Chemical Peels Form
Hale Cosmeceuticals
2011 S. Main Street
Bloomington, IL 61704
Name: ______________________________________ Date: ________________
Address: __________________________________________________________
City: _____________________________ State: ________ Zip Code: _________
Shipped By: _______________________________________________________
Product
Size
Quantity
Ordered
PH
Level
Price
Glycolic Acid Peels (Plastic Bottles)
G-20
G-30
G-40
G-50
G-70
G-20-B
G-30-B
G-50-B
2oz.
2oz.
2oz.
2oz.
2oz.
2oz.
2oz.
2oz.
/
/
/
/
/
/
/
/
32oz
32oz
32oz
32oz
32oz
32oz
32oz
32oz
1
1
1
1
1
2.9
2.9
2.9
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
Salicylic Acid Peels (Glass Bottles)
S-20
S-20-B
S-35
S-35-B
2oz.
2oz.
2oz.
2oz.
/
/
/
/
32oz
32oz
32oz
32oz
1
2.9
1
2.9
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
L-30
L-50
L-30-B
L-50-B
2oz.
2oz.
2oz.
2oz.
/
/
/
/
32oz
32oz
32oz
32oz
1
1
2.9
2.9
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
$15.00/$100.00
Jesseners Peels (Glass Bottles)
SLR-7/7/7
SLR-14/14/14
2oz. / 32oz
2oz. / 32oz
2.5
2.5
$15.00/$100.00
$15.00/$100.00
Blended Peels (Glass Bottles)
GSL-30/7/7
SM- 20/10
Phytic 25% / Glycolic 35%
Phytic 25% / Glycolic 50%
2oz. / 32oz
2oz. / 32oz
2oz. / 32oz
2oz/ 32oz
1
1
3
1
$15.00/$100.00
$15.00/$100.00
$25.00/$200.00
$25.00/$200.00
Lactic Acid Peels (Plastic Bottles)
Neutralizer
4oz
50
50
50
50
5.00
Hale Cosmeceuticals
Your Skin Health Company
Peels
Glycolic Acid is a superficial peeling agent, naturally derived from sugar cane. It is beneficial in
improving skin, treating age spots, decreasing facial lines, and rejuvenating the skin’s surface. Alpha
hydroxyl peels, such as Glycolic help to reveal a younger, healthier looking skin by stimulating
collagen and elastin growth, and accelerating the skin renewal process. It will minimize the
appearance of fine lines and wrinkles; allow better absorption of treatment products, and is an
intense cleanser for mature skin.
Salicylic Acid loosens and removes aging cells, oils, and debris attached to the skin pore surface. It
is oil-soluble and lipophilic so it penetrates sebum filled follicles and cleans out clogged pores.
Salicylic acid stimulates new healthy skin cell production and increases collagen formation, resulting
in marked improvement in acne prone skin. Salicylic acid will decrease fine lines, smooth skin, even
out pigmentation and reduce pore size, while shedding dead and damaged skin cells.
Lactic Acid is a non-irritating rapid exfoliator. It is an alpha hydroxyl acid derived from sour milk;
ideal for sensitive skin or skin unable to tolerate glycolic acid. Lactic acid peels help to eliminate
germs, toxins, and dead cells. It also helps to maintain the skin’s pH factor. Lactic acid occurs
naturally in the skin and is a primary component of the skin’s natural moisturizing factor. It is less
harsh and more moisturizing than Glycolic acid skin peels. Lactic acid will help to stimulate and speed
skin cell turnover on the surface, producing more vibrant and smoother-looking skin. In the deep
layers of skin, new collagen & elastin will be stimulated, making the skin thicker, tighter and firmer.
The Jessner peel is a highly effective peeling agent formulated with a combination of Resorcinol,
Lactic Acid and Salicylic Acid. This peel is to be used by only experienced peel users who have done
Salicylic 20% or Glycolic 50% or higher. The Jessner peel is used to lighten areas of hyper
pigmentation, treat mild acne and acne scars, and to treat photo-damaged and aged, sun damaged
skin. Jessner peels are used when a deeper peel is needed. They cause the top layers of skin to
flake off while stimulating the deeper layers. The top layers are the most sun-damaged, wrinkled,
unattractive layers; after they are removed, the new fresh layer of skin, the dermis, is also stimulated
by the Jessner peel, causing new fibroblasts and collagen to develop, reducing the depth of lines and
wrinkles. Repetitive peeling with Jessner peels improves tone, texture, and quality of the skin.
FDA guidelines recommend testing any product that contains BHA on a small area of skin before
applying it to a large area. If using BHA products, one experiences skin irritation or prolonged
stinging, STOP using product and consult a physician. DO NOT exceed the recommended
applications. Keep away from infants & children and always use a sun protection when using BHA
products. If using Retinol product, stop 2 weeks prior to doing the peel.
Glycolic Peel Instructions:
Apply a few drops of the Glycolic Acid solution to a gauze pad or a brush and gently apply to skin,
avoiding eyes, lips, and mucus membrane areas. Leave the solution on initially for 30 seconds;
building up to 1 to 2 minutes as tolerance increases (you may fan the area during this time to
alleviate discomfort). Contact time of glycolic should never exceed 5 minutes. Remove all traces of
peel with water or a baking soda & water combination or our DMAE 5% to neutralize. Apply Hale
Cosmeceuticals Dermist M3HA to moisten & take away redness.
Glycolic Acid Peels come in 20% 30% 40% 50% & 70 % strengths
Also a 20% 30% & 50% blended strength
Salicylic Acid Peel Instructions:
Apply a few drops of the Salicylic Acid solution to gauze pad or a brush and apply peel gently to the
skin in a circular motion; after 30 seconds rinse with cool water. Note a frosting or tingling sensation
may occur and this indicates product is exfoliating the skin. This peel may be used every 2 to 3
weeks. Apply Hale Cosmeceuticals Dermist M3HA (Hyaluronic Acid) to moisten & take away any
redness.
Salicylic Acid Peels come in 20% & 35% strengths. Also a 20% & 35 % blended strength
Lactic Acid Peel Instructions:
Apply 2 to 3 drops Lactic Acid solution to a gauze pad or a brush and apply to the face where it is
needed. Keep solution at least a quarter of an inch away from the eyes, lips and mucus membranes.
Do not leave on more than 5 minutes. Remove all traces of peel with copious amounts of water. Pay
special attention to areas around the eyebrows, behind the ears, and in the creases around the nose.
Pat dry with cotton or paper towel (do not rub the skin at this stage). Apply Hale Cosmeceuticals
Dermist M3HA (Hyaluronic Acid) to moisten & take away any redness. This procedure may be used
every 10 to 14 days.
Lactic Acid Peels come in 30% & 50% strengths. Also a 30% & 50% blended strength
Jessner Acid Peels Instructions:
The Jessner peel should be applied by experienced peel users only. This solution is applied with light
gentle brush strokes onto the skin and should be layered. A mild stinging sensation may be felt for
several minutes after application. Using a gauze pad, apply 2 to 3 thin coats to entire facial area,
avoiding eyes & lips (may use a fan to cool skin). Leave on according to client tolerance level, not to
exceed 2 to 3 minutes. Remove peel with water or a water & baking soda combination. Apply Hale
Cosmeceuticals Dermist M3HA to cool & soothe any redness. This procedure may be applied every 2
to 3 weeks.
Jessner Acid Peels come in SLR 7/7/7 and SLR 14/14/14 strengths
Blended Acid Peels Instructions:
Apply a few drops of the GSL solutions and gently apply to the skin with a brush or gauze pad. Avoid
eyes, lips, and mucus membrane areas. Leave the solution on for 30 seconds; and build up for 1
minute to 1 minute 30 seconds as tolerance increases.(you may use fan the area during this time to
alleviate discomfort. Remove the peels with water, baking soda water combination, or DMAE
neutralizer to neutralize the peel. Apply Hale Cosmeceuticals Dermist M3HA (Hyaluronic Acid) to
hydrate and minimize redness. As for the SM acid solution use a gauze pad or a brush and apply the
the skin gently in a circular motion. Then after 30 seconds, rinse with cool water or use DMAE
neutralizer spray to neutralize the skin. Note a frosting or tingling sensation may occur and this
indicates product is exfoliating the skin. You can use this peel every 2 to 3 weeks. Be sure to apply
Hale Cosmeceuticals Dermist M3HA (Hyaluronic Acid) to hydrate and minimize redness on the skin.
Blended Acid Peels come in GSL 30/7/7 and SM 20/10 strengths.