The Prepaid "Glow" Package With Four Contraindications

Do not perform today

• 30% glycolic peel: she is on nightly tretinoin (last use 2 nights ago) and her cheeks are actively peeling from sun exposure. Retinoids thin the stratum corneum and increase photosensitivity; a 30% peel on that barrier risks chemical burn, post-inflammatory hyperpigmentation in a Fitzpatrick III, and prolonged redness. Typical guidance is to stop retinoids roughly 5 to 7 days before a peel and to avoid peeling sun-damaged or compromised skin entirely until it has recovered.
• Brow wax: waxing freshly treated, sun-exposed, retinoid-thinned skin can strip the epidermis. Even with a 2-day gap from tretinoin, the peeling cheeks make this a postpone, not a today.
• Extractions over the peeling areas: risk of tearing skin and introducing infection.

Postpone

• Waxing and peel until the peeling resolves and she has been off tretinoin for about a week - realistically 7 to 10 days out, with a re-check at the appointment.
• High-frequency and extractions on the compromised cheek area.

Safe today

• Gentle cleanse, hydration, and a calming mask away from the peeling zones; brow shaping by tweezing if the skin is intact; and a revised plan for the package. Her cold sore 10 days ago is healed, so no active lesion - but note it, because any future lip or facial wax or peel near that site warrants caution and she should know her trigger.

Decline the skin tags. Removing a skin tag means cutting tissue. That is a medical act outside an esthetician's scope of practice in Georgia, regardless of how small the tag is or how many times a client says she has had it done before. Cutting skin carries bleeding, infection, and scarring risk, and it belongs to a physician or dermatologist. Refer out.

Milia are a judgment call, not a free pass. Extractions are within esthetic scope, but lancing with a needle is a different act, and the area under the eyes is thin, vascular, and unforgiving. The defensible answer: do not lance; treat with gentle exfoliation and refer stubborn milia for professional removal. If your scope of practice question is genuinely close, the standard is to err toward referral - an esthetician's license does not cover breaking skin.

The wording matters. Say what you can do, not just what you can't: "Skin tags need a medical provider - here's what I can do for texture and tone." Then note the referral in the client record with the date. Scope-of-practice violations are license issues, not customer-service issues, and "the client asked me to" is not a defense.

Handling the owner. The prepaid package is a business problem, not a reason to perform a contraindicated service. Bring it back to risk in concrete terms: a 30% peel on retinoid-thinned, sun-peeled skin can produce a burn and a PIH that costs the salon far more than one package visit, and the esthetician's license - not the owner's - is on the line. Offer the owner three workable options: substitute an equal-value calming treatment today, extend the package expiration, or refund that visit. Get the decision in writing if the owner pushes back.

Client file contents.

• Intake answers verbatim: tretinoin 0.05% nightly, last use 2 nights ago, sun exposure 4 days ago, visible desquamation, cold sore history with a lesion 10 days ago (healed).
• Fitzpatrick type III and the reason it matters for PIH risk.
• Services requested, services performed, services declined with the reason for each.
• The revised treatment plan with dates and the re-check criteria (peeling resolved, off tretinoin about a week).
• The package adjustment and who authorized it.
• Signed informed consent for whatever was actually performed.

Contemporaneous notes are what protect you if she returns with a red, peeling face and a different memory of the conversation.