If you follow the advice of magazines such as Vogue and Harper’s Bazaar, social media “skinfluencers,” or your favorite skin-care brands, you may have read that exfoliating — the process of detaching dead skin cells — is a vital step in achieving healthy skin. According to these sources, exfoliation can amplify the results of topical products such as serums, masks and moisturizers, boosting the skin’s “glow” and “radiance,” as well as cutting down on acne and signs of sun damage.
But if you ask dermatologists, they’ll tell you that not only is exfoliation usually an unnecessary step, many people overdo it.
“Our skin cells naturally exfoliate on their own,” said Chicago-based dermatologist Caroline Robinson. The skin cells migrate from the deepest layers to most superficial layers, and slough off roughly every 28 days, she added, although the process can take longer as we get older. “Products and tools that help us exfoliate are designed to encourage a healthy behavior our skin does naturally.”
Exfoliants are either chemical or manual (or physical), or a combination of both. Chemical exfoliants usually use hydroxy acids to dissolve the bond between skin cells, loosening dead skin for removal. Hydroxy acids fall into three categories:
● Alpha hydroxy acids (AHAs) can penetrate to the deepest layers of the skin, depending on acid and dosage, which is why stronger iterations are often used in a dermatologist’s office to both exfoliate and stimulate collagen production. Both in-office and at-home options at the correct dosage can improve the appearance of wrinkles and sun damage, and cut down on acne and clogged pores, but are often too strong for sensitive skin types. Common AHAs are glycolic, lactic, mandelic, malic, tartaric and citric acids.
● Beta hydroxy acids (BHAs) are traditionally used to treat acne and clogged pores. Salicylic acid is the most commonly used BHA, popular for its ability to calm inflammation.
● Polyhydroxy acids (PHAs) are “second-generation AHAs”; they are most suitable for sensitive, reactive skin including rosacea, since they do not penetrate as deeply as other hydroxy acids. PHAs also provide additional antioxidant protection and moisturization. Popular PHAs are lactobionic acid, gluconolactone and galactose.
There are also enzyme exfoliants, which come from fruits such as papaya, pineapple and pumpkin. These tend to be to be gentler than hydroxy acids and may have anti-inflammatory properties.
Manual exfoliation uses a product such as a face scrub or a tool such as a mechanical face brush to “scrub” and loosen the dead skin cells. Microdermabrasion and dermaplaning are manual exfoliation treatments performed in-office.
Terms like hydroxy acids and microdermabrasion aside, exfoliation is nothing new. Queen Cleopatra bathed in sour milk to reap the benefits of naturally occurring lactic acid, an alpha hydroxy acid, and the Romans and Greeks were known to use corrosive agents such as limestone as a manual exfoliant.
But now, the shelves of beauty retailers and drugstores are stocked full of exfoliating options: exfoliating facial cleansers and toners, exfoliating facial scrubs made with ingredients such as rice-based enzyme powder, and body scrubs that contain salt or sugar granules. (Body exfoliants also come in chemical, manual and/or a combination of both kinds of exfoliants.)
There are more than 1 million #exfoliate posts on Instagram, while #exfoliate videos have been viewed nearly 220 million times on TikTok. In 2020, facial exfoliant sales were up 9 percent year-over-year, Larissa Jensen, vice president of beauty at the NPD Group, a market research firm, said in an email. “In fact, it [facial exfoliants] was the only segment to gain among the larger facial skincare category, which includes cleansers, face creams, and face serums.”
“We are living in a society of over-exfoliators,” said Joshua Zeichner, a New York-based dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. Consumers have unrealistic expectations, according to Zeichner: “People try and achieve the ‘radiance and glow’ from exfoliation that they see in images and videos on social media, and unfortunately we do not have an objective way of measuring these terms.”
Atlanta-based dermatologist Tiffany Clay said she has seen an increase in facial over-exfoliation in her patients over the past year. “Patients who follow these ‘skinfluencers’ come into my office with compromised skin barriers due to exfoliating too often and with something too abrasive,” she said.
Clay added that she prefers chemical exfoliants over manual exfoliants for the face, because chemical options give more control. “When it comes to manual exfoliation, it’s all about pressure.” If you’re grinding a manual or physical exfoliant into your skin, you can create microtears in the skin and disrupt its barrier, she said.
Just because a product label tells you to exfoliate twice a day doesn’t mean you should, said Ranella Hirsch, a dermatologist based in Cambridge, Mass. “If you blindly exfoliate, you risk tearing apart your barrier, which is made up of functional skin cells that tightly regulate what comes into the body.”
One of the most problematic myths, according to Hirsch, is that you should exfoliate dry, flaky skin. She likes to use the analogy of bricks and mortar to explain why that’s not the case. Flaking skin usually happens because the mortar holding the layers of skin cells together (made up of lipids and fats) is low, and the bricks (keratinocytes) are falling off. “When we exfoliate, we use hydroxy acids and enzymes to break the bonds that hold the cells together, which is what we don’t want. When you have flaky, dry skin you need to moisturize, not exfoliate.”
Damage from over-exfoliation can present in many ways, including tightness, shininess, stinging, redness and increased sensitivity, Hirsch said. “We tend to grossly overestimate what our skin can handle.”
That’s why she recommends that people new to facial exfoliation “start low” with a low-percentage exfoliant, “start gentle” with less irritating ingredients, and “go slow” by beginning with one night a week and then gradually adding more only if your skin tolerates it. One of Hirsch’s favorite at-home exfoliants is Josh Rosebrook Daily Acid Toner, which she said is gentle enough for sensitive skin — even if you use retinoids. For acneic skin, Hirsch likes Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant.
While, again, exfoliating your body isn’t necessary, Hirsh said hands, feet and sometimes arms and legs can benefit from regular exfoliation. You don’t have to show the same caution with those body parts as you do with your face, neck and chest, she said.
Clay recommends being careful with certain foot treatments. “Some people with very thick layers of skin on their feet may need a jump-start with a pedicure or at-home chemical foot peel. These should be done in moderation because although the soles of the feet may seem very thick, too much exfoliation may cause the skin to become too thin, leading to tears, cuts and infections.”
After exfoliating your face or body, it’s important to always follow up with a moisturizer, said Zeichner, who usually pairs exfoliating products with moisturizers that have skin-repairing ingredients such as niacinamide, ceramides and/or oatmeal. He recommended moisturizers from CeraVe, La Roche-Posay and Aveeno. And, the experts said, you should always apply sun protection when using exfoliants.
Because it’s easy to over-exfoliate at home, some dermatologists prefer in-office treatments, seeing the latter as a controlled burn compared with a wildfire. New York-based dermatologist Macrene Alexiades said in an email that she recommends exfoliation as an option for people with oily skin, large pores and, in some cases, wrinkles. “Specifically, with respect to sun damage and wrinkles, I use exfoliation [in-office] as an artist tool to resurface the skin and induce new collagen,” she said.
She and Robinson both recommend in-office chemical peels — which use one or more exfoliating chemicals to create an injury of a specific skin depth with the goal of stimulating new skin growth and improving surface texture and appearance. “When I administer a medical peel in-office, I get a full thickness resurfacing of the skin, and then we allow the skin to rejuvenate itself over a 28-day cycle,” Alexiades said.
“Chemical peels are one of my favorite in-office procedures because they are so simple to integrate and I can use them on all skin types,” Robinson said. They can speed up your product results, she added. “Sometimes if our skin cells are not turning over as quickly as they would naturally — then our skin-care products are not penetrating where they need to.”
Finally, Zeichner emphasized patience when it comes to seeing the benefits of exfoliation. “To see an improvement in texture, tone, hyperpigmentation or lines could take several weeks to months of regular use,” he said. He concluded, however, that there is only one way to achieve perfect skin: using a good social media filter.