Six Weeks of Retinoid, Nine Days of Healing
A 26-year-old woman arrives for brow, upper lip, and chin waxing. Her intake notes Fitzpatrick IV, nightly adapalene 0.3% gel over the entire face (started four months ago), a medium-depth chemical peel at a med spa nine days ago, and a course of doxycycline for acne that she finished two days ago. She says she stopped the adapalene "three days ago to prepare." At the edge of her left brow is a raised dark-brown mole she has had for years but that "looks a little bigger lately." She also volunteers that she gets a cold sore "every single time" her lip is waxed. It is day two of her period. She is not pregnant and has no known allergies.
1. Which of the three areas do you wax today, and why?
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None of the three - no facial waxing today. Every area shares the same compromised facial skin:
- Adapalene: a topical retinoid, still nightly until three days ago. Retinoid-induced thinning of the stratum corneum persists roughly 1–2 weeks. Waxing can avulse epidermis, not just hair, causing erosions and possible scarring.
- Chemical peel nine days ago: medium-depth peels leave skin in active renewal for 1–2 weeks or longer; the barrier is still fragile.
- Doxycycline finished two days ago: a photosensitizing drug, still in her system, raising risk of exaggerated inflammatory response.
- Fitzpatrick IV: if the skin is stripped, she is at meaningful risk of post-inflammatory hyperpigmentation on the lip and chin - highly visible and slow to fade.
Offer instead: brow shaping by tweezing only (no strip wax, no hard wax, no threading over a recently peeled face if it would tug the same skin), keeping well away from the mole. Book the waxing for at least two weeks after the peel and with a prescriber-cleared retinoid break - typically about a week off the retinoid, as directed by her physician, not by you. Document the refusal and referral.
2. How do you handle the mole and the recurrent cold sores in the same visit?
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The mole: do not wax, tweeze, scrape, or treat over it. You do not diagnose, but you do describe objectively and refer: note in the chart that it is raised, dark-brown, at the brow margin, and that the client reports recent change. Use plain language - "this is something a dermatologist should look at" - and avoid saying "it's probably nothing" or naming a diagnosis. Recent change in a pigmented lesion is a referral trigger, and waxing over a suspicious lesion risks trauma to tissue that needs evaluation.
The cold sores: her history of an outbreak with every lip wax means the trauma of waxing is a reliable trigger for herpes simplex reactivation. Do not wax the lip. Advise she discuss antiviral prophylaxis with her physician if she wants lip waxing in the future. If she ever arrives with tingling, burning, or a visible vesicle, she is contagious - no service on that area, no product double-dipped, and hands washed before and after.
Period: not a contraindication, but sensitivity is often higher; note it and expect more discomfort if you do wax later.
3. She pushes back: "I've had waxing on adapalene before and it was fine." What is your response, and what do you document?
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Acknowledge, do not argue, and hold the line. Prior tolerance is not evidence of current safety: this is a different skin state (post-peel, recent antibiotic, active retinoid) and the outcome you are trying to prevent - a strip of skin removed from her chin - is irreversible and slow to heal.
Give her a choice she controls: tweezing now, waxing booked for a specific date, or a referral to her prescriber to confirm when she can stop the retinoid. Offering an alternative keeps the relationship without compromising judgment.
Document: the products and dates she reported, the objective skin assessment, the exact services declined, the reason, the alternatives offered, and that she was informed of the risk of skin avulsion and PIH. If she declines the alternative and leaves, note that too. If she insists on waxing anyway, you may still decline - an esthetician is not obligated to perform a service she judges unsafe.