I have worked in the beauty industry for over 10 years and I will be completely honest with you, I find the world of facial laser treatment incredibly confusing. There are so many brands and types of lasers—they all seem to address different things. If you look at the treatment menus, sometimes it feels like it is written in a completely different language. If I find it disorienting, then I can’t imagine how difficult this area of the industry must be to navigate if you don’t have the access I have to dermatologists and estheticians.
I decided it was time to translate the laser language and hopefully clear up some confusion. To do this, I spoke to two of the UK’s leading laser experts: Professor Firas Al-Niaimiconsultant dermatologist and UK’s first professor of laser dermatology, and Debbie Thomasits founder D. Thomas Clinic specializing in facial laser treatments. I asked them to help us make sense of the confusing world of facial laser treatments and they did. Here’s what they had to say…
What is facial laser treatment?
I wanted to start with the basics to find out exactly what we mean by laser. “Lasers are essentially devices that contain light in an amplified way,” explains Dr. Al-Niaimi. “The light interacts with structures in our skin that lead to a biological response and ultimately gives us results.” Depending on the type of treatment you are having, facial laser therapy can help uneven skin texture, tone and is often a recommended route if you want to improve the appearance of fine lines, wrinkles and scars.
What are the different types of facial lasers?
When it comes to facial aesthetics, Thomas says there are three general categories: ablative, sub-ablative and non-ablative. “Ablative naturally peels away the skin either in spots or removes a full layer,” he says. “Sub-ablative creates peeling over the next few days, but doesn’t actually peel on the day of treatment, and non-ablative has no peeling at all.”
Ablative lasers emit light which is absorbed by the water in the skin. This damages the top layer of the skin, which causes it to peel off. It also heats the deeper layers of the skin, which stimulates collagen production. The growing skin should be tighter and smoother than before. These are powerful treatments and come with significant downtime.
Non-ablative lasers deliver light below the surface of the skin to cause a targeted, controlled injury. This creates a rejuvenating effect of skin cell renewal and collagen production. There is no immediate change in the surface of the skin. They are the mildest of the three and don’t require much downtime. They stimulate collagen production and help tighten the skin, improving texture and fine lines and wrinkles.
Sub-ablative sit somewhere in between. They do cause the top layer of the skin to peel, but in a much less intense and severe way.
How do you know which laser to choose?
I have mentioned how confusing a treatment menu can be when it comes to facial laser treatments. From Fraxel Dual and Clear + Brilliant to Nd:Yag and Endolift, it’s hard to pin down. However, it turns out we don’t need to worry about the names.
Both experts were keen to stress that trying to decipher what everyone is doing shouldn’t be about the consumer. “Your job is not to be a part-time physicist,” says Thomas. “Your job is to choose a team that will properly assess your skin and prescribe the right wavelength, pulse and pattern.” He says that instead of focusing on treatment, look for a team that will provide you with a thorough consultation so you can come up with an individualized treatment plan that best suits your needs.
“Ultimately it comes down to the condition you’re trying to treat,” adds Dr. Al-Niaimi. “Not the device brand.” He echoed Thomas’ recommendation saying that yes, treatment menus can be a little mysterious, but the important thing is to find a trusted clinician. “In short, don’t choose a laser by name,” he says. “Choose a professional who can justify why a particular wavelength or technology is right for your skin and your concern.”
The safest move is not to choose a laser from the list, but to choose the most experienced doctor in a reputable clinic.
Debbie Thomas
At what age can you start having facial laser treatments?
It’s not really about age, says Thomas, but more about what your skin needs right now. “You don’t gain lasers by age,” he says. “You earn them indicatively. The best plans face what’s in front of you and what you’re prone to, with an expert who designs a long-term, proactive skin health strategy rather than chasing quick fixes to an issue.”
It gave me an idea as to why some people come to see her at the clinic. Teens and early 20s may benefit from laser treatment when there is a medical or functional issue, such as significant acne, scarring, or problematic hair growth.
Those in their late 20s and early 30s are starting to visit her for early correction and prevention. “That’s where smart, gentle laser work comes in,” he says. “If you’re seeing early sun damage, pigmentation, mild redness, dullness, visible capillaries, or the first signs of texture change, then light resurfacing, from non-ablative resurfacing, can support collagen. Think of this phase as creating a maintenance regimen—periodic, targeted treatments that keep systems calm and collagen healthy.”
Finally, those in their late 30s and beyond can use facial laser treatments to add next-level support and rejuvenation. “When wrinkles, laxity and deeper texture changes occur alongside more prominent pigmentation and redness, more focused options are often required,” she says. “But if you had earlier preserved pigment, redness and collagen, the work is often lighter and more focused. The goal is strategic strengthening, not the repetitive ‘resets’ your skin needs to recover from every few years.”
Who is not a good candidate for facial laser treatment?
It all comes down to consultation again. Thomas says it’s less about looking at a “no list” and trying to see if you qualify, but more about disclosing your full medical and skin history when you talk to a doctor. However, she says if you have infections such as cold sores or ringworm, or areas with a deep tan or sunburn, then they’ll keep you away until they go away.
Those with a history of keloids, bad scarring, or recurrent post-inflammatory hyperpigmentation are a slight red mark and may limit the treatment plan and type of laser that can be used. If you have melasma or pigment disorders, then Thomas says that some lasers can stabilize the problem, while others can make things dramatically worse. This is specialist territory, he says.
If you are pregnant or breastfeeding, many clinics will not treat you. If you are taking photosensitizing medications (certain antibiotics, isotretinoin protocols, antifungals, certain acne and pain medications), this may increase your risk of burning.
If you are currently receiving medical treatment for an autoimmune disease, cancer, or are receiving strong immunosuppression or systemic medications that affect healing or clotting, these should all be declared to ensure you receive a safe treatment recommendation.
People with medium to very dark skin tones should be careful. However, they should be asked about their previous reactions to light. If there are cases of post-inflammatory hyperpigmentation, then this will be taken into account. This usually means certain wavelengths should be avoided, but there are melanin-safer options with the right settings.
What are the risks of facial laser treatments?
As with all treatments, there are risks, but Thomas was keen to stress the difference between an expected post-treatment reaction and a complication.
It’s perfectly normal, she says, to experience redness, warmth, mild swelling, slight dryness or sandpaper, crusting, temporary flare-ups of breakouts or cold sores (if you’re prone to them). This is all part of the healing process and should settle after a few days.
If you have redness that persists for more than a few weeks, or have temporary darkening or lightening of the pigment (especially on darker skin tones), or bruising or grazing, you should call your clinic for advice, as these can be treated at home.
What are considered risks or long-term complications are burning and scarring, persistent texture change, long-term or permanent pigment changes, or an infection that leaves marks or scars.
A good clinic will be just as great in aftercare as it is during the consultation.
What is the downtime for facial laser treatment?
Because of how different each treatment is, this can range from a few hours for gentle non-ablative, light vessel/pigment adjustments and gentle fractional treatments, to two weeks for a more punchy ablative resurfacing, full-field or high-energy fractional.
