURGERY PROCEDURES / 819
Face-Lift (Rhytidectomy) / 821
Forehead Lift (Brow Lift) / 823
Eye Lift (Blepharoplasty) / 825
Nose Job (Rhinoplasty) / 827
Facial Implants / 828
Breast Implants (Augmentation Mammoplasty) / 830
Breast Lift (Mastopexy) / 832
Breast Reduction (Reduction Mammoplasty) / 833
Breast Reconstruction / 835
Tummy Tuck (Abdominoplasty) / 838
Liposuction (Suction-Assisted Lipoplasty) / 840
28 THE ESTHETICIAN’S ROLE IN PRE- AND
POST-MEDICAL TREATMENTS / 844
Pre-Medical or Laser Intervention / 846
Cancer Patients / 849
Pre-Surgical Home Care / 849
Post-Procedure Guidelines / 850
When to Refer Back to the Physician / 855
PART 7 BUSINESS SKILLS / 857
29 FINANCIAL BUSINESS SKILLS / 858
Calculating Business Risk / 860
The Business Plan / 860
Financial Planning / 862
Protecting Business Assets / 865
Employee Compensation / 866
Understanding the IRS / 868
30 MARKETING / 874
The Definition of Marketing / 876
Customer Value / 878
Strategic Value / 879
Customer Relationship Management / 879
The Promotion Mix / 880
The Marketing Plan / 884
The Brochure, or Menu of Services / 885
The Internet / 886
The Use of Technology / 886
Marketing Responsibly / 888
REFERENCES AND RESOURCES / 891
GLOSSARY/INDEX / 900
ix
Procedures List
2–1: Proper Hand Washing Technique / 51
2–2: Preparing Tools and Implements for
Sterilization / 53
2–3: Policy and Procedure for Operating
Autoclaves / 55
16–1: Thermotherapy for Clogged Pores / 421
16–2: Treatment for Sensitive Skin / 425
16–3: Manual Microdermabrasion / 429
16–4: Alpha Hydroxy Acid (AHA) Treatment / 433
16–5: Jessner’s Solution or 20 Percent BHA
Treatment / 437
16–6: Application and Removal of a Powder
Alginate Mask / 441
17–1: Shiatsu Massage for Head and Neck / 466
17–2: Ear Reflexology Massage / 470
17–3: Stone Massage for the Face / 472
17–4: Manual Lymph Drainage Massage / 478
17–5: Machine-Aided Lymph Drainage / 486
18–1: IPL Photorejuvenation / 525
18–2: Performing Laser or IPL Hair Removal
Treatments / 530
18–3: LED Skin Treatment / 533
x
18–4: Machine-Aided Microdermabrasion / 536
18–5: Ultrasonic Facial / 541
18–6: Handheld Ultrasonic and Microcurrent
Service / 547
18–7: Microcurrent Lift and Firm Facial and Hand
Treatment / 551
18–8: Electrodesiccation Treatment for
Skin Tag / 556
19–1: Brazilian Bikini Wax / 595
20–1: Maximum-Coverage Airbrushing / 636
20–2: Eyelash Perming / 639
20–3: Applying Semipermanent Eyelash
Extensions / 643
20–4: Lash Extension Removal / 648
21–1: Steps for a Body Scrub with Hydrating
Pack/Mask / 677
21–2: Applying and Removing
Seaweed Wrap / 681
21–3: Herbal Body Wrap / 686
21–4: Soothing Leg Treatment / 691
22–1: 30-Minute Mini–Wellness Procedure / 719
23–1: Basic Marma Point Massage / 746
23–2 Shirodhara Treatment / 754
Preface
Now that you have the foundations of your esthetic
training, you are ready to journey into all of the
aspects open to those with more advanced education.
It is a new frontier ripe with opportunity for success
and personal satisfaction. The need for professional
estheticians with advanced skills continues to grow
in new and exciting ways, providing ample room for
personal success in a variety of career paths.
As you move forward from your basic training,
consider the many options open to the highly skilled
technician, and you will approach your course of study
with a positive attitude, study skills and habits, and
perseverance, even when the going gets tough. Stay
focused on your goal—to become skilled far beyond
the level of a basic licensed esthetician and to create
more options as you move forward in your career. If
any problems arise that may prevent you from reaching
your goal, talk to your instructor or support team.
Organization and
Chapters
By learning and using the tools in this text together
with your teachers’ instruction, you will develop the
abilities needed to build a loyal and satisfied clientele.
To help you locate information more easily, the
chapters are grouped into seven main parts:
Part One, Orientation, provides an in-depth look at
the evolution of esthetics and its advancements and
opportunities in today’s world, in addition to learning
problem solving and critical thinking and enhancing
soft skills.
Part Two, General Sciences, presents scientific
knowledge necessary for the safe practice
of esthetics. Chapters include topics on state laws
and organizations, infection control principles,
bacteriology, anatomy and physiology, chemistry, and
equipment safety tips and training.
Part Three, Skin Sciences, opens with the effects
of proper nutrition and stress on the body and
prepares students with the information to address
and identify clients’ skin issues and plan for the best
treatment protocols through skin analysis, selection
of ingredients and products, and even aromatherapy.
Part Four, Esthetics, begins with descriptions of the
hands-on, step-by-by step procedures for employing
both equipment and non-equipment techniques
in the treatment room. Readers can gain a diverse
repertoire of treatment variations and information on
safely customizing treatments to meet an individual
client’s needs.
Part Five, Spa and Alternative Therapies, discusses
the wide array of specialty spa treatments that
technicians can incorporate into their own signature
services; products such as body wraps and masks; and
Ayurveda and other alternative healing techniques.
Part Five also touches on the importance of client
privacy and preparation.
Part Six, Medical, offers a glimpse into working in a
medical setting, including surgical treatments; pre-
and postoperative care; and medical intervention
products, such as Botox, dermal fillers, and injection
vein therapy.
Part Seven, Business Skills, provides an overview of
operating your own business, including drafting a
business and financial plan, calculating the risks, and
complying with legal guidelines to marketing your
salon or spa.
New to This Edition
In this edition we have updated resources and
information to reflect the latest industry trends and
information. Some chapters have been streamlined,
some expanded. We have rearranged some to
enhance the learning experience based on your input.
pu
put.
t.
xi
Our industry is hungry for knowledge and, while we
have tried hard to satisfy you, many chapters could
be turned into a book on their own, and this is not
feasible in a text. But here are just some of the things
you can look forward to:
Chapter 4 Hormones: more detail on how hormones
affect us and our skin in all aspects of our lives.
Chapter 7 Chemistry and Biochemistry: details
on how to make this valuable science more
understandable and useful.
Chapter 8 Laser, Light Energy, and Radiofrequency
Therapy: clarification on the role of manufacturers in
the classification process and updates in this rapidly
changing field.
Chapter 11 Skin Typing and Aging Analysis:
rearrangement to consolidate information and provide
new information including the Roberts Skin Typing
System, which is crucial for anyone using light
therapy devices.
Chapter 12 Skin Care Products: Chemistry,
Ingredients, and Selection: a whole new look provides
the latest information about topics from AHAs to sun
protection with a lot more in between.
Chapter 18 Advanced Facial Devices: many new
updates, including the addition of laser hair removal
to the light devices section in order to keep all
advanced devices in the same chapter.
A Fresh Design
Milady Standard Esthetics: Advanced, 2nd edition
includes more than 1,200 full-color illustrations and
photographs, along with a new text design similar
to the eleventh edition of Milady Standard Esthetics:
Fundamentals for easy transition from the basic to
the more advanced material. The procedures are
formatted with clear, easy-to-understand directions
and step-by-step photographs to help students
visualize important techniques.
xii
Educational Elements of
This Edition
Many features are included to help you recognize and
master key concepts and techniques.
Learning Objectives
At the beginning of each chapter is the list of learning
objectives, which is the important information in the
chapter you will be expected to know. Icons placed
within the chapter indicate that a learning objective
has been completed.
Chapter Glossary
At the beginning of each chapter is a list of key terms.
The first time a key term is used and defined in the
text, it will appear in boldface. All key terms and their
definitions are included in the glossary at the end of
the chapter as well as in the Glossary/Index at the end
of the text. The glossary terms and definitions from
Milady Standard Esthetics: Fundamentals, Eleventh
Edition, also appear in the back-of-book Glossary and
Index for easy reference.
Why Study This?
Milady knows, understands, and appreciates how
excited students are to delve into the newest and
most exciting skin care trends, and we recognize
that students can sometimes feel restless spending
time learning the basics of the profession. To
help you understand why you are learning each
chapter’s material and to help you see the role it
will play in your future career as an esthetician,
Milady has added this new section to each chapter.
The section includes three or four bullet points
that tell you why the material is important and
how you will use the material in your professional
career.
 F O C U S ON
The “FYI” features offer additional important
information related to the content.
Throughout the text are boxes in the outer column
that draw attention to various skills and concepts that
will help you obtain your goal. The “Focus On . . .” CAUTION!
pieces target all aspects of personal and professional
development. These topics are crucial to your success
as a student and as a professional. Some information is so critical for your safety and the
safety of your clients that it deserves special attention.
The text directs you to this information in the
ACTIVITY “Caution!” features found in the margins.

Here’s a Tip
The “Activity” boxes offer engaging and timely
classroom exercises that will help you understand
firsthand the concepts explained in the text. These helpful hints draw attention to situations that
may arise or give you quick ways of doing things. Look
for these tips in procedures and throughout the text.
Did You Know? Review Questions
The “Did You Know?” features call attention to At the end of each chapter is a list of questions
a special point and provide information that will designed to test your understanding of the
enhance your understanding of what you are learning information just presented. Your instructor may ask
in the text. you to write the answers to these questions as an
assignment or to answer them orally in class. If you
have trouble answering a question, go back to the
chapter, review the material, and try again.
REGULATORY AGENCY
ALERT Resources
The resources offer Web addresses and references for
additional information and activities. You can find
Laws differ from region to region, so it is important this information in the back of this textbook.
to contact state boards and provincial regulatory
agencies to learn what is allowed and not allowed
where you are studying. The “Regulatory Agency
Alert” icon appears in this text next to procedures
or practices that are regulated differently from state
to state, alerting you to refer to the laws in your
region. Your instructor will provide you with contact
information.

xiii
Extensive Teaching and Learning Package
Although Milady Standard Esthetics: Advanced is the center of the curriculum, students and educators have
a wide range of supplements from which to choose. All supplements have been revised and updated to
compliment the new edition of the textbook.

STUDENT SUPPLEMENTS
SUPPLEMENT TITLE SUPPLEMENT DESCRIPTION
Exam Review • Contains chapter-by-chapter questions in multiple-choice format to help prepare for the
written portion of licensure exams.

• Revised to meet the most stringent test-development guidelines.

• Questions are for study purposes only and are not the exact questions that will be seen on
licensure exams.

Workbook • Designed to reinforce classroom and textbook learning.

• Contains chapter-by-chapter exercises.

• Included are fill-in-the-blank exercises, matching exercises, short-answer questions,

crossword puzzles, word searches, and illustrations to label, all coordinated with material
from the text.

Step-by-Step Procedures • Can be used in conjunction with the textbook or on its own to brush up on key procedures.

• Each procedure step is clearly explained and is accompanied by full-color photos.

• At the end of each procedure you will find a rubric to note, organize, and interpret data
gathered from observations of student or professional performance.

Student CD • Interactive resource designed to reinforce classroom learning, stimulate the imagination,
and aid in preparation for board exams.

• Includes:

• More than 100 video clips that demonstrate procedures and theoretical concepts.

• Chapter quizzes that provide 10 questions at a time but draw from a quiz bank of more
than 1,200 questions.

• An arcade with four different types of games.

• An audio glossary that pronounces each term and provides the definition.

• Content follows and enhances Milady Standard Esthetics Advanced.

xiv
 SUPPLEMENT TITLE SUPPLEMENT DESCRIPTION
Interactive eBook • Requires an Internet connection.

• Enables highlighting, note-taking, and bookmarking.

• Has search capabilities.

Milady U Online • Provides an alternative way to study for licensure exams, whether taken on a computer or
Licensing Prep on paper.

• Offers familiarity with a computerized test environment during licensure exam preparation.

• Features include:

• 24/7 availability; students have the flexibility to study from any computer.

• Chapter tests, quizzes, and comprehensive exams that draw from more than 1,200
multiple-choice questions.

• All questions are available in both English and Spanish.

• Immediate results with rationales to assist with knowledge acquisition.

• Robust reports that help students determine areas of study they need to focus on.

• For more information or to order, visit www.miladyonline.cengage.com.

Educator Supplements
Milady offers a full range of innovative resources created especially for esthetics educators to make the
classroom preparation and presentation simple, effective, and enjoyable.

SUPPLEMENT TITLE
Milady Standard Esthetics Advanced Course Management Guide Print Binder
Milady Standard Esthetics Advanced Course Management Guide CD
Milady Standard Esthetics Advanced Instructor Support Slides CD
Milady Standard Esthetics Advanced Student CD School/Network Version
Milady Standard Esthetics Advanced DVD Series

Thank you for choosing Milady as your Total Learning Solutions Provider. For additional information on the
student and educator supplements or to place an order, please contact your Milady Sales Representative or visit
us online at www.milady.cengage.com.

xv
Orientation
PA R T

Chapter 1
CHANGES IN ESTHETICS

© Christy Thompson/www.Shutterstock.com
 Changes in
CHAPTER

Esthetics
Chapter Outline
• The Global Evolution of Spas
and Spa Treatments
• Advanced Education and
Employment Opportunities
• Developing Critical-Thinking
Skills
• Enhancing Soft Skills
• Privacy Laws
• Professional Organizations and
Publications
 Learning Objectives
After completing this chapter, you should be able to:
LO1 Describe the evolution of the esthetics industry.
LO2 Discuss the need for advanced education and list a variety of employment
opportunities.
LO3 Identify and discuss the steps of critical thinking and problem solving.
LO4 Explain soft skills and how to incorporate them into your work.
LO5 List Health Insurance Portability and Accountability Act (HIPAA) guidelines and your
legal obligations to your clients’ privacy.
LO6 Reference a broad range of resources to assist you in the industry.

Key Terms
Page number indicates where in the chapter the term is used.
Health Insurance holistic spa spa therapy
Portability and pg. 12 pg. 4 pg. 4
Accountability Act
(HIPAA)
pg. 13
© Phil Date/www.Shutterstock.com

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sthetician. The term has become common as awareness of skin treatments, hair removal, and more has
spread to the masses via magazines, television, and the Internet. No longer a Hollywood beauty secret,
estheticians are in demand everywhere. With changing attitudes about aging, the public is seeking out
estheticians, which is resulting in increased industry growth. Esthetics is listed in U.S. Bureau of Labor reports
as one of the top ten growth fields for 2008–2018.
Before the twentieth century, beauty techniques developed and transitioned at a snail’s pace. In today’s world,
technology and popular demand have brought the industry to an entirely new level of sophistication. New
modalities, products, and techniques are constantly popping up in the media. Although some innovations are
only smoke and mirrors, many are legitimate and safe and offer significant rewards. More people are making
career changes and turning to the satisfying field of esthetics as their new opportunity. This includes people
with advanced degrees such as nursing, communication, chemistry, education, and marketing.
As the medical profession has expanded into cosmetic enhancement, opportunities and demands for well-
educated estheticians have grown and diversified. Similarly, as the public becomes more informed, estheticians
are sought out. Baby boomers’ desire, willingness, and financial ability to do whatever is necessary to lengthen
good health and youthfulness have had a huge effect on the industry. So each new technological advance
offers the esthetician an opportunity to add to and improve his or her current skill set and to reach a broader
market share. Most important, a solid knowledge of the supposed latest and greatest treatments offers
the chance to educate the public. A poorly trained or misinformed esthetician is a far greater threat to the
industry than the medical profession. That said, if estheticians are to successfully meet challenges, they must
constantly seek out education, encourage research, and take the time to root out the facts.

Why Study Changes in Esthetics?

Estheticians should study and have a thorough understanding of changes in esthetics because:
• For estheticians to successfully move forward, it is important to know where we have come from and that
“new” ideas and trends are often a revision of something from the past. Ancient therapies may offer insights
to established client appreciation and effectiveness or value to the new or updated services.
• As our industry expands, more career opportunities develop. Learning about new career opportunities can
influence your personal choices and your professional and financial success.
• Learning the skill sets that can help you achieve your personal and professional goals will help make those
goals into realities.
• Gaining a rich understanding of practices that ensure a client’s confidentiality by employing HIPAA
standards will help you retain clients because of the steps you follow to protect them. Privacy guidelines
enhance client trust.

The Global Evolution of
Spas and Spa Treatments
Understanding the history of the spa and spa
treatments helps the esthetician know the purpose
of a treatment and how the treatment evolved.
The origin of the word spa has several possibilities.
One theory is that the word may be derived from
the Walloon (a dialect of the French language)
word espa, which means “fountain” and originates
from the name of the Belgian town Spa. Other
possibilities are that spa is an acronym of the Latin
phrase sanitas per aquas (“health through water”) or
that it originates from the Latin word spagere (“to
scatter, sprinkle, moisten”) (Figure 1–1). All origins
communicate the process: the use of water and the
implication of healing. The water treatments provided
in the spa are variously called balneotherapy, spa
therapy, and hydrotherapy; these terms can be used
interchangeably.

1 4 Changes in Esthetics Part 1: Orientation


Figure 1–1
Spas originally developed as a means of healing via water.
Although many spa treatments seem new and never
before tried, the reality is that most of the spa
treatments provided today are derivations of ancient
treatments. It is thought that spa treatments began
in bathhouses in ancient Greece and in the Roman
Empire. Originally, Roman bathing culture had a
medicinal focus before evolving toward relaxation.
There were three types of bathhouses in Rome: balnea
(home), balnea private (private baths), and balnea
public (public baths). Known for their vast aqueducts,
the Romans created enormous bathhouses on their
newly conquered lands, and they combined baths
with other healthy endeavors, such as exercise and
© Ximagination/www.Shutterstock.com
massage. The best-preserved of the ancient Roman
spas is the famous Spa of Bath, England, which
allows visitors to see how these baths functioned. Spa
treatments highlighted the benefits of mud therapy,
and elite Romans began to enjoy these luxuries.
Part 1: Orientation
ACTIVITY
Visit http://www.romanbaths.co.uk and explore the
ancient Roman spa of Bath, England, to appreciate
the engineering and advancements of this ancient
civilization.
When the Roman Empire fell in AD 476, only a
few of the original bathhouses escaped destruction.
During this time, public bathing was prohibited by
the religious culture; some people avoided bathing
for years. Most bathhouses were turned into churches
because prayer was considered more important than
relaxation.
There was not much advancement in spa culture from
this time until the thirteenth century, when Moorish
influence rose in southern Europe. A fastidious
people, the Moors contributed to a resurgence
in bathing and in public bath popularity. Again,
bathing was primarily for the purpose of relaxation.
But medicinal processes, such as bloodletting (the
bleeding of the patient), were also performed at the
baths. During medieval times, bloodletting, also
known as phlebotomy (fluh-BAHT-uh-me), was a
popular treatment for a wide variety of ailments.
Bloodletters believed that reducing excess blood from
the body restored balance and good health. Today’s
phlebotomist is a medical professional who draws
blood from the body for diagnosis.
The sixteenth century and the Renaissance period saw
another decline in the use of public baths. This was
due to many factors, including the lack of firewood
to heat the bathhouses and water and common public
fear that the bathhouse was the cause of diseases such
as syphilis and leprosy. Nevertheless, the wealthy
continued to visit bathhouses, though they preferred
natural sources, such as hot springs or mineral water.
During this time natural mineral springs gained
popularity. An attempt was made to analyze the
water’s mineral content scientifically to establish if
there actually was any therapeutic value in balneology,
the study of bathing for health purposes. At this
time, the philosophy of drinking the water as well
Changes in Esthetics 5 1
 as bathing in the water became commonplace. The
general population did not drink a lot of water, and
physicians recommended drinking large amounts
of the mineral waters for potential curative effects.
One early “bath” was used exclusively for drinking
mineral water. Additional pools were built for bathing
purposes.
During the seventeenth century, the French joined the
movement with both hot and cold springs. They used
cold springs for drinking therapies only and hot
springs for drinking cures as well as bathing. The
French took these therapies quite seriously, and it was
at this time that physicians became an integral part of
the spa experience.
As the popularity of bathing in springs grew, scientists
attempted to replicate natural mineral springs’
benefits for medicinal purposes. A nineteenth-century
Bavarian monk, Father Sebastian Kneipp, believed
that using water to eliminate waste from the body
could cure disease. He developed more than 100
different hydrotherapy treatments using water in
solid, liquid, and vapor forms to treat individuals.
His treatments included washings, wraps, packs,
compresses, steam, and baths (Figure 1–2).
When Europeans began to immigrate to the United
States, they brought the spa concept with them.
But it wasn’t until the mid-1800s that hotels and
guesthouses built near mineral springs started drawing
guests to enjoy the waters. This movement led to
what was known as spa resorts. These resorts, which
© Milady, a part of Cengage Learning. Photography by Larry Hamill.
Figure 1–2
Steaming is just one of many hydrotherapy treatments.
1 6 Changes in Esthetics
also included theaters and casinos, became very
popular with both the elite and middle classes over
the next few decades.
When depression hit in the 1930s, development of
spas halted in the United States, and many European
spas that had catered to Americans closed. After
World War II, with the worldwide economy on the
rise, spas regained popularity, and new treatments,
such as health and exercise regimens, mud therapy,
balneology, and hydrotherapy, were added. Eventually,
however, the focus of preventive practice lost ground
to the advances of modern medicine. Spas once again
went on the decline.
Today, there is a worldwide spa revival that recognizes
the benefits of preventive therapies (Figure 1–3).
One of the fastest-growing industries in the United
States, spas have become an important component
of American and global life. According to the
2011 U.S. Spa Industry Report published by the
International Spa Association (ISPA), revenues from
spas in 2010 were $12.8 billion. This is an increase
of $3.4 billion since 2006. Despite economic
impacts, spas are growing and expanding to meet
© Yanik Chauvin/www.Shutterstock.com.
Figure 1–3
Mud treatments are experiencing renewed popularity.
Part 1: Orientation
 Review Questions
1. How has the medical community contributed to the esthetics community?
2. Why has advanced esthetics education become so important?
3. From what country is the term spa believed to have originated?
4. What is the meaning of the term spa?
5. List three terms for water treatments.
6. Who is credited with inventing hydrotherapy treatments such as wraps and steam baths?
7. List five different areas in which an esthetician may find employment.
8. List each step in developing critical-thinking skills.
9. List several ways you can tune in to your client’s needs.
10. What is HIPAA and how does it affect you?

Glossary
Health Insurance a federal act passed in 1996 and enacted on April 14, 2003 outlining federal privacy
Portability and standards for patients. The act covers access to medical records, notice of privacy practices,
Accountability Act limitations on use of personal medical information, prohibitions on using patient information
(HIPAA) for marketing, stronger state laws, confidential communication, and complaint procedures.

holistic describes the practice and/or philosophy of treating the person as a whole and remaining
alert to all of a client’s needs rather than focusing solely on a disease or disorder.

spa a term originally meaning “health through water.” Today it most often refers to day spas or
destination spas, where clients can find a wide range of treatments.

spa therapy water treatments provided in a spa.

1 16 Changes in Esthetics Part 1: Orientation

PROCEDURE

IMPLEMENTS
AND MATERIALS
Preparation
• Nail brush Ensure that the materials are available.
• Soap
•
•
Paper towels
Access to sink with hot and
Procedure
cold running water 1 1 Wet your hands with warm
running water.

2 2 Apply soap (either

antimicrobial or plain) as directed
by the manufacturer and thoroughly
distribute it over your hands.

3 3 Vigorously rub together all

surfaces of your lathered hands for
20 seconds, including the following:
a. Between the fingers
b. Thumbs
c. Wrists
© Milady, a part of Cengage Learning. Photography by Dino Petrocelli.
d. Nail beds
e. Beneath the fingernails
f. Palms of the hands

Friction is the most important part of hand

washing. Proper hand washing should take
approximately 60 seconds.

Part 2: General Science Infection Control 51 2

 PROCEDURE

Proper Hand Washing Technique (continued)

4 4 Choose a clean, disinfected nail brush. Wet the nail brush, pump soap
on it, and brush your nails horizontally back and forth under the free edges.
Change the direction of the brush to vertical and move the brush up and
down along the nail folds of the fingernails. The process of brushing both
hands should take about 60 seconds.

5 6 7

5 Thoroughly rinse your hands,
from the top of the wrists down to
the fingertips, under warm running
water to remove any residual soap.
6 Blot hands dry with a
disposable paper towel. Take the
time to pat your hands dry. Do not
rub your hands together vigorously,
as this can cause microscopic
abrasions that compromise the
skin’s integrity.
7 If the hand washing sink
does not have foot controls or an
automatic shutoff, use a clean
paper towel to turn off the faucet
and to handle any doorknobs to
avoid recontaminating your hands.

8 8 Dispose of the paper towel you used to dry your hands in a trash receptacle.
9 As an optional step, apply hand lotion as needed. Make sure your lotion will not affect your
gloves. Do not use any products containing petroleum with latex.

Post-Procedure
© Milady, a part of Cengage Learning. Photography by Dino Petrocelli.

Inspect your hands, including cuticles, for any visible microabrasions. If any are
present, wear gloves to prevent microorganisms from entering this portal.

Clean-up and Disinfection

10 Clean and then disinfect the sink area on a routine scheduled basis such
as at the end of the day and/or at the start of the day.
11 Dispose of the paper towel used to disinfect in a trash receptacle.

2 52 Infection Control Part 2: General Sciences