Laser resurfacing in London

How lasers act on skin

A laser emits light at a single wavelength. Resurfacing devices use wavelengths absorbed strongly by water, which is abundant in skin, so the energy is deposited where it is aimed and converted to heat. Depending on the device and the settings, that heat either vaporises tissue or heats it without removing it.

Fully ablative

Removes the epidermis and part of the dermis across the whole treated area. The most powerful option and the one with the longest recovery and the highest risk. Rarely the first choice today.

Fractional ablative

Removes columns of tissue with untreated skin in between, which heal from the edges. Substantial results with markedly faster recovery than fully ablative treatment.

Non-ablative fractional

Heats columns of dermis while leaving the surface intact. Less downtime, more sessions, a gentler result.

Vascular and pigment-specific devices

Different wavelengths targeting haemoglobin or melanin rather than water. Used for redness and for brown marks, and covered on the pigmentation and rosacea pages.

Why skin type governs everything

Melanin absorbs laser light. In darker skin there is more melanin in the epidermis to absorb energy that was intended for elsewhere, which raises the risk of burns and, far more commonly, of post-inflammatory hyperpigmentation.

That does not mean laser is unavailable in skin of colour. It means device selection, wavelength, density, energy and cooling all have to be adjusted, that treatment should be more conservative, that priming and post-treatment pigment management matter more, and that a test patch is essential rather than optional.

For skin of colour specifically, radiofrequency microneedling is frequently a better first choice because it disrupts the epidermis far less. See radiofrequency microneedling.

What it treats well, and what it does not

Treats well:

• Fine lines, particularly around the mouth and eyes.
• Sun-damaged, textured skin.
• Atrophic acne scarring, especially boxcar scars.
• Some solar pigmentation, with the right device.
• Enlarged-looking pores and general surface irregularity.

Does not treat:

• Volume loss. Resurfacing a deflated face improves the surface and not the shape.
• Significant skin laxity.
• Deep dynamic lines caused by muscle movement.
• Melasma reliably, and aggressive laser can make it substantially worse.
• Active acne, which needs treating first.

Recovery, described accurately

This is where expectations most often fail, because recovery is routinely understated in marketing.

• Non-ablative fractional: redness and swelling for two to three days, a rough sandpaper texture for up to a week, then flaking.
• Fractional ablative: significant swelling for two to three days, oozing and crusting in the first days, then peeling. Presentable at around seven to ten days, with residual pink for weeks.
• Fully ablative: weeks of recovery and months of residual redness. A different order of commitment.

Plan for it properly. Take time off if the treatment warrants it. Arrange the appointment when you are not about to travel somewhere sunny, and expect to be strict about sun protection for months rather than weeks. See aftercare.

Risks

• Post-inflammatory hyperpigmentation, the commonest complication and the reason for conservative settings in darker skin.
• Prolonged redness, sometimes for months after ablative treatment.
• Infection, including bacterial, and reactivation of herpes simplex. Antiviral prophylaxis is usual for ablative work.
• Scarring, uncommon and serious, associated with excessive energy or with poor aftercare.
• Loss of pigment, which can be permanent and is more likely after deeper treatment.
• Worsening of melasma.
• Ectropion and other eyelid problems where periorbital skin is treated aggressively.

Choosing where to have it

1. Which specific device and wavelength, and why that one for my skin?
2. What Fitzpatrick type have you recorded, and how does it change your settings?
3. Will you patch test, and when will you review it?
4. How many sessions, and what is realistic between each?
5. What antiviral or antibiotic prophylaxis do you use, and why?
6. What is the plan if I develop pigmentation afterwards?
7. How much downtime should I actually book?
8. Who is medically responsible for this treatment?

The clinic guide covers verification of the last question in detail.

Sequencing laser with everything else

Resurfacing is usually the most disruptive thing you will do to your skin, so it should sit at a sensible point in a plan rather than at the start of one. Skin that is actively inflamed, actively breaking out or actively pigmenting is skin that will heal unpredictably, and treating it produces the complications this page has spent several sections describing.

A reasonable order runs: settle any active skin disease first, medically if that is what it takes. Establish daily sun protection and, where appropriate, a retinoid, for several weeks. Treat pigmentation topically before treating it with light. Then resurface. Then maintain.

Spacing matters afterwards too. Convention is to leave around two weeks between resurfacing and injectable treatment in the same area, and considerably longer after ablative work. Facials, waxing, threading and abrasive products should be left alone for at least a fortnight, and often longer, and the practitioner should tell you when to restart each rather than leaving you to guess.

Finally, plan the maintenance before you book the treatment. A resurfacing result sits on skin that continues to age and continues to be exposed to ultraviolet light. Without daily protection and a reasonable routine, the improvement erodes, and the erosion is usually blamed on the laser rather than on the six months that followed it.