I Think the Skin Industry Has a Stimulation Problem: why I’ve become more interested in knowing when not to treat
When I first started working in skin, I think I believed progress naturally meant doing more. More active ingredients, more exfoliation, stronger treatments, more advanced technology. If someone wanted better skin, surely the answer was to find the next thing we could introduce to make that happen.
And to be fair, it makes sense that our industry thinks this way. We work in an industry built around treatments and products. New technology is exciting. Before-and-afters are compelling. Clients understandably want to feel like something is being done, and as clinicians, there is satisfaction in being able to offer something that feels active and corrective.
But the longer I've worked with skin, the more I've started to question whether we're always asking the right question. Instead of constantly asking, “What else can we do?”, I think sometimes we need to ask:
“Is this skin actually ready for us to do more?” Because I think the skin industry has developed a stimulation problem.
We’ve somehow made stronger synonymous with better
There is a particular language that exists around skin treatments. Stronger. Deeper. Medical-grade. Advanced. Clinical strength. Maximum results.
All of those words create the impression that there is a hierarchy in skincare where the more aggressive treatment must be the better one. A gentle treatment becomes something you have while you're waiting to graduate to the “real” treatment. I don't see skin that way anymore.
I love advanced treatments. We use skin needling, professional peels and other modalities at Curated because there are absolutely situations where creating a controlled stimulus within the skin can help us work towards a particular goal.
But the treatment itself isn't impressive to me simply because it's advanced. What matters is whether it's appropriate for the skin in front of me. You can have access to an incredible piece of technology and still make a poor clinical decision with it. Equally, sometimes a seemingly simple treatment that focuses on hydration, calming the skin and supporting function is exactly the right decision.
Advanced doesn't automatically mean better. Appropriate does.
Skin needs to be able to respond to what we’re asking it to do
This is probably where my thinking has changed the most throughout my career.
Many professional treatments work by deliberately creating some form of controlled stimulus. Skin needling is an obvious example: we're intentionally creating controlled micro-injury to initiate wound-healing processes. That can be incredibly useful when we're working towards certain goals, particularly things like acne scarring and aspects of skin remodelling.
But if we're deliberately asking the skin to respond and repair, I want to think about the condition of that skin before we ask it to do so.
Is it significantly inflamed? Is it reactive? Is the barrier compromised? Is the client already using a routine that is pushing the skin too hard? Are they sleeping terribly, going through a period of significant stress or experiencing another change that is affecting how their skin is behaving? What are we actually trying to achieve with this treatment?
I used to think much more about what treatment matches the concern. Now I think just as much about whether the skin is ready for the treatment. That distinction has become a huge part of the way we practise at Curated.
Sometimes skin is already telling you it’s had enough
I have a very non-scientific analogy that I use with clients all the time. Imagine a toddler who is completely overwhelmed and screaming. They're tired, they're upset, nothing is making sense anymore and they're at the point where even asking them to put their shoes on could send them over the edge.
You probably wouldn't respond by giving them increasingly complicated instructions. You'd calm them down first. That's sometimes how I think about highly inflamed, reactive skin. Obviously skin isn't literally a screaming toddler, but the analogy helps explain why my instinct isn't always to immediately introduce another active ingredient or stronger treatment when something isn't improving.
Sometimes the skin is already telling us it's struggling. Adding more stimulation because we're frustrated with the result can just create more noise. So before we start asking the skin to do something more complicated, sometimes I want to get it calm enough that we can actually see what we're working with.
This is where “strengthen before we stimulate” came from
A huge part of our approach at Curated is built around this idea. When someone comes in with acne, pigmentation, redness, texture or another concern, of course we want to work towards improving it. But the concern isn't the only thing I see when I look at someone's skin.
I see the condition of the skin surrounding it. If someone has acne but they're also incredibly dehydrated, reactive and inflamed from over-treating it, my first step might not look particularly acne-focused to them.
If someone wants to treat pigmentation but their skin is irritated and struggling to tolerate their existing routine, I may not immediately reach for the strongest corrective treatment available.
If someone books skin needling because they've heard it's amazing for their concern but I don't think their skin is in the right position for it yet, I will tell them that. That isn't us doing nothing.
Preparing the skin is part of the treatment. Sometimes the most clinically useful thing we can do today is create a better foundation for what we want to do three months from now.
I think social media has made this harder
We're constantly shown the intervention. You see the peel being applied. The needling pen moving across the skin. The dramatic mask. The machine. The immediate glow. The skin peeling three days later. The before-and-after.
What you rarely see is the six months of fairly boring consistency surrounding it. You don't see someone cleansing properly every night. You don't see them applying their Vitamin A consistently. You don't see the SPF they put on every morning.
You don't see the appointment where we decided not to do the treatment we originally planned because the skin had changed. Those things aren't particularly exciting to film. But they're often the things that make the exciting treatment make sense.
I think this is part of why clients sometimes arrive believing that professional treatments are responsible for most of their result, when my philosophy is almost the opposite. I often describe skin journeys as roughly 80% homecare and 20% professional treatment. That's not a scientific statistic; it's simply the way I explain how important the daily work is compared with what happens during the relatively small amount of time you spend with us in clinic.
Treatments can absolutely help us achieve better and sometimes faster results. But they shouldn't be trying to compensate for foundations that aren't there.
We’ve done the same thing with skincare
The stimulation problem doesn't stop when you leave the clinic. I used to think a comprehensive skincare routine meant having something from almost every category. You needed your exfoliant, your active serum, Vitamin A, Vitamin C and whatever else belonged on the checklist.
My thinking around that has changed a lot. Now I'm far more interested in the quality and overall formulation of what someone is using than whether we've ticked every possible ingredient category. I'm also much more conscious of what happens when several individually useful products are layered into one routine.
We forget that the skin experiences the entire routine. It doesn't know that your exfoliating cleanser came from one brand, your acid toner from another and your retinoid was recommended by somebody else. It experiences all of those things together.
Sometimes a client arrives with a bathroom cabinet full of excellent skincare and my recommendation is still to remove half of it. Not because the individual products are necessarily bad. Because more good things don't automatically create a better routine.
Knowing when not to treat is a clinical skill
I actually think this is one of the biggest differences between simply being able to perform a treatment and being able to create a treatment plan. It's relatively easy to learn what a treatment does.
It's much harder to know when not to use it.
There are days where a client comes in expecting a particular treatment and we change the plan after looking at their skin. Sometimes that's disappointing. I understand that, particularly when someone has been looking forward to progressing into something more corrective.
But I'm not interested in performing a treatment simply because it was written in the calendar. The plan needs to be able to move.
Skin changes. Health changes. Seasons change. Medications change. Stress changes. What was appropriate when we planned your next appointment six weeks ago may not necessarily be what your skin needs when you actually walk through the door.
That's why I don't think the treatment itself should ever become the goal. The skin outcome is the goal. The treatment is just one tool we may use to get there.
More inflammation isn’t proof that something is working
I think we've also become slightly conditioned to associate visible reaction with efficacy. If it tingles, it's working. If we're red afterwards, it must have been a good treatment. If the skin peels, something is happening. If there's no downtime, maybe it wasn't strong enough.
There are treatments where an inflammatory or visible response is expected as part of the mechanism, and there are circumstances where controlled injury is exactly what we're trying to create. But that doesn't mean the biggest possible reaction equals the best possible result.
Inflammation isn't a trophy. The aim isn't to prove that we did something to your skin. The aim is to create an appropriate biological response for the outcome we're working towards while managing risk and respecting the individual skin.
Sometimes you'll leave Curated looking pink. Sometimes you'll leave looking incredibly hydrated and calm. Neither tells you, by itself, whether the treatment was “better”. Context does.
This philosophy can feel slower at first
I understand why someone who has been struggling with their skin doesn't necessarily want to hear that we need to spend time on foundations. They want the acne gone. They want the pigmentation gone. They want the scar gone.
They've already spent months or years thinking about it, so being told we're going to start by simplifying their routine or calming their skin can feel like another delay. But I'm not interested in creating the fastest possible treatment plan on paper.
I'm interested in creating the most sensible plan for the person sitting in front of me. Sometimes we can progress quickly. Sometimes the skin asks us to slow down.
And sometimes slowing down at the beginning gives us much more freedom later because we're no longer trying to correct a concern while simultaneously managing a skin that's becoming increasingly irritated.
This is why our skin journeys aren't built around getting everyone onto the most advanced treatment possible. They're built around progression. Strengthen. Normalise. Target. Treat. Preserve. And the amount of time someone spends in each part will be different.
I don’t want clients to be afraid of treatments either
There is another extreme I want to avoid because I don't believe the answer to over-treatment is becoming scared of doing anything to the skin. Skin is resilient.
Appropriate stimulation can be incredibly valuable. Active ingredients can be valuable. Exfoliation can be valuable. Skin needling can be valuable. Professional peels can be valuable. The point isn't that stimulation is bad.
The problem is stimulation without enough consideration for why we're doing it.
If we're creating a response in the skin, I want there to be a reason. If we're adding an active ingredient, I want there to be a reason. If we're progressing into a more advanced treatment, I want there to be a reason. And if we're deciding not to do something today, I want the client to understand the reason for that too.
That's what evidence-informed skin care should look like to me. Not doing the most. Doing what makes sense.
My definition of a good treatment has changed
Earlier in my career, I probably would have judged a treatment largely by what happened during the appointment and what result we could create afterwards. Now I think about it much more broadly. Was it the right treatment for this skin? Did it fit within the longer-term plan? Was the skin prepared for it? Did the client understand why we were doing it? Was there something simpler that would have achieved what we needed?
And perhaps most importantly: did we need to treat at all?
I think being willing to ask that final question is important in an industry that financially benefits every time the answer is yes. There will always be another product we could sell. There will always be another treatment we could perform. There will always be a newer machine, stronger active or more exciting modality. But our job isn't to find the maximum amount of treatment somebody can tolerate.
Our job is to make good decisions about their skin. And sometimes the best decision is to do more. Sometimes it's to do less. Sometimes it's to refer. And sometimes it's simply to give the skin time to do what we've already asked it to do.
That's probably the biggest thing nearly a decade of working with skin has changed for me. I'm far less impressed by how much we can do to the skin. I'm much more interested in knowing when we actually should.
— Shae
Founder & Dermal Clinician
Curated Skin Aesthetics
