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- [00:00]
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- [00:32]
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- [00:59]
Tessa Zolli
Hello guys. Welcome back to the Treatment Room podcast with your host, Tessa Zolli. So today we're going to be talking all about acne as a specialty and as a career for estheticians. I am joined by the best possible guest to speak on this topic, Douglas Preston, who happened to be my, my esthetician and acne specialist back in the day before I officially really got into this niche. Douglas, welcome to the show. We're excited to have you.
- [01:33]
Douglas Preston
Thank you. It's always wonderful to be on your podcast. It's a lot of fun.
- [01:38]
Tessa Zolli
Yes, it is. And this is a spontaneous episode so we're extra lucky to have you today. So Douglas, do you want to speak a little bit on your background as an acne specialist and esthetician?
- [01:51]
Douglas Preston
Sure. And again, thank you again for having me on your program. I like I said, I really do enjoy it. This is my 44th year of aesthetics now as a practitioner. I've actually retired. I finally put my steamer and extractor down and off and I have to tell you, I do miss it. But you know, there's other aspects of business that I handle. So I'm still in the game and probably always will be. Acne was not my original focus. It was age management treatments. I switched to including acne and I, by the way, it never was exclusively acne. We'll talk about that later. But it kind of happened by accident in a sense. And that's when a. And this is in my last practice that I had, I've had a couple when a pediatrician brought her son to me for an acne condition. And I thought, my gosh, here's a doctor bringing her child to me for acne care. She should be able to do it. But she did not want to go the medical route. She didn't want him using drugs to handle the treatment and thought maybe I could handle it for her. It turned out quite well. I cleared him up. And after that, she and her entire medical office, pediatrician office, began to send their teenage clients to me and younger actually, from 12 up, for acne. And suddenly I had a booming acne business, and it grew from there. So that's really how that began. Prior to that, in working with congestive skin, I had developed a special comedone extractor for this purpose. Some of you all may have heard of that, called the Preston extractor with an Rx at the front of it. And that's become a worldwide phenomenon. It's the most effective tool there is for extractions. And so since then, I've developed certification programs and training programs both live and online. And that's all done under the banner of Preston Acne Pros, and you can find us online under that name.
- [04:20]
Tessa Zolli
Do you think acne is an area of esthetics that you would recommend estheticians get into? Why do you think it could be a good career move?
- [04:32]
Douglas Preston
Well, I certainly do, and there's a number of reasons for it. Certainly, if your focus is on skin care, as an esthetician, you may be doing other things as well. But if skin care and facial treatments is the core of your business, then certainly acne care broadens your client base by quite a bit. Not only with teenagers, but young adults and even adults who have adult onset acne or who have follicular congestion that may maybe not, as it may not be inflamed, but certainly visually it's not desirable and it's something that we want to correct. So, yes, I think it's a fantastic career and a growing one as more and more people are experiencing acne but seeking alternate sources of treatment for it. Not just medical, but also natural remedies and so forth, and a non traditional, which to a great degree, the work we do as estheticians would qualify for that.
- [05:46]
Tessa Zolli
Yes. And before we get into more about training, just as a baseline for anyone listening who's not familiar, could you explain a little bit about what is the difference between, you know, congestion versus comedones? How would you define that versus cysts and deeper breakouts?
- [06:09]
Douglas Preston
Sure. There's a broad spectrum of acne conditions and causes. What I have Done is I drill down into a specific area of acne treatment which I call congestive acne. This is where the follicles are blocked by a combination of sticky sebum and epithelial matter, dead skin cells that are shedding at a high rate, mixing with this sticky sebum and causing a blockage in the follicle. Now that on its own is not necessarily going to cause a pimple or, or hot inflammation. You may just have a closed comedone there, which visually doesn't look very good, or you may have a blackhead which never becomes infected, let's say traditionally infected. There's some new research about going on right now about unseen or sort of silent inflammation that actually leads to congestion. But I begin where the congestion is visible and in the follicle and is either creating a visual problem, an inflammation problem with pimples, or both. And the reason that I focus on that is because it's the most common type of acne that estheticians will encounter. And it's also the easiest for us to get some clearing in because we can concentrate on follicular relief. And whether or not your, your client wants to participate in that, you know, in the, in the sort of full spectrum of home care. Right. Which is very difficult to get many of them to do. If your extraction skills are, are good and you're, if, and you're efficient and you know what you're doing with this, you can get tremendous clearing results. And without your client having to follow through on every single aspect of home care, which I don't know about you, but very few of mine really participated in that to some degree. Yes, mostly partially, and in some cases not at all. They just let me do the whole thing. And because I have this extraction tool that works so well for that. This area, this area of managing follicular congestion once it's already in place, not prevention, because prevention is another thing. But if it's there, then that's really where the space where I come in and say, okay, let's do a really good job here so that we can create improvement without necessarily having to manage the entire issue.
- [09:05]
Tessa Zolli
Yeah, I want to spend some time talking about extractions because I think it's an area of our industry where we could use some improvement. You know, there are risks to it if it's not done correctly. Right. I see a lot of that where, you know, the extractions maybe were not thorough and part of the infection is still in the pore, leading to a bunch of purging and kind of a worse situation or I've seen clients that have gotten real infections from extractions being done not only by estheticians but even in doctor's offices.
- [09:42]
Douglas Preston
Right.
- [09:43]
Tessa Zolli
So there's some risk involved, but it can be a great thing to relieve that congestion. So when it comes to an esthetician who really wants to get the right training, do you think just going to esthetician school is going to give them enough training or what else would you suggest?
- [10:00]
Douglas Preston
No, esthetician school will give you no training. And there's reasons for that. And in fact, anybody who takes one of my programs, training programs, that's one of their main complaints is that they went through esthetician school and if they touched on extractions at all, it was very, very minor. There's reasons for that. And the first reason, primarily for schools is that their job is to get the, their student to pass their state board exams. And extractions is not on that, on that test. It's not part of it. So they don't go there. The other reason is really, quite frankly, it's a business reason, and that is that extractions lead to trouble if they're not done properly. The school doesn't have the proper training and the esthetician, of course, is not trained in it at all. So when you start squeezing on the skin that's delicate like this, where bacteria is involved, you run high risk of secondary infections and so forth for no real benefit for the school. So they want to stay away from that. I can't blame them at all. So postgraduate education is where you're going to find your extraction training. There's different people who do it. I of course, think I have the superior method, needless to say, and it's been around for four decades, but it is a frustrating thing. So estheticians really are going to want to get extraction focused training. It is a skill. It takes a certain amount of courage and confidence in order to do it correctly. Particularly if you're using the Preston extractor. It's a serious extraction tool, but at the same time it must be done correctly, as you said. But increasingly it is a modality that customers, particularly acne customers, demand. But they don't want it to be an unpleasant experience. Unfortunately, it often is because of a lack of training or in many cases an esthetician who is overly aggressive without realizing it.
- [12:10]
Tessa Zolli
Absolutely. Yeah, let's talk about that too, because that's a big complaint. I hear from clients that, well, it can either kind of be either one of these, you know, not enough was gotten out of the skin or it was too long, it was overly aggressive, like you said, and it was super painful. And that's what sticks with the client. Do you have any tips for estheticians when it comes to doing extractions more effectively and just how to provide the best overall experience for the client?
- [12:46]
Douglas Preston
Sure. The biggest problem that I've been able to detect is insufficient communication between the service provider and the customer. Now, when you have your initial consult with a potential customer, we need to really get a thorough understanding of what their expectations are, and particularly if we're going to be doing extractions. So if I think that's going to be part of the service, we're going to talk about that. So I might ask, have you had extraction treatments in the past? If so, what was your experience like? And so here you're going to find out what went on. What I usually hear are one of two things. One is they hardly did any at all, or they attacked me and it really hurt and it was very unpleasant. Okay. So in both cases, what I'm hearing is that there was no negotiation between the esthetician and the client. This needs to happen. So if I think extractions are going to be a part of what I'm going to do, I'm going to talk about that separately from all the rest of the. Of the treatment. Say, let me. Let me explain some things about extractions for you. Here's why we do them. Let me tell you my method for doing this. And we're going to do this to the degree that we need to. As long as you feel comfortable with it, I'll show you the tool that I use. We're going to do this together. So I'll be checking with your comfort level as we go along. If it's working fine for you, fantastic, then great. We'll just get out. We'll do as much as need be. If it's not agreeing with you, please let me know. We'll find another way, or we won't do that at all. But you're in charge here. So when you do this with a customer and you bring them into the service as having some control, they are much more tolerant of any discomfort that you might create. They're more patient with it, and they are. They're less inhibited because they're not waiting for something to go wrong. Right. Or they're gauging you against a bad experience. And I can promise you almost nobody ever does this. And so, and especially dermatologists, if, for heaven's sake, if they. Or you know, an esthetician that they have is going to treat you. You know, you're just ahead with a, with a, with a bunch of congested follicles. So you want to have, you want to show your skill verbally first, engage the customer, get their agreement to do this so they feel confident in you. And I can tell you, you can do so much more. The satisfaction rate is much, much, much higher.
- [15:36]
Tessa Zolli
Absolutely. I feel like also what you're saying is helping to build trust when for so long they've probably felt, you know, frustrated by this condition. And like, they've been in a lot of situations with providers where they haven't felt seen or like that trust has been built. And I hear it all the time, the complaints about the dermatology visits, which is, you know, nothing against the derms. We've talked before about how it's. The insurance system is. So it doesn't allow for much time, but I think when you're a young person struggling with this condition, how much it affects you day in and day out, and you're seeking help in a professional and you just don't get that so often when you go in for these visits. So, yeah, I love what you're saying. Really taking the time to set the expectation, talk to them and involve them in this process, which is pretty vulnerable. Like, you know, you're meeting a new person, sharing your bare skin with them, and you have to go through a somewhat uncomfortable process. Right. Sitting there. It can be painful.
- [16:43]
Douglas Preston
It can. And certainly tens of thousands of treatments that I performed in my career, I removed a lot of follicular congestion. And yeah, in some cases, in many cases it was uncomfortable, but the client was satisfied with the fact that they were getting what they wanted. I did on, you know, what that felt like. But again, it was a process we did together and you weren't exactly living across the street from me.
- [17:15]
Tessa Zolli
So the guys, I would drive two hours to go see Douglas because this tool, which we are going to link in the show, notes the Preston extractor. And I'll. I'll leave my code as well for you guys. We have a special code for our listeners and anyone watching, but this tool is really special. It does allow you to get deep congestion out without trauma to the skin. So, you know, while nothing is painless when it comes to extractions, it's. It is exceptional and I think it is the best on the market. So I went out of my way.
- [17:51]
Douglas Preston
To see Douglas and I miss you, by the way.
- [17:54]
Tessa Zolli
I miss you too.
- [17:58]
Douglas Preston
What I found, also with a Lot of estheticians is that one of the reasons they underperform is that it's a lack of confidence. You know, they haven't had proper training. They're really worried about getting a negative reaction from their client. In some cases they have, and they're scared, and so they don't want to go any further. And so they'll sometimes create a philosophy that protects them from having to advance their skills. Right. It's like, well, clients don't like it, or I feel like that, you know, we shouldn't do this, or, you know, or, you know, this is the only method that's safe. And there's a lot of misinformation and misunderstanding out there under extractions. You know, I've taken every chance in the world that was legal with that extraction process. I mean, I've done everything on every type of skin, and I'm aggressive, but because I know I can do this. And I've created some miracles with just extractions alone on clients who wouldn't do anything but just show up, right, and have me remove this. Little by little, we were able to get ahead of the infectious cycle. So confidence is something that we build over time. Right. We don't start out that way. And I think it's a good idea to accept the fact that perhaps, you know, you're not feeding healing strongly about extractions simply because you're not schooled in it. And that makes sense, and it's probably the wise way to go. But it would really benefit anybody who even is doing just age management treatments. And you have clients with closed comedones and lots of open comedones around the eyes on the nose. Again, that's a visual problem. That's what I call an aesthetic problem, not an acne problem. Technically it's acne, but I consider it aesthetic. And let's face it, it's visual. Clients look better when that's out, and that's one of the reasons they come to see us, is they want that change and we have to deliver it. You were mentioning earlier about incorrect extractions. One of the things that's really important when you're dealing with congested follicles is to really understand what's down in that place down in there. And sometimes post extraction, breakouts happen because of a stimulation of a certain type of acid that leads to more congestion, therefore more bacterial interaction with that.
- [20:34]
Tessa Zolli
Are you talking about purging, Douglas?
- [20:37]
Douglas Preston
No, not purging. Purging is something that. It's interesting. My wonderful colleague Rebecca James Gadbury sent Me a couple of papers recently on advances in acne.
- [20:49]
Tessa Zolli
Oh, wow.
- [20:50]
Douglas Preston
Treatment. And one of the things that was in there, I had to laugh at that today, was the myth behind purging. Well, I always knew it was a myth from the very first time I heard about it in beauty school. It didn't make sense to me because physiologically it's not possible. It is an incorrect way to explain a phenomenon that happens that. That is actually not good. And it is not purging. It is reactive, and it can be avoided. So, for example, just to give you an idea, I know I'm a little off track here, but this might be helpful to people. In my very first year as an esthetician, people, and I would interview people, I would say, what is it about facial treatments you've had in the past that you don't like? And they would say, well, I break out for two or three days after I said, why is that? They said, well, they said that, you know, my skin was purging toxins. And I heard a couple of our professional educators back in the day saying, yeah, you know, we're. We're. We're purging toxins. I said, what toxins? Which ones? So you never could name them. And I said, and where are they? Where are these toxins if they're in the skin? Right. I mean, let's say a facial is not going to draw something out of living tissue. A facial is going to remove something that's topically present. So I said, so if these toxins are present, how come we're not getting a reaction until we do a facial? They're there. They can do it. The fact is that it's not that at all. And I knew that. So what I did was I explored the various ways that skins could react post facial. And one of the things I discovered right off was that when you're using heavy lipids, such as a massage cream or a massage oil on the skin and you work that in, right? You're using pressure and heat while you're doing that massage. Many, if not most estheticians leave that on or wipe it off a little bit, right? But they leave it on because it's a molly and it's nice. That will break you up. So what I did was when I ran my spas and I had my big body of estheticians who worked for me and we trained them. What we did was we, after the massage, we used an emulsifying cleanser and removed every trace of it and then went on in our next Steps, we experienced zero purging because we didn't cause it. Do you see what I mean? And that's why our satisfaction rate was so high, because that wasn't necessary. And. And let's face it, if the. If the toxins are there, they're not. And you don't see a problem. What is the problem? And when you bring it out and you break out for three days, and then after that, you look normal again, what's the point? You're not any better off. So this is the thing that, you know, when you really study this business of skin care, you find out that there are certain things that sound good, may not be, but when it. Again, going back to extractions, there are. There are proper ways to do it and ways that are incorrect. But what you have to know is, what is it that's down in the follicle, that blockage that is actually causing this issue? And you have to get that out. And then when you purge, for example, or, you know, you're just breaking out cosmetically, basically, is what's happening. There are no comedones in those little pustules. It's just pus. But in a comedone that is infected, there's a blockage down there. You have to find that. Now, you can cause problems if you're really super aggressive and you breach the follicular wall and introduce bacteria into the dermis. That can happen. Okay, it corrects, too. But generally speaking, if you do this correctly and you clean everything out, that skin is going to immediately improve its appearance because the cascade of events that's taking place in there has now been interrupted and the skin will clear. That's why it's so critical when we're dealing with acne that's visually evident.
- [25:11]
Tessa Zolli
What do you think is the biggest mistake estheticians make when doing extractions?
- [25:20]
Douglas Preston
One, not paying careful attention enough to the client's response to that. Two, not prioritizing the right kinds of extractions. For example, if you've got active acne and you have lesions, you have pustules, right? You want to address that. But really, because if you look at the space and realize, okay, we have blocked follicles that are in the process of becoming these active pustules, then if you want to clear the skin, your target extraction should be on the blockages that have not yet progressed into that open inflammation. And therefore, we're talking about closed comedones, or what sometimes referred to as maturation arrest. And sometimes a closed comedone will never advance to an inflamed and infectious stage, just sit there. But that is the case. So it is. It's not having a good plan, not being too aggressive on certain types of lesions, particularly infected lesions. If you work those too hard, you can again, you can burst the follicular wall.
- [26:33]
Tessa Zolli
Would you say leave. Estheticians should leave inflamed lesions alone, or would it be different with your tool?
- [26:42]
Douglas Preston
If you have a large pustule on the skin? My extractor is not designed for that. This is something you want to open up. You can use just cotton swabs. I mean, just a pair of cotton swabs and relieve it that way. If you are in a state where you have a, you can use a lancet, then I would open it up that way and then use cotton swabs on the side to massage it. And. But remember, you're going, you're, you're going to get infectious debris first, pus and probably some blood. And at the bottom of all of that mess is a plug. And that's got to come out. If you don't get that and the skin closes back around it, the cycle repeats and can worsen. So you have, you really do have to understand what you're doing. And it's just a matter of study, Right. That's all. And learning. But we need to make sure we're investing in that education so that we can advance our skills and therefore our businesses.
- [27:39]
Tessa Zolli
Is there anything estheticians should be doing as far as prep for these extractions that would lead to a better outcome?
- [27:46]
Douglas Preston
Yes. And it depends on what you're doing. I find a lot of times people over prep for it because their method of extracting is, is, is, is pretty pale. But, you know, you know, a salicylic cleanser. I was reading that people saying, oh, you shouldn't use steam when you're doing this well, because it's too hot. I just find that funny. That's like saying, I'm not going to go swimming because, you know, the pool is eight feet deep at one end. Well, go, go on the other side. It's only two feet, right? I mean, you don't have to do that. So if your steamer, you want to check with your client and make sure that the steamer feels comfortable. And if it's not better, back it up. Right? Move it away a bit.
- [28:30]
Tessa Zolli
You know what is funny? And maybe that I think this deserves, maybe a little more communication between the client and the esthetician is explaining, like what the steam should be because some clients almost just think they need to sweat and have the most intense steam, like super close to their face, which is also, you know, just maybe too much. We don't want excess steam. And it's not necessary.
- [28:58]
Douglas Preston
Well, we're not trying to damage the skin.
- [29:00]
Tessa Zolli
No.
- [29:01]
Douglas Preston
Or to stimulate bacterial growth.
- [29:03]
Tessa Zolli
Right.
- [29:04]
Douglas Preston
Or a glandular activity. I've never had anybody tell me they didn't get enough steam. But again, we're engineers, as service people, you know, we're supposed to let people know what's going on. Now, if you overdo it, you're going to sound like you don't have much confidence. Right. But some of the basics where the client is going to experience something that is, you know, that might be significant physically or, you know, even. Even in terms of scent, we have to prepare them for this. And so when it comes to something like steam, I explain what it's for. Right. This is to apply an even. An even veil of moisture at a warm level. Because going back now to what you were saying, first I'm going to use a salicylic cleanser to try to loosen up some of the material in the skin. And then generally I will use a proteolytic or keratolytic enzyme, papain, broline, in combination under steam so that we can loosen up the epithelial matter, but also to raise the ph of the skin. We want that skin soft and pliable, which, when you've got a higher PH level, you will achieve that. And then at that point, I start extracting. After that, then you can apply a toner if you want, because we do want to, you know, to change the ph back to an acidic level. And cold applications if need be. And then anything else you want to use, you know, red light therapy or blue light therapy, depending on your approach, you know, that's up to the esthetician, but prepping for extractions. Yeah, I do a few minutes of cleansing, about five to seven minutes with a proteolytic enzyme topical. Does the crustacean lotion and enzyme mask remove that and I go right in and start extracting. And if you have the right tool, you don't need to keep heating the skin up again. In fact, the Preston extractor is so effective, you really could even use it on just cold skin right on top of it. Preferably not, but it will work. Absolutely. But the best way is with that.
- [31:28]
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- [31:47]
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- [32:22]
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- [32:29]
Douglas Preston
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- [32:31]
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- [32:32]
Douglas Preston
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- [32:50]
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- [32:59]
Tessa Zolli
Mobile.Com and what makes your tool so different?
- [33:07]
Douglas Preston
It is the only tool of its type and and I developed it as a result of frustration with all the other tools, extraction tools that are out there. In fact I was working with my engineer today on, on a possible new concept and we were on Amazon looking at some of the existing tools and you can, you know that you would, you'll find a case, you know, have 10 different devices in there, right? Piercing tools and you know, things that you know, loops and cup and holes and all of that. All of that was available in 1981 when I got into this business 44 years ago and these tools have not advanced since. It's the same ones but they weren't allowing me to do What I needed to do, which was to reach underneath the skin under a follicle and lift material out. The closest way I could achieve that was with cotton swabs. But they're big and bulky, they're not precise. And so, so I created a tool that would allow me to put localize pressure on a single follicle, get it under that follicle and lift. But not only just for that purpose, but in really difficult parts of the face to treat, such as below the chin, the neck, the lower chin. That skin is soft, it's hard to reach. It's very sensitive. No extraction method works down there. Maybe your fingers, you know, that are wrapped with some tissue, but that's again, that's not precise. You know, you're, you're grabbing a lot of skin and squeezing it. It's a tremendous amount of non localized pressure. You know, it's just a clunky way of going about doing things. And so I knew what I was looking for in terms of how a tool would work. Nothing existed. So I modified a medical tool originally to try to create this kind of shape. And after a lot of experimentation and also creating methods. Right, because once I got this tool, then I figured how to use turned out to be quite a phenomenon. And now it's patented and it's sold worldwide. We ship all over the world.
- [35:29]
Tessa Zolli
And you've partnered up with Face Reality as well?
- [35:33]
Douglas Preston
Yes, we have. That is a little bit of a different track here. Face Reality had approached us a couple of years ago because they were very interested in our extraction process. They have their acne training down very, very well. I don't think you could do better than Face Reality, but the area of extractions is kind of a space that I own, if you will. I mean, there's lots of ways to do it, right? There's only one Preston way. And they knew that that was superior to what they had been doing and wanted to incorporate that into their educational programs. And we have done that. In fact, I'll be with them in Las Vegas next month doing demos for the extractor. So they are, besides Preston acne pros, they are our only distributor of that tool in the United States. States and outside. We, we do sell outside as well, but, but we've had a nice partnership in that regard and it works well.
- [36:37]
Tessa Zolli
Good. I wanted to touch on picking a little bit because I still remember, you know, the education you gave me as a client about picking. And I was wondering if you could share that with, with us a little bit about, you know, what are you actually doing to the skin, what are the risks involved when, you know, just say a non professional. Of course a professional could do it too, but a non professional, maybe a young person sees acne on their face and they just want to get it off. Like, what's the psychology behind that? And then what's the risk of picking at your skin?
- [37:19]
Douglas Preston
You know, it's an interesting subject because I'm quite different as a practitioner. For one, I do things my own way. I figure as long as they're legal and they work right, I can plan this for myself. So I don't follow anybody's protocol. I don't follow anybody's product line, anything like that. I do this on my own. I make my own decisions based on experience. And when it comes down to picking, as a skincare professional, I'm very, very realistic. I do not try to control behavior outside of my office. Right. People do what they want to do. If they want to lose weight, they have to do things that they're not going to want to do. They need to exercise, go to the gym, cut out all these foods. Not. Yeah, right. So a few will, but most won't. That's why it fails so much. And when we're talking about things like picking, okay, clients are going to pick, they pick. I mean, almost 100% of my clients pick. Nagging doesn't change it. I would have parents who would say, you know, can you tell Sarah not to pick? I said, sure, Sarah don't pick. And then we. And she'd laugh and I'd laugh, right, because she's gonna pick. If they want to pick, they're gonna pick. And they pick out a stress, they pick out of, you know, nervousness, right? Everybody's got a, you know, a high powered mirror, right? A five powered mirror, if not a ten. Sometimes estheticians would say, well, I don't let my clients have those. And I just laughed and said, look, if your client doesn't have a high power mirror, you need buy them one. Because it's what they see up close that nobody else sees that gets them into our office. Right. These are good for business. So you want them to see these things. Now, picking, usually where picking creates scarring, is when it's done with a fingernail or tools. And oftentimes it is on very inflamed tissue, like a pustule. And if you squeeze that or you dig out some living tissue, then when that skin heals, there is, there is tissue missing that would otherwise be there to replace itself. It's Gone. So now you can have a divot. And by the way, when we talk about scarring, I'm not talking about discoloration. And this happens a lot. People will say, well, I don't want to scar. Well, what do you mean by scarring? Well, red marks, it's last a while. That's not a scar, that's a blemish. There's a difference. A scar is literally tissue disfigurement. Okay, so we're talking about a race scar, a pit scar, keloid, whatever that is, a scar, it's a repair. It's a patch on the skin for a trauma that happened. But if we're talking about, you know, some post inflammatory hyperpigmentation or erythema or some kind of pigmentation, that's a blemish and usually it's temporary, but there's a difference. Okay, so it's really important to understand the difference between scarring and discoloration. They're not the same thing. But if we. If, but, but where a person is going to have pitting as a result of their own picking, it's because they got really aggressive, like I said, with a tool or a fingernail, and they've dug out some tissue. Also, if they created a huge infection, there may be some burnout in that follicle that will then cause some pitting. So I certainly have a few scars from when I was a teenager and digging with my fingernails. Right. Some people have used all kinds of crude instruments on their skin from, you know, from hairpins to, you know, tools out of the, out of the garage. I mean, I heard some crazy stories, but picking is something people do as a result of frustration, as a result of nervousness and so forth. So it's what I'm trying to explain to the esthetician is, look, it is not our obligation to control behavior. It is not our obligation to make people follow through on their home care routine or even to buy one. That is not our responsibility. Our responsibility is to determine what's the, what the problem is, respond to it with our knowledge, and let it go at that.
- [41:54]
Tessa Zolli
I wanted to ask you, you know, I get this question often. What is going on when a client says, I'm continuously breaking out in the same place over and over again.
- [42:08]
Douglas Preston
Okay. Oftentimes that's the cheek area, I find, but a lot of times it's in the hormonal zone. Right. So around the mouth, chin, lower area, then we're dealing with systemic issues there. And that may be something that's a little. That's going to require a little more control. Right. So here's where you're dealing with gut health, with lifestyle, with stress, with bad diet, with, you know, recreational drugs, alcohol, you know, over, over consumption of caffeine. There are so many things incorrect product selection. Right. We can't control all of that, but we can at least keep investigating to see if we can find what some of the influences are there and control that. In some cases, it just keeps happening. And if I can't control it, usually I can at least mitigate it. And for many people that's good because I don't have a cure for it. Doctors don't have a cure for it. Right. And, and so we need to be practical about that. You know, my job is to control this condition as much as I can until finally it corrects itself, which usually it will over time. And there's various, various schools of thought about that. And I have my own. But, but that is a common problem. I saw it many, many times, you know, that a person would have this area and you know, people say, well, you know, you need to, you need to wash your pillowcases more often. Okay. Maybe don't sleep on that side of your face. Beware of, you know, how you handle your skin. All of those things are influential, but they may not be the foundational problem here. And you know, and it's just, that's why we call it practice. It's just study. Right. Until we can find a way to, to, to, to reduce it.
- [44:09]
Tessa Zolli
Absolutely. Have you seen something to the effect of a pore getting damaged and then it being almost just easier for it to fill up or break out?
- [44:23]
Douglas Preston
Not necessarily an IND individual follicle. It's possible that that could happen, that you might have one that is structurally weaker than others. So that if there is some congestion in there, perhaps the strength of the follicular wall is not adequate to handle what's going on in there. Then we also may have just a distended follicle which doesn't really break out, but is permanently dilated. And it fits, fills up with sebum, but also with topicals and, you know, you press that out as well.
- [44:57]
Tessa Zolli
Yes.
- [44:59]
Douglas Preston
And, and, and I. Most people have one of two of those somewhere on the body.
- [45:04]
Tessa Zolli
I've got one.
- [45:05]
Douglas Preston
Yeah.
- [45:05]
Tessa Zolli
It makes anyone feel better.
- [45:07]
Douglas Preston
Yeah. And so it's a common, you know, feature. There are, there are ways to medically to eliminate that, but it's not worth the problem. It's just something we notice. And again, that's the five power mirror. You Know, phenomenon.
- [45:22]
Tessa Zolli
Mm mm. How about these poor clogger checkers, these online, you know, copy paste ingredients. I'm really curious to hear your take because they've become so popularized. What do you think about them?
- [45:39]
Douglas Preston
Well, not everybody agrees as what's comit. Genesis.
- [45:43]
Tessa Zolli
Sure. Yes.
- [45:46]
Douglas Preston
You know, when I, when I look at the lists, it fluctuates from time to time. And some, and in some cases, you know, what used to be, you know, a. No, no, gets revived as a, as a plus. For example, the thinking about a certain emollients has changed.
- [46:08]
Tessa Zolli
Shea butter, for example.
- [46:10]
Douglas Preston
Exactly. And some of the synthetics too.
- [46:16]
Tessa Zolli
So I know we've talked about dimethicones and.
- [46:20]
Douglas Preston
Yeah, silicone, dimethicone and trimethicone. Well, you know, there are people who really. I have seen reactions to that. And yet on the overall, there are people who feel that they're perfectly fine. My colleague Dr. Mark Lees is a fan of it, and I am more so now than I used to be. But I think it was also corresponding ingredients that were created, creating some interactive problems with those, with those, with those emollients. And so, you know, we just don't know. And then it's individual by individual. So there's no, there's no boilerplate template rule that applies to everybody. But for marketing purposes, you know, of course. Right. It's, you know, it's cut and paste, as you said, and then totally makes.
- [47:10]
Tessa Zolli
People feel like they can understand what's going to affect them.
- [47:14]
Douglas Preston
And it's all about selling things to people really. But, you know, even with something like acne, it doesn't. It depends on the subject, you know, but we don't all have a super deep, not a desire to know everything about something that affects us. Right. If you go to buy a cell phone, for example, and you go into Apple to buy a nice iPhone, do you really want to spend a couple hours with a sales geek who will explain how all the mechanics work? No, you just want the damn thing to work so you can get online and text and call people. Right. And with acne, you'll have people who really are just. They study it like crazy, but don't necessarily wind up at a conclusion. They just wind up with more clues. And then from those clues, you have to decide, well, what, what applies to me and what doesn't. And the whole time you're changing, and I find those people are constantly experimenting with new products and exacerbating the issue. Right. Here's the new miracle thing, right? And influencers are out there who you Know, are causing more acne than they're correcting. And, you know, it's a free for all.
- [48:32]
Tessa Zolli
Totally, totally. And it kind of just. Everyone wants to overcompensate, you know. But is it actually getting to the root? I don't know.
- [48:42]
Douglas Preston
Yeah.
- [48:43]
Tessa Zolli
My last question for you, Douglas, is when a client is working with a dermatologist and they're on, you know, prescriptions, are there certain ones that you will not do extractions when they're taking or work with somebody when they're taking certain prescriptions? And how can estheticians work with dermatologists if the client is seeing both?
- [49:08]
Douglas Preston
Well, if the, if the client patient is on Accutane, then, you know, generally it's best to pause any kind of work with them. I feel. Okay, this is just opinion for the duration of the drug cycle and maybe two or three months after, so the skin can reconstitute its strength. If they're using tretinoin, for example, then you got to be a little bit more careful because you've thinned the skin there. And then you could experiment a little bit with, know, what might work and what won't work. And it depends again on also how often they're using it. Right. And what percentages and so forth, how reliable they are about that. So, but as a rule, if they're under topical treatment, like, again, like tretinoin, then you definitely want to be careful if you Accutane, needless to say, if it is just simply some antibiotics, well, the antibiotics are just trying to assist the body in controlling the inflammation and the bacteria. You can pretty much work, you know, with that without too much concern. The course, the goal is to get them off of those things. And while we can't prescribe medication, and I certainly can't tell somebody to stop taking the medication, you know, that's a decision they have to make. We can advance their clearing to the point where they can make that decision on their own and say, you know what, I don't think I need this any longer. And then we don't have to be responsible for the decision, but certainly for the basis upon which that decision is made. And that's always nice when someone is able to park the pill bottles and just, you know, and work with, you know, with non pharmaceutical means to correct a problem. Yeah.
- [51:14]
Tessa Zolli
In my experience, clients are pretty eager to get off those prescriptions if they're coming to you as the esthetician.
- [51:22]
Douglas Preston
Absolutely. And those are only controls anyway, as we know, you know, just like us crutches. Yeah, they're Just controls and they don't always work and very oftentimes they have side effects which are very unpleasant and most people would rather not do it. And also, when we're talking about reliability here, it's tough enough to get people to do a skincare regimen according to instruction. Right. Well, there's a reason why when you get a prescription from a physician, you got that paperwork that comes with it and it's very adamant about, look, you, you've got to take every one of these pills exactly the way they're prescribed. You can't go on and off with them. This isn't going to work. Anybody who ever had a bladder infection and got sulfa drugs for that and didn't take them all after you felt better, you don't want to do that. The signs of that may go away in four or five days, but you better take all 10 days of those pills or you're going to really have health payments. And so because traces turn back into, you know, into full blown problems. And so, you know, we, we, and we tend to be a more pleasant experience. Even with extractions, you know, they could talk to us. Right. But I, I had entire families that came to me for, for acne, but certainly wasn't.
- [52:47]
Tessa Zolli
Same.
- [52:47]
Douglas Preston
Yeah, same. Yeah. But it's where they wanted to be. And you know, and the results as a whole were pretty good. Never 100%. There were a few cases where I simply could not get to the bottom of it. My client would come in weekly, they did not improve. And at that point then I would make what I would consider to be an ethical decision about steering them towards something more effective that, you know, would, would work for them. And sometimes they didn't want to stop coming, but, you know, I, I would want, I would want them to change because I did want them to improve. And I knew that there were, there were, there were resources available that would do that.
- [53:32]
Tessa Zolli
Yeah, that makes sense. How do you think, you know, is the best way to approach that conversation? If you feel like ethically it's not improving, are you just pretty cut and dry?
- [53:45]
Douglas Preston
It's not easy, you know, because you have to think about this. If a person's not showing a lot of improvement, but yet they're dedicated to coming to see you, there's something more going on there. And very often it is a, there is a relationship factor in there. I know I had a boy who was about 15. He and his mom would come and I was not getting, I was not getting anywhere with his treatments. They were really bloody messes honestly. But he loved coming in there and every now and then he'd bring me a gift and you know, he just liked talking to me. And the mom did and I finally had to tell her, I, I cannot help your son. I just can't. And I can't feel good about what I'm putting him through. These were painful treatments for no, for no apparent benefit. Here's the thing. There were a couple of times, this was about a two year relationship. There were a couple of times when he actually followed my directions and we saw a real improvement. And then it stopped. And I began to think that he might be self sabotaging because if he got better and got over this, he wasn't going to be coming back in anymore. You see what I mean? And I think that was what was happening. And so when I finally said, I, I, I'm, I'm going to terminate our work together, he was very upset, cried. And I said, I'm, you know, it's not about you. You know, you can come in anytime and when, you know, if your skin's looking better, I can still be helpful. But this is not the answer. And now that is an extraordinary situation. I had two or three of those in 40 years, but I had them. And so you have to kind of put your, you know, your psychotherapist hat on and say, okay, there's something else happening here and you can pretty much surmise it without having to, you know, dig it out and get it in the open. Who we are, it's our job.
- [55:54]
Tessa Zolli
Yeah. No, but we all go through that. You know, there's always challenges.
- [56:00]
Douglas Preston
Oh yeah.
- [56:01]
Tessa Zolli
In this business.
- [56:01]
Douglas Preston
What a wonderful career though.
- [56:03]
Tessa Zolli
Yeah, yeah. But, you know, it's like the silver lining is you help, you helped him at least feel emotionally, you know, like, taken care of for the time he was coming.
- [56:14]
Douglas Preston
Yeah. I never saw him again when, after that, but, but my hope was that they found an answer because he certainly needed it and he was going to scar horrifically. And that's another reason why I was pushing him. Hopefully he went on Accutane honestly because that was the only thing I could see that was going to arrest this and it needed to happen. He was going to have a terrible legacy of scarring. And the best thing I could do is to stop and, you know, try to direct them hopefully totally and understand.
- [56:49]
Tessa Zolli
When your, your scope stops and when he needs something else.
- [56:55]
Douglas Preston
Sometimes you just gotta do it. Yeah.
- [56:57]
Tessa Zolli
Yeah. Well, Douglas, I've loved our conversation. Thank you so much for sharing everything you did. Where can we Find you. Yeah. How can estheticians who want to learn from you get in touch?
- [57:12]
Douglas Preston
Yes. Well, my website is Preston acnepros.com There's a lot there. I'm my extractor there. And by the way, if you use Tess's code, which is Tess T E S S10. So just one, you know, one word, Tess 101 0. If you're purchasing an extractor, you'll save 10% on that, on that tool. You just put the coupon code in at checkout and it will come up for you and it'll, it'll save you some money. Also you'll see my training programs there, both in person and online trainings. There's a lot of material there and I highly recommend that you look at that for acne therapy in particular and to advance your skills. I also have a certification program which was quite thorough and it's, and it focuses on acne certification for congestive acne, like I said, which is the kind of acne you're going to see more of than anything else. And I recently started a program called Mentoring Mondays. Today was going to be the day I started it, but I had a conflict. This is a free program. It'll be one Monday a month if you go onto my website, Preston acnepros.com and join the site. So go to login and then just create a password and so forth. Then go to Mentoring Mondays. You can register for these sessions. They're hour long sessions and it's all about the business of aesthetics. And there'll be a theme for each meeting. This is the same work I do as a business consultant, not a teaser. It's not a way to get you to buy anything. This is literally kind of a gift that I'm doing for the industry that's treated me so well for so many years. If you register for the, for the program each month you'll receive a link to, to a Zoom program and you'll be able to come into that. And I highly recommend it because you're going to learn an awful lot at no cost to you. So please join us. And there we are. Tess, what a, what a pleasure. Who knew we'd be talking today?
- [59:31]
Tessa Zolli
I know, I'm so glad we did this. I, I know the listeners are going to get a ton of value out of this conversation. So thanks as always for being so generous with your time. We love having you. And guys, go check out Preston website. It'll be linked in the show notes. We'll have the discount code for the tool and any classes you want to take with him. Anything else you want to add, Douglas?
- [59:58]
Douglas Preston
Yeah, let me plug also my Instagram site, which is Preston Acne Pros, but you're going to have to do underscores between the. The. Between the two, the three words. We used to have it as just Preston Acne Pros. We got hacked a couple of years ago, lost everything, so we're still rebuilding. Yeah, it was awful. And so we had to create an entirely new site. The old one's still there, just that the hackers stole my password. Now I can't get back in, so it's just going to just sit there and die. But Preston Acne Pros with underscores, and I put a lot of good information on that on that site as well, so visit me there. I love it and share it with others because it's a great way to learn.
- [60:43]
Tessa Zolli
And you do your demos right on Instagram of the tool. That is great to see.
- [60:48]
Douglas Preston
I also have a YouTube channel, which is Preston Acme Pros, without the underscores. And there's lots of demo videos for the extractor and other things there as well. So lots of information out there if you're interested in seeing what we're doing. And we appreciate it.
- [61:07]
Tessa Zolli
Love it. Well, thank you so much for joining us. I hope you guys enjoyed this episode. We'll have to do it again soon. And thank you again, Douglas. We appreciate it.
- [61:18]
Douglas Preston
Love the friendship. Take care.