VA Master Esthetics cheat sheet

Virginia licenses estheticians and master estheticians through the Department of Professional and Occupational Regulation (DPOR), Board of Barbers and Cosmetology; scope of practice is set by statute and regulation, not by product labeling.

Procedures that cut, inject, penetrate living tissue, or remove tissue beneath the epidermis fall outside an esthetics license in Virginia and require medical licensure or physician delegation.

Virginia esthetics licenses renew on a biennial (two-year) cycle, and licensees must keep the Board informed of current address and name changes.

Cleaning removes visible debris; disinfection with an EPA-registered hospital-grade tuberculocidal product kills most pathogens on nonporous tools; only sterilization (autoclave or chemical sterilant) destroys bacterial spores.

Disinfect implements for the full contact time printed on the product label; shortened "quick dips" do not achieve the labeled kill claim.

Porous items (sponges, cotton, wooden applicators, cloth headbands, nail files) cannot be reliably disinfected and must be discarded after a single client.

Blood- or body-fluid-saturated waste goes into labeled red biohazard bags; needles and blades go into rigid, puncture-resistant sharps containers.

Hand hygiene with soap and water or an alcohol-based rub is required before and after every client and after glove removal; gloves are worn for contact with blood, body fluids, and broken skin.

Safety Data Sheets (SDS) for every chemical in the facility must be on site and accessible to employees under OSHA Hazard Communication rules.

Epidermis, deep to superficial: stratum basale, spinosum, granulosum, corneum; stratum lucidum appears only in palms and soles.

Epidermal turnover averages about 28 days in young adults and slows with age and photoaging, which affects peel and resurfacing scheduling.

Melanocytes sit in the stratum basale and transfer melanin to roughly 36 keratinocytes each via melanosomes; Langerhans cells (spinosum) are immune, Merkel cells (basale) are mechanoreceptors.

Acid mantle pH is approximately 4.5–5.5, maintained by sebum, sweat, and filaggrin breakdown products; it governs enzyme activity and microbial selection.

Dermis has two layers: papillary (loose areolar tissue with capillary loops) and reticular (dense irregular collagen I and III plus elastin).

Resident flora includes Staphylococcus epidermidis, Cutibacterium acnes (anaerobic, sebaceous follicles), and Malassezia; disruption of the barrier favors overgrowth.

Bacteria are prokaryotic with no nucleus; fungi are eukaryotic with chitin walls; viruses lack cells entirely and must replicate inside a host cell.

Facial motor innervation is the facial nerve (CN VII); facial sensation is the trigeminal nerve (CN V).

Hyaluronic acid, a glycosaminoglycan, can bind up to about 1,000 times its weight in water and drives dermal hydration and volume.

Fitzpatrick scale: type I always burns and never tans; type VI rarely burns and is deeply pigmented; higher types carry greater risk of post-inflammatory hyperpigmentation.

Glogau photoaging scale: I mild (no wrinkles), II wrinkles in motion, III wrinkles at rest, IV severe with actinic changes.

Wood's lamp emits ultraviolet light around 340–400 nm and is used on clean, dry skin; coral-red fluorescence indicates porphyrins from Cutibacterium acnes.

Patch-test a new peel, dye, or active product 24–48 hours before the first full treatment and document the result.

Health history must screen for isotretinoin use within 6–12 months, anticoagulants, photosensitizing drugs, pregnancy or lactation, herpes simplex history, keloid history, and immunosuppression.

A contraindication screen precedes product selection: active infection, open lesions, sunburn, or recent resurfacing defers treatment regardless of the client's request.

Informed consent must state benefits, risks, alternatives, expected downtime, and aftercare, and must be signed before the service begins.

Chart in SOAP format: Subjective (client report), Objective (findings), Assessment (analysis), Plan (treatment and home care).

Treatment plans sequence from least to most aggressive and state expected number of sessions, intervals, and objective endpoints.

Classic massage movements: effleurage (gliding), petrissage (kneading), tapotement (percussion), friction, and vibration.

Sequence within a massage: effleurage to warm and assess, petrissage to mobilize deeper tissue, tapotement briefly (about 30–60 seconds) for stimulation, effleurage to close.

Stroke direction follows lymphatic flow: from the face toward submandibular and cervical nodes and then to the supraclavicular nodes.

Manual lymphatic drainage uses light pressure (roughly 30–40 mmHg) and slow, repetitive strokes, unlike deep Swedish technique.

Avoid pressure over the carotid sinus, the thyroid gland, the trachea, and the globes; anterior neck work stays lateral and superficial.

Massage raises local blood flow and lymphatic return; it does not alter collagen structure or permanently change pore size.

Absolute or deferring contraindications include fever, acute infection, recent surgery, thrombosis, uncontrolled hypertension, and severe cystic acne.

Standard facial sequence: consultation and analysis, cleanse, exfoliate, extractions if indicated, massage, mask, treatment serums, moisturizer, sunscreen.

Alpha hydroxy acids: glycolic (smallest molecule, fastest penetration), lactic, mandelic, tartaric, citric; beta hydroxy acid: salicylic (lipophilic, keratolytic).

Peel strength is determined by acid concentration, pH and free-acid value, contact time, number of layers, and skin preparation - concentration alone is not predictive.

Trichloroacetic acid is self-neutralizing as it binds protein; glycolic acid requires timed dilution with water or application of a sodium bicarbonate neutralizer.

Jessner's solution is 14% resorcinol, 14% salicylic acid, and 14% lactic acid in ethanol, used as a superficial peel or as a TCA primer.

Depth classification: superficial peels act in the epidermis with no frost; medium peels reach the papillary dermis and produce white or pink frost; deep peels reach the reticular dermis and are physician-performed.

Visible frosting indicates protein denaturation and is the clinical endpoint - stop applying and evaluate rather than layering further.

Salicylic acid is avoided with aspirin allergy, salicylate sensitivity, pregnancy, and renal impairment because of systemic absorption risk.

Discontinue retinoids 5–7 days and isotretinoin 6–12 months before a peel; clients with herpes history receive prophylactic antiviral therapy before medium or deep peels.

Aftercare: broad-spectrum SPF 30 or higher, gentle non-exfoliating cleanser, no retinoids or scrubs for 5–7 days, and no picking or peeling of desquamating skin.

Systems use aluminum oxide or sodium chloride crystals with vacuum return, or a diamond-encrusted tip with vacuum only; diamond tips are reusable after cleaning and disinfection.

Depth is controlled by vacuum pressure, crystal flow or tip grit, number of passes, handpiece speed, and the amount of skin tension held by the free hand.

A single superficial pass removes on the order of 10–15 micrometers of stratum corneum; more passes and higher pressure increase depth and risk.

Typical protocol is a series of 4–6 treatments spaced 2–4 weeks apart, with outcomes plateauing once the epidermis has adapted.

Contraindications include active or cystic acne, severe rosacea, telangiectasia, active herpes, recent isotretinoin (6–12 months), photosensitizing medications, keloid history, and pregnancy as a relative caution.

Do not treat the eyelids, areas of thin or fragile skin, or bony prominences under high pressure; vacuum pressure over bone can cause bruising.

Defer microdermabrasion for 7–14 days after waxing, chemical peels, or laser treatments in the same area.

Mechanical exfoliation complements but does not replace chemical exfoliation; combining modalities in one visit requires reducing intensity of each.

Selective photothermolysis requires a wavelength absorbed by the target chromophore and a pulse duration equal to or shorter than the target's thermal relaxation time.

Key chromophores: melanin (broad absorption 400–1100 nm), oxyhemoglobin (peaks near 418, 542, and 577 nm), and water (strong absorption above roughly 1200 nm).

IPL is broadband filtered light (about 500–1200 nm) emitting many wavelengths at once - it is not a laser, and filters determine the target.

Common wavelengths: 532 nm KTP for superficial pigment and vessels, 755 nm alexandrite and 810 nm diode for hair removal, 1064 nm Nd:YAG for deeper targets and darker skin types.

Fitzpatrick IV–VI skin requires longer wavelengths, longer pulse durations, aggressive epidermal cooling, conservative fluence, and a test spot because of post-inflammatory hyperpigmentation risk.

Wavelength-specific eye protection is mandatory for the client, the operator, and anyone in the treatment room, with a warning sign posted at the door.

Cooling methods - contact chillers, cryogen spray, and cold gel - protect the epidermis while allowing adequate fluence at depth.

Delay treatment 2–4 weeks after sun exposure or tanning; tanned skin absorbs more epidermal energy and burns unpredictably.

Test spots with 24–48 hours of observation are indicated whenever pigmentation, medication, or recent tanning raises risk.

Microneedling creates controlled punctures typically 0.5–1.5 mm deep, triggering growth factor release and new collagen III that later matures toward collagen I.

Microneedling contraindications: isotretinoin within 6 months, active acne or infection at the site, keloid history, anticoagulant therapy, immunosuppression, and pregnancy as a relative caution.

Therapeutic ultrasound at 3 MHz penetrates about 1–2 cm and suits the face; 1 MHz reaches 3–5 cm and suits the body.

Ultrasound contraindications: pregnancy, malignancy, pacemakers, thrombosis, and direct application over the heart, thyroid, eyes, and gonads.

Galvanic desincrustation uses the negative pole, producing an alkaline reaction that saponifies sebum and softens comedones before extraction.

Galvanic iontophoresis drives an ion with the pole of matching charge: the positive pole for positively charged (alkaline) actives and the negative pole for negatively charged (acidic) actives.

High-frequency (Tesla) current generates ozone and warmth for a drying, antibacterial effect on acne; avoid with pacemakers, metal implants, and pregnancy.

LED phototherapy: blue about 415 nm targets porphyrins in Cutibacterium acnes, red about 633 nm addresses inflammation and healing, and near-infrared penetrates deeper for tissue repair.

Mechanical vacuum and lymphatic devices are avoided over varicose veins, thromboses, active infection, and untreated hypertension.

Isotretinoin impairs healing and raises scarring risk: wait 6–12 months after the last dose before peels, microdermabrasion, microneedling, or laser.

Photosensitizing drugs include tetracyclines, fluoroquinolones, sulfonamides, thiazides, amiodarone, retinoids, and St. John's wort; they increase burn and post-inflammatory hyperpigmentation risk.

Anticoagulants and antiplatelets - warfarin, aspirin, clopidogrel, NSAIDs, fish oil - increase bruising and bleeding during extractions, needling, and injections.

Pregnancy and lactation exclude retinoids, hydroquinone, high-concentration salicylic acid, and elective resurfacing.

Hydroquinone is commonly used at 2% over the counter and 4% by prescription; prolonged unsupervised use carries exogenous ochronosis risk.

Clients with a herpes simplex history receive prophylactic antiviral therapy before medium or deep peels and ablative resurfacing.

In the medical esthetics model, diagnosis, prescription, and injectable orablative procedures remain with the supervising licensed medical provider; the esthetician works within delegated scope.

Refer to a physician for spreading erythema, increasing pain, purulent drainage, fever, or blistering after a treatment.

Keloid history, immunosuppression, uncontrolled diabetes, bleeding disorders, and active infection are relative contraindications to resurfacing procedures.

Service price floor = (provider labor + product cost + allocated overhead) per treatment; retail pricing commonly uses keystone, or double the wholesale cost.

Break-even client volume = fixed costs per period divided by (average ticket − variable cost per client).

In an established practice, revenue growth comes more from rebooking rate and average ticket than from new-client acquisition.

Virginia generally applies retail sales tax to tangible products but not to professional personal services; confirm current Virginia Tax guidance before changing pricing structure.

Employee versus independent contractor status is determined by control, scheduling, and financial arrangement tests, not by the presence of a signed contract.

Professional liability coverage must name the specific modalities performed, including lasers, IPL, chemical peels, and microneedling.

Before-and-after images require written client consent and must not be misleading; guaranteed outcomes cannot be advertised.

Par inventory level = (average daily use × supplier lead time in days) + safety stock.

Client records and health information are confidential; retain and dispose of them in line with Board, insurer, and privacy requirements.