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No Skin Care Professional Should Be Without Liability Insurance

by Mona Green

Estheticians, are you covered by an insurance policy? If not, one mistake could cost you your license. In the event that your employer does not provide you with insurance coverage, it is vital that you take measures to protect yourself. Here are some helpful tips:

Associated Skin Care Professionals suggests;

If you think you’re completely covered by your employer’s insurance, be sure to ask these four questions:

1 Will your employer provide you with a copy of the policy for you to review?

2 Does their policy cover you for all services you are performing?

3 When does the policy come up for renewal?

4 In the event of a claim, will it cover your legal defense?

Examples of Claims Made Against Estheticians according to ASCP.

  • Product/equipment problems
  • Injury caused by esthetician during the treatment
  • Client suffers injury due to accident ( not caused by treatment)
  • Alleged problems with no real incident

If an incident occurs:

1 Assess injuries. Obtain medical help; seek treatment immediately.

2 Don’t get defensive or hostile; don’t admit fault.

3 Take photos, if possible. Write a detailed account of actions and conversations

4 Contact your insurance carrier immediately.

5 Know what your carrier suggests before an incident happens.

For more information contact www.ascpskincare.com

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Exfoliate Your Way to Glowing Skin!

by Lisa Johnson

The skin is the largest organ of the human body. It’s our job to maintain it and keep it looking its best. One way we can ensure proper skin health is by exfoliation. Exfoliation is the act of removing dead skin cells from the epidermis.

The question is, why should we exfoliate?

Our skin is constantly generating new skin cells in the dermal layer and sending them up to the epidermis. As our skin cells rise to the epidermis, they gradually begin to die. The dead skin cells are then sloughed off. The process normally takes 28 days for the cells to reach the top. This process is called cell turnover.

Unfortunately, as we age our cell turnover rate slows down. The process that should take 28 days can take up to triple the time. These cells start to pile up unevenly on the skin’s surface giving us a dry, rough, and dull appearance. This is where exfoliating can help because it can help remove the dead skin cells to reveal new, fresher, younger cells from below.

There are two types of exfoliation: mechanical and chemical.

Mechanical exfoliation is the process where the dead skin cells are physically rubbed off by some sort of an abrasive. The main method of mechanical exfoliation is body and facial scrubs. Scrubs can be made of salt, sugar, aluminum oxide crystals, apricot kernels, pumice, almond shells, or even coffee grounds. Another form of mechanical exfoliation is microdermabrasion. Traditional microdermabrasion is a more aggressive from of exfoliation that uses a machine to blast crystals on the skin and then sucks them back up into a hand piece for disposal.

Chemical exfoliation is the act of removing dead skin cells by breaking down the chemical bonds between skin cells with the use of alphahydroxy acids, betahydroxy acids, and enzymes. AHA’s are mild acids that exfoliate the skin. These acids can include glycolic, lactic, tartaric, and malic. BHA’s are acids used for oilier skin types. The most common BHA is salicylic acid. BHA’s are great for people suffering from acne. Enzymes are used to dissolve dead skin cells and tend to be better for more sensitive skin types. The common enzymes used are pineapple, papaya, and pumpkin, among many others.

As with anything, too much of a good thing can be bad. Over-exfoliating can lead to issues with the skin. It can cause excessive dryness if done too frequently and using certain methods too often can lead to premature thinning of the skin. Another issue that can arise with exfoliation is the sensitivity to UV exposure.

Exfoliating is an important part in maintaining healthy skin. Always follow guidelines set by your skin care provider in order to achieve safe and effective results from exfoliation, and remember to always follow it up with sunscreen to keep that youthful glow.

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Would You Rub this on Your Face?

by Mikala Ewald

Would you rub this on your face?

Do you clean your makeup brushes on a regular basis? If not, you may be doing just that!

Makeup brushes harbor bacteria that is picked up from the skin, makeup products, the lining of makeup bags/cases, the air, and counter tops. The warm moist air that is often found in bathrooms create an ideal environment for bacteria to colonize and spread.

Since makeup brushes harbor bacteria, they can spread infectious diseases, such as MRSA, that are highly contagious. MRSA and other staph infections cause skin irritations, redness, abscesses, and boils. In addition to infectious disease, the bacteria found in makeup brushes can also cause acne breakouts.

Personal makeup brushes should be cleaned with an antibacterial soap or brush cleaner once a week at the very least to prevent this bacteria from being spread onto the skin during makeup application. Makeup brushes that are used in a professional setting must be cleaned after being used on each individual client and should never be shared. And at home, just like your toothbrush, makeup brushes should not even be shared with family and friends!

Frequent brush cleaning may seem tedious or unnecessary, but without this important step in your beauty and skin care routine, healthy skin is difficult to achieve!

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Luscious Lashes: Everything You Want to Know about Lash Extensions

By Christen Brummett

Everyone wants long, thick fabulous eyelashes and lash extensions give you immediate, beautiful lashes. However, there are a lot of misconceived notions about them. Check out the following information below on the investment in beautiful lashes.

•60-120 eyelashes are applied to each eye, so the time investment can be significant. Plan to be there at least 3 hours. Most places allow you to bring an iPod or some other device to listen to.
•Lash extensions are not permanent. Just as your natural eyelashes shed off, your false eyelashes will shed with them.
•To properly maintain your lashes you should have them filled every 3 weeks to replace the lashes you have lost.
•Pulling and picking can not only take out the false eyelashes, but can also rip out your natural eyelashes, so….don’t do it! If you need to have the eyelashes removed, please make an appointment to do so.
•Products you put on your eyelashes can break down the glue. Look for things like glycols and carbonates…these ingredients will make your eyelashes shed more quickly.
For more information or to schedule an appointment for eyelash extensions, call Clary Sage College at 918.298.8200!
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Makeup Brushes

By Lisa Johnson

Have you ever gotten new makeup that came with a brush you had no idea what to do with? Many people shy away from using makeup brushes because they feel like they are too messy, too complicated, or just because they have no idea what do with or how to take care of the brush.

Brushes were actually made to make our lives easier. They were designed to help us enhance our makeup and even make the process more enjoyable. The brushes allow us to create exotic looks and blend color in a way that had never been achieved with the disposable applicators. Although quality brushes may be an investment in the beginning, with proper care they can be a near-permanent addition to your makeup bag as they last for many years.

Makeup brushes come in a variety of shapes and sizes. The main factor to look for is the quality of the hair or fibers of the brush. Brushes come in two types, real hair and synthetic fibers. There is a purpose for both in a makeup bag. The real hair brushes are usually made from animal hair such as mink, squirrel, horse, raccoon, ox, sable, and even goat. The synthetic brushes are usually made from taklon, nylon, and plastic. The real hair brushes are mainly used for applying dry products while the synthetic can be used for liquids and creams.

The care of brushes is extremely important for extending the life of a brush and for the health and safety for you and your client. It’s very important that all brushes be cleaned with either a medical grade brush cleaner and a shampoo made for brushes. Brushes are to be cleaned after every use or after every client. Each brush needs to be cleaned and allowed to lie flat to dry in order to keep the glue bonds together between the brush and the handle. The brush should never be allowed to dry upright because the water will drip down weakening the glue bonds and causing the brush to separate from the handle. Before using a brush again it must dry completely.

How or what you use your brush on is really up to you, but here are a few tips for brushes that may be giving you a little trouble!

Foundation Brush

Foundation brushes are usually made of synthetic hairs or fibers. Their primary purpose is to apply liquid or cream foundation in an even streak-free manner. You aren’t using your hands to apply the foundation so it is more sanitary and usually less wasteful.

Concealer Brush

Concealer brushes are similar to a foundation brush. They are made of synthetic fibers and made to use with a liquid or a cream concealer. They are smaller than a foundation brush to allow for reaching smaller areas without tugging or pulling of the skin. They are also better for sanitation purposes and cutting waste of the product.

Powder Brush

Powder brushes can come in a variety of shapes and sizes. A good powder brush will be a real hair brush that is loosely packed so the brush is able to blend powder over the desired area. The brush is made for the basic purpose of applying loose or pressed powder in a light application.

Blush Brush

A blush brush is considered very similar to a powder brush. The shape of the blush brush can vary from flat on top to tapered. They are all designed to achieve the same contouring of the cheek area. Blush brushes are made of real hair and also packed loosely to allow for the loose or pressed blush to be applied in a lighter application and then blended.

Fan Brush

Fan brushes can be made of synthetic or real hair. Synthetic fan brushes are made to apply liquids, creams, or gels to the skin. The real hair fan brush is made to be more of a clean-up or highlighting tool. It is packed loosely so you are able to wipe any excess powder type of product from the face. It works very well when wanting apply a shimmer powder or a highlighter.

Eye shadow brush

Normally, eye shadow brushes will be made of real hair. They come in many shapes and sizes. The 3 main types of shadow brushes are contour, angle, and blending. Contour brushes are tightly packed brushes that are used mainly for depositing color. They can, however, be used for some blending. Angled brushes can be loosely or tightly packed. They are also used to blend and deposit color. The last major type of brush is the blending brush. This brush is packed very loosely to allow for lightly moving color and blending color together.

Eyeliner brush

Most eyeliner brushes are synthetic brushes. They are made to make small lines near the lash line. The brushes can be used with liquid, cream, powder, or gel. The also vary in size and shape. You can find these brushes in tightly packed, angled, pointed or flat topped shapes.

Lash and Brow brush

Lash and brow brushes are usually synthetic or plastic brushes. They are used to add color to brows or to tame brow hair. The lash end is used to separate lashes before and after mascara is applied.

Lip brush

Lip brushes are usually synthetic fibers. This brush is used to outline or fill in lip color. They are angled or flat on top. These brushes are great when wanting to use the bottom part of a lipstick.

How you choose to use each brush is entirely up to you. Brushes were intended to make our lives easier when it comes to makeup. The key is to be creative, have fun, and try different brushes to achieve your desired look.

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The Number One Method of Skin Protection

By Lisa Johnson

When we think about sunscreens we think about summer time and laying out by the pool. However, sunscreen is not just for the summer. It is a vital part of our daily skin care routine year around. You can get just as much sun in December as you can in July. The question is what kind of sunscreen and what level of protection is necessary to avoid burning and aging of your skin.

There are two main types of sunscreen you will need to consider when deciding what sunscreen is best for you. Sunscreens fall into the categories of physical and chemical. They both work very differently, but are essential in fighting the harmful effects of the sun.

Physical sunscreens are usually called sun block. They work by deflecting or blocking the sun’s rays from your skin. They are used to protect from UVB and some, but not all, UVA rays. The main ingredients you will find in a physical sunscreen are titanium dioxide and zinc oxide. Some people can have allergic reactions with titanium dioxide in physical sunscreens. The consistency is usually thicker and can be harder to apply. Physical sunscreens are known to be very safe and don’t cause free radicals.

Chemical sunscreens are the second type of sunscreen. They work differently than physical sunscreens. Chemical sunscreens work by absorbing the sun’s rays instead of deflecting them. This type of sunscreen can sometimes be called organic sunscreen. One drawback to an all chemical sunscreen is the fact that it can be irritating to the skin due to the amount of chemicals it contains. On a positive note, chemical sunscreens offer more protection against UVA and UVB rays than physical sunscreens. Some chemicals will even protect against the whole UVA spectrum. Not all chemicals have been approved by the FDA and there are some chemicals that may cause free radicals which can cause your skin to age.

Most sunscreens now offer the best of both worlds by using both a chemical and a physical sunscreen to give the skin ultimate protection. By using the positive aspects of both physical and chemical sunscreens, consumers can be confident that they are protected without causing any extra damage to their skin.

The second question consumers have when purchasing a sunscreen is what is SPF and what level is appropriate for their skin.

SPF stands for sun protection factor. Sun protection factor is the products ability to block or absorb the sun’s harmful rays. The number behind the SPF is used to tell how much longer you can stay in the sun with sunscreen on before you burn than without a sunscreen. With a basic SPF 15, you can stay 15 times longer in the sun that without a sunscreen before you burn. However, the increase in SPF does not increase proportionally. An SPF of 2 will absorb 50% of UV rays, SPF 15 absorbs 93%, and SPF 35 absorbs approximately 97%. Most dermatologists will recommend a minimum of SPF 15 for daily use.

Another factor to look for when deciding on a sunscreen is making sure that it is “water resistant” or “waterproof”. “Water resistant” is a product that will maintain its SPF level after at least 40 minutes of water exposure. “Waterproof”, on the other hand, is when the product maintains its SPF level after 80 minutes of water exposure. Reapplying your sunscreen will be based on the level and if its “water resistant” or “waterproof”. Remember that it must be applied after physical activity, sweating, or swimming.

In the last few years the FDA has made great strides on helping consumers comfortably pick a sunscreen and know the level of protection it actually provides. Until recently, sunscreens only provided consumers with the level of UVB protection. With new regulations consumers will know the level of UVA protection too. The UVA labeling will be represented by a Star System.

*One star is low protection

*Two stars is a medium protection

*Three stars is a high protection

*Four stars will be the highest protection available in an OTC sunscreen.

*If a product has less than one star it will contain a label stating “no UVA protection”

* The system will also help educate consumers on the harmful effects of the UVA and UVB rays.

Making a decision on how you protect your skin against the harmful effects of the sun shouldn’t be a decision you take lightly. When considering all the factors of aging and the possibilities of skin cancer, using sunscreen is a necessary component to great skin care and should be incorporated into everyone’s daily routine.

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The Importance of Skin Care at Home

By Mikala Ewald

Yes, going to see your esthetician on a regular basis is vital for radiant, healthy skin, but did you know that a good home care regimen can amount to up to 90% of skin health? If you don’t focus on your skincare at home, your trips to your esthetician will become a costly waste of time. Spa treatments such as facials, chemical peels, and microdermabrasion are great additions to your skin care regimen, and are a necessary maintenance for skin health and upkeep, but without proper care in between services these treatments will never offer long term results. These treatments are meant to be done on a regular basis as an add-on to your daily routine.

With the array of products on the market, how do you determine what products and steps should be included in your home care routine? Here are the essentials that should be included in everyone’s skin care routine to help you achieve beautiful skin.

Cleansers

Cleansers are designed to remove dirt, oil, debris, and makeup from the skin. Everyone should begin and end every single day with cleansed skin. Take your time cleansing your skin, do not rush through it, and make sure you rinse all residue from the skin. If debris, oil, and makeup are left on the skin, the chance of clogged pores and breakouts increases greatly. It is important to choose a cleanser formulated for your skin type.

  • Individuals who have normal or combination should look for a cleansing milk or a formula that gently moisturizes the skin and contains nothing abrasive.
  • Those who have oily or acneic skin should use a cleanser containing glycolic acid or salicylic acid. These typically appear in the form of gel or foaming cleansers.
  • Mature, dry, and sensitive skin types need an emollient cleanser that will add additional moisture to the skin. Ingredients like rose or any oil based cleansers work best for these skin types.

Toners

Toners are used to remove any residue left on the skin (a second cleanse), normalize the pH level of the skin, and help to close and contract the pores preventing oil or bacteria from clogging them. Toners are to be used directly after cleansing and may be left on the skin.

  • For normal or combination skin, choose toners that contain low amounts of alchohol: 4-15%
  • Oily and acne skin types can handle higher percentages of alcohol, and salicylic acid toners are very beneficial.
  • Individuals with mature, dry, and sensitive skin need very little to no alcohol in their toners. Ingredients like aloe and coenzyme Q10 work very well for these skin types.

Moisturizers

Moisturizers are designed to even out the oil and water balance of the skin, so even if you have plenty of oil on your skin you still need a hydrating moisturizer to balance your oil/water content. Depending on your skin type, you may choose to use a lighter moisturizer during the day and a heavier one at night. Many moisturizers also contain sunscreen, vitamins, and antioxidants to improve skin health.

  • Those with normal or combination skin should look for a moisturizer that contains both humectants (water content) like glycerin, sorbitol, or hyaluronic acid and moisturizers (oil content) like silicones.
  • Oily and acne skin types need hydrators that will attract water e.g. hyaluronic acid. Look for light lotions rather than heavy creams for this skin type. Those with oily and acne skin have a tendency to strip all oil and moisture from their skin as they believe they have too much, but repeatedly stripping the skin causes your body to overproduce oil making the skin even oilier.
  • Mature, dry, and sensitive skin types need oil content. Emollient ingredients, like silicone and squalene, are great.

Sunscreens

Sunscreens are essential for everyone, everyday. They help to prevent UVB (burning) rays from damaging the skin. Did you know that 85% of all aging is due to sun damage? According to one study, the use of a sunscreen of SPF 15 or higher during the first 18 years of life would cut lifetime risk of melanoma by 78%…can you imagine the difference you would make by wearing sunscreen every single day of your life?

Treatment Products

Schedule an appointment with your esthetician to determine which treatment products are best for you and your skin conditions. Your esthetician will also help you determine the frequency of use for these products. Treatment products are designed to correct or prevent specific skin conditions that one is prone to. Some examples are exfoliants, hydrating serums, antioxidants, lightening creams, acne spot treatments, etc.

For a detailed skin analysis and product recommendations, give Clary Sage College a call at 918.298.8200!

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Levels of Treatment for Aging Skin

Listed below is a three dimensional approach to skin treatment with three therapies available to choose from, depending on the clients needs.

“The best way to keep looking good and loving your skin is with a three dimensional skin rejuvenation treatment approach. A 3D skin rejuvenation treatment combines different clinical applications to attend to your skins every need. First, it increases collagen production then tightens saggy skin and improves skin texture and tone plus it continues to improve the skin even after the full duration of the treatment. Areas that are targeted by 3D skin rejuvenation are the “nasolabial” folds (lines that extend from the end of the nose to the end of the lips), wrinkles on cheeks, double chin, “marionette lines” (lines from the corners of the mouth to the jaw line) and crepe-like skin on the neck. The treatment is usually performed over three months however after every treatment session the skin looks better than before. The treatment can be performed on all skin types, but the skin care professional must adjust the treatment intensity to produce fresh, younger looking tissue and lasting results. The 3D combination skin therapy includes the following in classified levels:”

Type I Therapy – is directed at the epidermis (microdermabrasion/chemical peels/LED/IPL.

Type II Therapy – is directed at the dermis (radio frequency, laser/chemical peels/microcurrent).

Type III Therapy – Is surgical or injectable (cosmetic surgery, Botox, fillers).

Lynn Ross, L.M.E.
“Beautiful Skin at Any Age” Dermascope Feb 2011
mailto:newsletter @dermascope.com 1 Mar 2011

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Safe Tanning

By Lisa Johnson

Now that we are on the downhill slide of winter, people are starting to make plans for spring breaks and even summer vacations. With the feeling of spring in the air, many people take to tanning beds or laying out in the sun to get that “Healthy Glow”. The problem is getting that “Healthy Glow” is becoming more and more dangerous.

Tanning is a major epidemic among teens and adults in the United States. Most people say that having color on their skin makes them feel more beautiful. Over 18% of women and 6.3% of men have tanned in the last 12 months, according to the Archives of Dermatology. Those numbers are still considered to be on the low side.

With advances in medical research the direct correlation between skin cancer and tanning has been proven. Skin cancer among tanners is jumping at an alarming rate and expected to continue to rise just as rapidly in the coming years. Studies have shown that over 90% of skin cancer is caused from UV exposure from tanning outdoors or in a tanning bed. An even more frightening statistic is that tanners that use indoor beds are 74% more likely to develop melanoma than people that do not tan. Now the only way to get a safe tan comes out of a bottle, tube, or machine.

During all the recent media attention of safety with tanning beds, the FTC (Federal Trade Commission) made a ruling banning the Indoor Tanning Association from making misleading statements about the safety of using tanning beds. This also led to the large tax on the use of the indoor beds. Some states have even gone as far as to make it illegal to tan under 18 without a parent’s consent.

Due to the increasing rates of skin cancer many companies have developed “safe” ways to get that glow without risking one’s life. There are many products that promise a safe and easy tan that you can use in your own home or in a salon without any exposure to UV rays. The products used to safe tan are usually a cream, lotion, gel, liquid, a wipe, or even pills.

Most self -tanning products contain a chemical, dioxyhydroacetone (DHA), as the active ingredient. This causes a darkening of the stratum corneum, the outer most layer of the epidermis. This darkening is temporary until the dead skin cells are shed or sloughed off. Depending on how one exfoliates and takes care of their skin, most self- tanners are made to last only a few days per application. This is the case with lotions, creams, gels, and airbrush.

Sunless tanning pills are out on the market but not considered 100% safe according to the Mayo Clinic. Reactions are common after taking the pills due to high levels of a color additive called canthaxanthin. Many people have noticed abnormal skin coloring and hives. In extreme cases it can also lead to liver damage.

Many people feel that having a sunless tan is time consuming and too temporary. However, with the correct steps taken before and after, a sunless tan can last longer and be very quick and easy. By following a few quick steps, you can have a lasting, beautiful, safe tan year round.

1) Before you apply a tan make sure to exfoliate the area to be tanned thoroughly. You don’t want your tan to color the cells that are about to be sloughed off.
2) Make sure you have shaved areas that you normally shave before applying the tan.
3) Apply lotion to the areas you are applying your self-tanner to. Make sure all product is massaged into the skin before applying tanner.
4) Make sure to use a sunscreen along with your self-tanner.

For more information about sunless tanning call Clary Sage College at 918.298.8200, and be sure to follow The Skintourage on Twitter @theskintourage!

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Brazilian Waxing: The Front to Back of It

Brazilian Waxing: The Front to Back of It

By Lisa Johnson

When we think about hair removal we typically think about areas of the face, arms, and legs. However, when the seasons change, so do our hair removal concerns. As the summer season approaches so does swimwear, trips to the lake, and removing unwanted hair from all areas of the body, including the bikini area.

Brazilian waxing on women has been widely practiced in European cultures dating as far back as 4000 BC. Although many cultures removed hair as a custom, it was also removed for aesthetic purposes. The methods of hair removal have largely remained the same but technology has changed the materials used.

Brazilian waxing includes a couple different variations such as, the bikini wax, the landing strip, and the Sphinx. The bikini wax leaves only a small amount of hair left above and on the sides. The landing strip leaves a narrow vertical strip while all hair is removed from front to back. Most people consider a “true Brazilian” to be a Sphinx. The Sphinx, much like the rare cat breed, leaves nothing to the imagination…it’s all taken off, including all hair from front to back.

Although mainstream today, there have been times that the Brazilian has been controversial. With advanced skills of your Esthetician, Brazilian waxing can be done with minimal discomfort and no down time. The risk of infection is also greatly reduced with correct sanitation and disinfection. The consistent waxing of the bikini area will also diminish the amount of hair that returns and there will be little to no discomfort after routine treatments.

For more information, questions or to book an appointment for your Brazilian wax

Call Clary Sage College at 918.298.8200

Mineral Oil
The Great Debate

By Lisa Johnson
In the past few years, one of the skin care and cosmetics industry’s great debates has been over the use of mineral oil in products we use on our skin. Many cosmetics and skin care companies have taken a strong stand for or against the use of mineral oil in their products. They have even gone as far as to base the majority of their product education on why they feel it is important to use or not to use mineral oil on the skin. Many people feel the debate is fueled from the “natural” cosmetic and skin care companies to ensure sales of their product. It then becomes a debate of natural versus chemical.

To make an educated decision you first must know what mineral oil is. Mineral oil is a light, colorless, transparent, tasteless, odorless and oily liquid that will not spoil. It is an inexpensive byproduct produced in the purification of petroleum and during the production of gasoline and other petrochemical products from crude oil. It is available in light and heavy grades and is insoluble in both water and alcohol.

Mineral oil is found in many products that we use every day. It is used in food products, creams, lotions, cosmetics, preservatives, and baby care products just to name a few. It is also widely used to fight constipation.

There are positive effects from using mineral oil on the skin. Mineral oil works like a barrier between the skin and the outside elements. It acts as an occlusive agent which prevents water from naturally leaving body through the skin. Mineral oil actually does not dry out the skin, it is moisturizing and helps fight premature aging.

Many studies have been done to try to prove and/or disprove the harmful effects that mineral oil has on the skin and body. Some say that using it in a laxative form can cause bowels to lose their normal function and for one to become chemically dependent on a mineral oil laxative.

There are other concerns of the amount of use of mineral oil on young children and the elderly. Lipid pneumonia is a condition that results after the inhalation of lipids, fats, or oils. Humans naturally have a bacteria living in their nostrils. However when you accidentally inhale mineral oil droplets, this bacteria can be transferred into the lungs via the droplets resulting in lipid pneumonia.

Mineral oil has also been linked to various skin problems. Excess amounts of mineral oil can prevent the release of toxins in the body. While long-term use of mineral oil can cause dermatitis and skin irritation, it does not cause acne even though too much can irritate it.

Before you decide which side you are on, make sure to read all pros and cons and make your decision based on correct, unbiased information. Your skin is going to be with you for your entire life and it is your job to take care of it so it will always look its best.

Lipid Pneumonia