How to choose a skin clinic in London

A device is not a diagnosis

The commonest failure in skin treatment is not a badly performed procedure. It is a competently performed procedure aimed at the wrong finding. Melasma treated as sun damage. Post-inflammatory redness treated as scarring. A compromised barrier treated with more exfoliation. An undiagnosed lesion treated with a laser.

So the first thing to assess is whether the clinic is diagnosing or dispensing. A clinic that tells you what you have before it tells you what it would use is doing the job. A clinic whose recommendation is the same machine regardless of what walks through the door has an appointment to fill.

Ask for the diagnosis in plain words before you ask for the price.

What the regulators actually cover

Most people assume that anyone treating skin in a London clinic must be licensed to do it. The picture is more complicated.

• The Care Quality Commission registers providers of regulated activities in England. Much purely cosmetic treatment falls outside a regulated activity, so a competent clinic may have no reason to be registered. Where a clinic does provide a regulated activity, registration is required and can be checked on the CQC's own website.
• Individual healthcare professionals remain accountable to their own regulator: the General Medical Council, the Nursing and Midwifery Council, the General Dental Council or the General Pharmaceutical Council. Registration numbers can be verified directly.
• Most London boroughs licence premises offering certain treatments under local special treatment provisions. This addresses the premises, hygiene and equipment rather than clinical judgement.
• Prescription-only medicines, including several of the most effective topical agents for pigmentation and rosacea, can only be prescribed by a qualified prescriber. A practitioner who cannot prescribe has fewer tools available.
• Devices are regulated as medical devices. There is no general licensing requirement in England for who may operate many of them, though local licensing may apply.

The eight questions

1. What is your diagnosis of my skin, in plain terms, before you propose a treatment?
2. Which Fitzpatrick skin type are you recording for me, and how does that change the plan?
3. Will you patch test, and when will you review it?
4. Which specific device or agent, at what setting or depth, and why that one?
5. How many sessions, over what period, and when will we judge it?
6. How will you photograph me, and can I have copies?
7. What would you expect this not to change?
8. In what circumstances do you refer to dermatology?

The last question is the most revealing. Skin disease and skin ageing overlap constantly. A clinic that never refers is a clinic treating every finding as a cosmetic one, which is how undiagnosed conditions get lasered.

Signs of a clinic that assesses

• It examines your skin properly, in good light, and looks at more than the area you mentioned.
• It records a skin type and refers to it when explaining the plan.
• It asks about your current routine, and often tells you to simplify it.
• It tells you which of your concerns it will not be treating and why.
• It insists on sun protection as a condition of treatment rather than as an upsell.
• It patch tests before light-based treatment.
• It photographs under consistent conditions.
• It gives a timeline in months, not in weeks.
• It declines to treat when treatment is not appropriate.

Signs of a clinic that dispenses:

• The same device recommended to everybody.
• A package proposed before an assessment.
• A discount that expires when you leave.
• No patch test offered before light-based treatment.
• No mention of sun protection.
• Guaranteed results.
• A gallery with mismatched lighting or make-up.
• Treatment of a pigmented lesion without a diagnosis.

When you should be at a GP or a dermatologist instead

Several of the most common reasons people come to a skin clinic are medical problems with effective medical treatment available, often on the NHS. Going private for a procedure while skipping that is expensive and frequently less effective.

• Active acne. Effective treatment exists and untreated acne creates new scars.
• Rosacea with papules and pustules, which responds to prescription treatment.
• Any new, changing, irregular, bleeding or non-healing pigmented lesion. This needs medical assessment before anything else.
• Severe or sudden skin changes, or a rash with systemic symptoms.
• Hair loss that is sudden, patchy or associated with other symptoms.
• Suspected allergy or contact dermatitis, where patch testing by a dermatology service is the correct route.

A cosmetic clinic that recognises these and sends you to the right place is not losing your business. It is behaving like a clinic.

If something goes wrong

• Contact the practitioner who treated you promptly. Burns, blistering, spreading redness and signs of infection need same-day attention.
• If you cannot reach them and the problem is urgent, contact NHS 111 or attend an emergency department.
• Post-inflammatory pigmentation responds better when treated early, so report it rather than waiting to see whether it fades.
• Suspected side effects of a medicine or a device can be reported to the MHRA through the Yellow Card scheme by patients as well as clinicians.
• Concerns about a registered professional go to their regulator. Concerns about a CQC-registered provider go to the Care Quality Commission. Concerns about premises go to the licensing local authority.
• Misleading advertising can be reported to the Advertising Standards Authority.

Keep a written record of dates, devices, settings where given, agents used and what you were told. It is far easier to gather at the time than months later.