Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Taking on the EWG and Their Attempts to Scare October 31, 2011

Filed under: Recommended Reading,Skincare products — askanesthetician @ 5:51 am
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On October 19th The Beauty Brains (one of my favorite beauty related blogs) published a great post about how the EWG scares consumers needlessly over the safety of sunscreens and cosmetics.  Numerous times I’ve written in my blog about how I think the EWG’s sunscreen report does more harm than good in the end and that their fear mongering could potentially lead many people to stop using sunscreen thus contributing to the national epidemic of (truly preventable) skin cancer.  (The EWG also enjoys widespread media coverage in the popular press every time they come out with a new and ridiculous sunscreen report.)

Luckily, it turns out that I am not alone in my feelings about the EWG, and someone is actually doing something about this issue.  The main group taking on the EWG is called the Competitive Enterprise Institute a group who calls themselves:

a non-profit public policy organization dedicated to advancing the principles of limited government, free enterprise, and individual liberty. Our mission is to promote both freedom and fairness by making good policy good politics. We make the uncompromising case for economic freedom because we believe it is essential for entrepreneurship, innovation, and prosperity to flourish.

In an article from October 18th, 2011, on CEI’s website, called The True Story of Cosmetics Dana Joel Gattuso writes the following about the EWG:

The Campaign for Safe Cosmetics and its partner, the Environmental Working Group (EWG), are on a crusade to scare consumers away from using cosmetics and hygiene products that contain preservatives and other useful chemicals. As part of their effort to ban the use of synthetic ingredients from skin products, these environmental extremist groups are working to incite fear among consumers, making outrageous and bogus claims that we are poisoning ourselves by using lipstick, makeup, deodorants, skin creams, and even baby products. Specifically, they claim that the additives can cause cancer, create neurological disorders, or cause hormone disruption—even though they are present in trace amounts.

In fact, these preservatives protect users from bacteria. Present in quantities so small—typically, less than 1 percent of a product’s total weight—they are added to prevent contamination and to protect consumers from the buildup of dangerous bacteria that can cause eye infections, skin rashes, and even deadly infections such as E. coli and Salmonella.

Parabens, for example, are added to makeup, deodorants, moisturizers, and body creams to prevent bacteria, fungi, and mold. According to the Campaign for Safe Cosmetics, parabens are linked to breast cancer and can cause hormone dysfunction. Yet scientists have refuted the claims, arguing that concentrations of parabens in cosmetics are too small to have an adverse effect, and are at levels in our body thousands to millions of times lower than naturally produced estrogens.

Another example is the chemical oxybenzone, used in sunscreens to protect users from the ultraviolet rays that can cause skin cancer. The Environmental Working Group warns consumers to stay away from oxybenzone because it “contaminates the body” and can cause hormone disruption and cell damage. Yet cancer research organizations such as the Skin Cancer Foundation refute EWG’s assertions, arguing that there is no evidence to back the claims of oxybenzone risks. These cancer foundations worry that such fear mongering will scare consumers away from using sun block products that protect consumers from the risks of skin cancer from the sun’s rays.

I was happy to read what CEI wrote about the EWG, their tactics, and shoddy research, but then I found out a bit more about the CEI and was pretty upset.  It turns out the CEI is supported by and partners with very conservative groups (like Philip Morris) and furthermore (and this really upset me), according to the website Sourcewatch, they deny certain scientific facts like how greenhouse gases are causing climate problems:

 CEI is an outspoken anthropogenic (human-caused) climate change skeptic and an opponent of government action that would require limits on greenhouse gas emissions. It favors free-market environmentalism, claiming that market institutions are more effective in protecting the environment than is government In March 1992, CEI’s founder Fred Smith said of anthropogenic climate change: “Most of the indications right now are it looks pretty good. Warmer winters, warmer nights, no effects during the day because of clouding, sounds to me like we’re moving to a more benign planet, more rain, richer, easier productivity to agriculture.” [19]

In May 2006, CEI’s global warming policy activities attracted attention as it embarked upon an ad campaign with two television commercials. These ads promote carbon dioxide as a positive factor in the environment and argue that global warming is not a concern. One ad focuses on the message that CO2 is misrepresented as a pollutant, stating that “it’s essential to life. We breathe it out. Plants breathe it in… They call it pollution. We call it life.”[17] The other states that the world’s glaciers are “growing, not melting… getting thicker, not thinner.”[17] The other states that the world’s glaciers are “growing, not melting… getting thicker, not thinner.” It cites Science articles to support its claims. However, the editor for Science stated that the ad “misrepresents the conclusions of the two cited Science papers… by selective referencing”. The author of the articles, Curt Davis, director of the Center for Geospatial Intelligence at the University of Missouri-Columbia, said CEI was misrepresenting his previous research to inflate their claims. “These television ads are a deliberate effort to confuse and mislead the public about the global warming debate,” Davis said.  (From Sourcewatch)

Luckily it turns out that there is a way to support better oversight for the cosmetic industry without needlessly scaring consumers or compromising on your morals.  You can support the Safe Cosmetic Alliance which is:

comprised of leading beauty and personal care product and services industry trade organizations representing manufacturers, suppliers, distributors, retail owners, salon/spa owners, and licensed beauty professionals who support science-based legislative and regulatory policies that enhance consumer and product safety standards.

Together, Alliance members account for nearly 8.2 million U.S. jobs and contribute nearly $189 billion in U.S. GDP every year. The beauty and personal care industry is one of the fastest growing employment segments globally.

Members of the Safe Cosmetics Alliance touch people’s lives every day and reach virtually all Americans who use cosmetic and personal care products, as well as beauty salon services. We represent every aspect of the beauty and personal care industry, including:

  • Your local salon and spa owners, employees and licensed beauty professionals
  • Retail employees that sell cosmetics at your favorite store
  • Independent business owners and direct sales representative agents who sell directly to consumers
  • Companies ranging from small startups to global corporations

We believe it is critically important that laws and regulations reflect the current advances in science and technology, enable industry to innovate, meet consumer expectations, and continue to earn their confidence.

The Safe Cosmetic Alliance has created a petition that asks the FDA to update their oversight over the cosmetic industry.  According to the Safe Cosmetic Alliance website:

While the personal care product and services industry has exhibited an impeccable safety record going beyond the current requirements for safety, it is essential the law keeps pace with advances in science and technology. We must provide new tools for the FDA that modernize and strengthen oversight of personal care products, increase transparency, and enhance existing consumer safety measures.

We can keep our favorite cosmetics and personal care products at the highest level of safety by giving the FDA new tools that improve and strengthen their oversight of personal care products. That is why we must urge lawmakers to support science-based legislation that includes:

  • New FDA review of the Cosmetic Ingredient Review (CIR) Expert Panel findings.  CIR is a non-profit, independent panel of scientists and physicians who currently review ingredients used in cosmetics and personal care products in the U.S.
  • New FDA process to review cosmetic ingredients, allowing the FDA to review and set safety levels for trace contaminants used in cosmetic and personal care products.
  • Registration with the FDA by manufacturers of personal care products. This would make the current voluntary reporting program mandatory for all cosmetic manufacturers and would include the registration and reporting of facilities, product ingredients, and unexpected adverse events that may occur.
  • Requiring the FDA to issue good manufacturing practices for personal care products.

You can sign the Safe Cosmetics Alliances petition here.

Bottom Line:  While I am glad to see that someone is taking on the EWG and refuting their claims I am saddened that the rest of CEI’s politics make me uncomfortable (why can’t people stop fighting the idea of global warming and start doing more about it?  If you don’t believe global warming is a real threat take a few hours out of your day to watch An Inconvenient Truth).  As such I was glad to hear about the Safe Cosmetics Alliance’s work and petition.  Better oversight from the FDA for cosmetic and beauty products will help all consumers, and I hope these efforts will succeed.  (And thanks to The Beauty Brains for doing a great job at keeping their readers updated on all these developments)

 

Should You Buy Home Laser and Light Devices? Do They Really Work? October 27, 2011

In our quest to look our best many of us have contemplated buying a handheld home skincare device.  Perhaps a light device that claims to erase acne or get rid of wrinkles (check out this new gadget from Japan).  Or maybe a home laser device that will remove unwanted hair (I’ve definitely considered that one).  These devices cost hundreds of dollars and make big promises.  Their appeal is obvious – invest your money once in a device and use it in the privacy of your home, on your time and schedule.  No more trips to the spa or doctor’s office for light treatments and laser hair removal.  The device is yours – for always and forever.  But before you invest in a handheld piece of skincare equipment think again.  Many of these devices are not worth both the investment of money and time.

In her book Feed Your Face Dr. Jessica Wu cautions against buying a handheld focused heat devices like Thermaclear or the Zeno Mini to treat acne (page 91):

There is some scientific evidence that heat may help clear acne.  Pulsed light, lasers, and radio-frequency devices (which are available only at a doctor’s office) have all been shown to kill the acne-causing bacteria P. acnes as well as temporarily decrease inflammation and shrink oil glands.  There are two main differences, however, between these medical instruments and a gadget you can buy at a drugstore:

1.  Lasers and other medical-grade devices typically come outfitted with a fan or a chilled tip so the laser can reach deep into the dermis (where your oil glands and bacteria sit) without burning through the top layers of the skin.  A store-bought device, especially one without a cooling system, won’t penetrate as deeply and therefore can’t be as effective.

2.  Studies show that killing P. acnes bacteria alone isn’t enough to stop breakouts.  To treat acne most effectively, you also need an anti-inflammatory component.  Even some of the antibiotics we commonly use to treat acne (substances that by definition are intended to kill bacteria) are prescribed at very low doses that are meant to reduce inflammation rather than kill P. acnes.  Medical grade lasers work because they kill bacteria and reduce inflammation, something handheld devices can’t.

Before you invest in any device there is something to keep in mind – the FDA clears medical devices for safe use but not devices labeled beauty devices.  The majority of handheld devices are marketed as beauty devices which means that they aren’t necessarily entirely safe for home use.  According to The New York Times article Taking Home the Lasers, Pulsers and Sonic Care there are many medical and compliance issues to keep in mind when it comes to these devices:

Dr. Sandra Lee, a dermatologist in Upland, Calif., fears patients will develop what she calls laserexia. “If it says, don’t use more than once a day, but if you’re a teen and you use it more than once a day, are you then at risk for scarring?” Dr. Lee said. “I worry about misuse.”

Some machines (among them TRIA Skin Perfecting Blue Light; LightStim for Wrinkles; and Levia Personal Targeted Phototherapy, which helps with psoriasis, eczema and vitiligo) have been peer-reviewed by medical experts, but not all. And the Food and Drug Administration clears only medical devices, not beauty devices, a distinction not always obvious to consumers.

“It gets squishy when companies say ‘We’re not making medical claims; we’re making beauty claims,’ ” said Dr. Mathew M. Avram, director of the Massachusetts General Hospital Dermatology Laser and Cosmetic Center in Boston. “What is a medical claim? It becomes a hard area to define.”

“If you make a claim that you can benefit someone’s appearance and you’re going to use a device to accomplish that,” he continued, “I think there needs to be the same level of scrutiny that a device used in a physician’s office would undergo.”

There have been some crackdowns on unwarranted claims. Last spring, the National Advertising Division of the Council of Better Business Bureaus (NAD) requested substantiation for promises made by VISS Beauty, for its Intense Pulsed Light Hair Removal Device. When the company refused to participate in a NAD review, the division referred the claims to the Federal Trade Commission and the F.D.A. And in September, the Federal Trade Commission shut down two smartphone apps, AcnePwner and AcneApp, for claiming that they could treat pimples with lights emitted from their display screens.

Even with effective devices, “there may be unforeseen uses and unforeseen consequences that may arise,” said Dr. Avram, listing the possibility of scarring, soreness, redness and hyperpigmentation, not to mention product malfunctions.

There’s also the “slight potential” for squamous or basal skin cancers from the ultraviolet light sources, said Dr. Neil Sadick, a clinical professor of dermatology at Weill Cornell Medical College, though he said that at-home devices used less energy than the machines in doctors’ offices.

The biggest hurdle, doctors say, is patient compliance; it requires some fortitude to beam a laser on your legs for 20 minutes a day. Dr. Sean Benham, a hair-loss and hair-transplant specialist in Santa Monica, Calif., likes the HairMAX LaserComb, a light-based hair-restoration device that costs about $600. But he said he saw many patients who simply tired of the routine, which involves “combing” the hair with an electronic wand for about 10 minutes, three times a week.

“People drop out of using it,” Dr. Benham said. “It’s so complicated and demanding, most of my patients say it just sits by the TV.”

There are opposing expert opinions to what I have quoted above.  Dr. Leslie Baumann, on her Skin Type Solutions website, has the following to say about handheld home light devices in an article entitled do-it-yourself vs. in-office beauty treatments: Which should you choose?:

At-home vs. in-office light-based treatments 

Dermatologists commonly use blue light in the office to improve acne, but a recent study shows that patients need treatments every three days for optimal improvement.  Not so practical, right?  That’s why at-home devices such as the Tria and Omnilux hold promise for keeping skin clear.  But anti-aging devices are a different story.  At this time, at-home wrinkle-reducing devices aren’t nearly as effective as their in-office counterparts, as while there may be an app for that as close as your phone, medically speaking it’s not going to do much for your skin.  Bottom line:  For acne, at-home devices are a do, but do-it-yourself anti-aging devices are a don’t.

Personally both the time and monetary investment would keep me from purchasing any of these products, but if you feel differently be sure to check out some reviews (like these on Sephora) from actual users before making your purchase.  Certainly none of these products are impulse buy material – be sure to think before you leap into buying such products.

 

How to Read a Skincare Product Label October 24, 2011

Filed under: Beauty/Cosmetic Products,Skincare products — askanesthetician @ 5:44 am

Education is the key to being a savvy skincare consumer.  One important component to being educated about skincare is knowing how to read a product label.  Knowing how to read a product label helps you make better informed decisions about which skincare products to buy.

Reading skincare product labels can be complicated, mainly because of the indecipherable ingredients found in products.  One way to better understand skincare product ingredients is to buy a cosmetic ingredients dictionary so you can look up ingredients.

When you are looking at the actual list of ingredients keep a few things in mind (well more than a few things).  I like Dr. Ellen Marmur’s summary of how to read a product label (found on pages 274-275 of her book Simple Skin Beauty):

The label must list ingredients from the highest concentration to the lowest, so if the antiaging element you’re looking for, be it niacinamide or vitamin C, is near the bottom, there’s not enough in the product to do anything.  (Keep in mind; a high concentration of the chemical is one way to get it into the skin).  Most often, a cosmeceutical acts primarily as a good moisturizer, which is wonderful, but it won’t have much more than superficial and temporary results.  Most of the ingredients on the label – the water, moisturizers, binders, and preservatives that make up the vehicle – are inactive.  Often an antiaging product includes silicone to provide a smooth texture to the product and make the complexion look smoother too.  It may also contain a little glycolic acid or lactic acid to exfoliate the skin and provide instant gratification.  There elements don’t actually change anything below the surface of the your skin.  At least make sure that the antioxidant or peptide you’re buying is very near the top of the ingredients list.  Decoding the label has limitations, however.  Most of the time a product does not state the concentration or percentage of the ingredients (and it doesn’t have to).  And too high a concentration of some ingredients, such as vitamin C, can be toxic to the skin.  You also can’t tell from the label whether an ingredient, like an antioxidant, is stable or not.

Keep some other important issues in mind when looking at product labels.  Once again I’ll turn to Dr. Marmur’s book for an explanation (pages 110-111):

The FDA does not require cosmetics to undergo approval before they are sold to the public.  Only ingredients that are classified as drugs, elements that affect the structure or function of the body, are in any way regulated.  These drugs are labeled as active ingredients above the cosmetic components, or inactive ingredients.  The manufacturer must provide scientific proof to the FDA that active ingredients are safe and effective.  As far as cosmetic components go, they much be listed in descending order by quantity.  So if water is the first ingredient listed, it’s the most plentiful element in the product.  If an antioxidant is last on the list, there’s probably just a trace of it included.  You should question whether that popular antioxidant or all-the-rage natural ingredient is mainly marketing or has been proven effective in the amount contained in the product.

So before you believe the claims presented in advertisements or beauty articles be sure to turn the skincare product you are interested in buying around and read the ingredients.  Make sure that the ingredients you really want to try out on your skin are amongst the first 5 or so ingredients listed.  If you see the ingredient toward the middle or at the bottom of the ingredient list don’t bother purchasing the product.

 

Further reading and resources:

Understanding product labels, particularly the ingredients, involves continually educating yourself about formulations and ingredients.  Sometimes I wish I was better at chemistry so that I could become a cosmetic chemist so that I could really understand skincare ingredients and formulations.  Luckily, there are many resources out there to help you along.  Here are some of my favorite websites for skincare product information:

And check out what the FDA has to say about cosmetic labeling and labeling claims.

 

Autumn Sun Protection Tips October 20, 2011

Never put your sunscreen away!  Even as the temperatures start to drop you need to remember that sunscreen is as important as always.  If you question my year round committment to sun protection please keep a few things in mind (these facts are from The Skin Cancer Foundation):

The sun’s damaging ultraviolet (UV) radiationcan harm your skin, regardless of the temperature. The majority of the UV rays that hit the earth, in fact, are ultraviolet A (UVA) rays, which are present in about equal intensity throughout the year. Sun protection is a year-round commitment!

Excessive exposure to UV radiation is considered the main cause of approximately 90 percent of all skin cancers, and is also associated with eye damage, including cataracts; premature skin aging; and reduced immune system functioning.

Fall weather is usually nice enough to enable you to spend time outdoors, and many people still participate in outdoor activities this time of year along with being spectators at outdoor sporting events (baseball season isn’t over yet and football season is going strong).  If you are participating in outdoor sports and simply a spectator to a game be sure to not only use sunscreen but to also wear protective clothes, a hat, and sunglasses.  And just like you would in the summer – seek shade when outside particularly between the hours of 10 am and 4 pm.

Make sun protection a year round priority and you’ll reap the benefits of healthy and beautiful skin.

Source and Further Reading:

 

Caring for Your Skin During Cancer Treatment October 17, 2011

 

 

I’ve had the privilege to volunteer for The American Cancer Society’s great program Look Good …  Feel Better for over a year now.  When I run a session of the program the first thing that I talk about is caring for your skin while undergoing cancer treatment.  I wanted to share some of those tips in this post though please keep in mind that the information contained in this post is not meant to negate or replace the information you are receiving from your oncologist.  If you have any questions about the information contained in this post please ask your doctor.  Furthermore, the information that I am presenting here is general in nature so your specific needs may be different.

The September issue of the spa professional publication Les Nouvelles Esthetiques & Spa contains quite a few articles that address the care of cancer patients.  The article Chemotherapy and the Skin by Jennifer Linder, MD is a great resource for both the cancer patient and the skincare professional.  It starts off with some important information:

As we know, chemotherapy is necessary to eradicate various types of cancers, but it undeniably wreaks havoc on the skin.  As the largest organ of elimination, the skin of those undergoing chemotherapy has an overwhelming task.  In addition to simply trying to process the drugs that are introduced into the body during these necessary treatments, the skin also is reacting to the unavoidable increase in emotional stress that a cancer diagnosis will likely cause.  …

Common side effects 

Chemotherapeutic drugs’ most common effects on the skin are severe dryness, sensitivity, allergic reactions, flushing, hyperpigmentation, photosensitivity, and folliculitis (an acne-like skin rash of the follicles).  Additionally, these patients are more susceptible to developing infections due to the suppression of their immune systems.  For these reasons, a gentle approach to treatment and home care product use is critical.

Be sure to baby your skin during cancer treatment:

  • Look for skincare products labeled “for sensitive skin”, “gentle”, and “soothing”
  • Fragrance can irritate sensitized skin so make sure your skincare products are fragrance free
  • Use warm water when you wash your face and body and don’t stay too long in the shower.  Long, hot showers, no matter how good they feel, dry out the skin
  • Gently pat your face and body dry after showering and washing your face.  Rubbing your skin will just irritate it.
  • Moisturize with products that contain both humectant and occlusive ingredients.  Humectant ingredients draw moisture to our skin and occlusive ingredients prevent moisture from evaporating from our skin
  • Use body and face moisturizer immediately after you shower when your skin is still damp.  Damp skin absorbs skincare products better
  • Consider switching to dye and fragrance free laundry detergents

Sun protection is key during cancer treatment since chemotherapy can cause photosensitivity:

  • Always use a sunscreen of spf 30 daily even if you are only leaving the house for a short period of time
  • Since chemical sunscreen ingredients can irritate sensitive skin look for a sunscreen with titanium dioxide and zinc oxide as its active ingredients (Vanicream is a good choice)
  • Wear protective clothing, a hat, and sunglasses when you are outside or in the car
  • Try to avoid sun exposure between the peak hours of 10 am to 4 pm

More resources and further reading:

 

California Is the First State to Ban Indoor Tanning for Minors October 13, 2011

Filed under: skin cancer,sun protection — askanesthetician @ 6:14 am
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I was delighted to hear the other day that California has become the first state to ban the use of tanning beds by anyone under the age of 18.  The law goes into effect on January 1st, 2012.

According to The Skin Cancer Foundation:

Close to 2.5 million teens tan indoors in the US every year, increasing their risk of developing melanoma by 75 percent. Indoor tanners are also 2.5 times more likely to develop squamous cell carcinoma, and 1.5 times more likely to develop basal cell carcinoma.

The law aims to protect minors from the dangers of tanning beds:

“Tanning is like smoking, we know what the cause is. We protect our minors from cigarettes. This is the same thing. As many as 40% of 17-year-old girls are exposed to tanning beds, and we need to protect them,” says Darrell Rigel, MD, skin cancer expert and member of the American Society for Dermatologic Surgery Association (ASDSA). “We hope this will help girls form healthy habits and decrease the rates of melanoma in women especially.”

Melanoma is the No. 1 form of cancer in people ages 25-29, according to the Skin Cancer Foundation. Rates for melanoma in this age group are seven times higher for women, the primary factor being the use of tanning beds, says Rigel.

The American Academy of Dermatology expressed support for the law in a statement, noting that use of tanning beds sharply increases the risk of melanoma, the most deadly form of skin cancer. A recent study from the University of Minnesota’s Masonic Cancer Center and School of Public Health shows that people who use any type of tanning bed for any length of time are 74% more likely to develop melanoma, and frequent users of indoor tanning beds are 2.5-3 times more likely to develop melanoma, than those who never use tanning devices.

Source:  California Bans Indoor Tanning for Minors  from Skin Inc.

 

I applaud the California legislators and Governor Brown for enacting this law.  I hope it helps to educate minors and ultimately saves lives as well.

Further Reading:

 

Spa Etiquette October 10, 2011

Filed under: Spa Services — askanesthetician @ 6:03 am
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Some time ago I wrote a post about how to get the most out of your facial which gave tips on what to do before, during, and after a facial in order to enjoy your experience.  Recently I came across an article in Allure called Everything You Always Wanted to Know About Spa * but were afraid to ask which answers lots of questions on what to expect and how to behave in a spa.

The article clearly states how important it is to speak up both before and during a spa treatment in order to get the best possible service.  It is totally within your rights as the recipient of a treatment to say something when you aren’t enjoying your treatment.  Do keep in mind that certain services – waxing and facial extractions chief among them – are never pleasurable.  One common thing I hear from people, especially people who rarely have facials, is that they had a facial and did not like the steam during the treatment but were too polite to say anything.  Though steam is great for opening up the pores allowing for easier extractions and it also helps to soften the skin, a facial can definitely be performed without steam.  So if you just don’t like the way steam feels on your face or if the steam is too strong be sure to let your esthetician know.  Spa professionals are not mind readers.  The more feedback you can give before and during a treatment is helpful to the person performing the treatment.  After all we want you to return for another treatment and to recommend us to your friends so the more enjoyable your experience is the more likely you are to do both of the above.

The article also discusses tipping.  Unless otherwise stated that tipping is against spa policy, believe me your spa technician is going to appreciate a tip.  Even if you have gotten a facial from an esthetician at a doctor’s office you still can and should tip.  How much you tip is, of course, up to you but it is a good idea to tip between 15% to 20% of the cost of your service.  A kind word, a thank you, or positive feedback is always appreciated as well.  If you were really happy with your service think about writing a review for the spa, mentioning by name the person who gave you the service, on Yelp! or another online review site.  Of course, if you were treated badly or had a poor experience, you can also write about that on one of the internet review sites.  Getting the word out about your esthetician or massage therapist is always appreciated.  Spas thrive on good word of mouth.  One last word about tips – technicians appreciate tips in cash so that they don’t have to wait to receive their money.

Arriving on time or calling if you are running late, being polite, and being relaxed are all hallmarks of a great spa guest.  When you come in for a treatment it is a great opportunity to forget your troubles.  If someone falls asleep during a treatment with me I actually take it as a compliment.  Remember that a spa treatment is a treat and enjoy it!

 

 
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