I have worked in the beauty industry for over 10 years, and I'm going to be completely honest with you, I find the world of facial laser treatment incredibly confusing. There are so many brand names and laser types—all seeming to tackle different things. If you look at treatment menus, it sometimes feels like it's written in a completely different language. If I find it discombobulating, then I can't imagine how tricky this area of the industry must be to navigate if you don't have the access that I do to dermatologists and aestheticians.
I decided that it was time to translate the laser language and hopefully clear up some confusion. To do so, I spoke to two of the UK's leading laser experts: Professor Firas Al-Niaimi, a consultant dermatologist and the UK's first Professor of Laser Dermatology, and Debbie Thomas, founder of the D.Thomas Clinic that specialises in facial laser treatments. I asked them to help us understand the confusing world of facial laser treatments, and they delivered. 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 lasers. "Lasers are essentially devices that contain light in an amplified way," explains Dr Al-Niaimi. "Light interacts with structures in our skin that lead to a biological response, and this is ultimately how it gives us results." Depending on the type of treatment you go for, facial laser treatment can help uneven skin texture, tone and is often a recommended route if you are looking to improve the appearance of fine lines, wrinkles and scarring.
What are the different types of facial laser?
When it comes to facial aesthetics, Thomas says that there are three overarching categories: ablative, sub-ablative and non-ablative. "Ablative physically peels the skin either in dots or a full layer is removed," she says. "Sub-ablative creates shedding over the coming days, but doesn’t actually peel on the day of the treatment, and non-ablative has no peeling at all."
Ablative lasers emit light which is absorbed by water in the skin. This destroys the top layer of the skin, which causes it to peel. It also heats the deeper skin layers, which stimulates collagen production. The skin that grows back should be tighter and smoother than before. These are powerful treatments and come with significant downtime.
Non-ablative lasers deliver light below the skin's surface to cause a targeted, controlled injury. This creates a knock-on effect of skin cell renewal and collagen production. There is no immediate change to the surface of the skin. They are the most gentle of all three and don't require much downtime. They stimulate collagen production and help with skin tightening, improving texture and fine lines and faint wrinkles.
Sub-ablative sit somewhere in between. They do cause the upper layer of skin to peel, but in a much less intense and severe way.
How do you know which laser to choose?
I've 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 difficult to decode. However, it turns out we needn't worry about the names.
Both experts were keen to stress that trying to decipher what each one does shouldn't be on the consumer. "Your job isn’t to become a part-time physicist," says Thomas. "Your job is to choose a team that will assess your skin properly and prescribe the right wavelength, pulse, and plan." She says that rather than focusing on the treatment, seek out a team that will offer you a thorough consultation so that you are able to come up with a bespoke treatment plan together that best suits your needs.
“It ultimately comes down to the condition you are trying to treat," adds Dr Al-Niaimi. "Not the branding of the device." He reiterated Thomas's recommendation by saying that yes, treatment menus can be a bit mystifying, but the important thing is finding a reliable clinician. "In short, don’t choose a laser by name," he says. "Choose a practitioner who can justify why a particular wavelength or technology is appropriate for your skin and your concern.”
The safest move is not to pick a laser from the list, but to pick the most experienced practitioner in a reputable clinic.
Debbie Thomas
What age can you start getting facial laser treatments?
It's not really a question of age, says Thomas, but more about what your skin needs now. "You don’t earn lasers by age," she says. "You earn them by indication. The best plans treat what’s in front of you and what you’re prone to, with an expert designing a long-term, preventative skin-health strategy instead of chasing single-issue quick fixes."
She gave me an idea of what some people come to see her in the clinic for. Teens and early 20-year-olds might benefit from laser treatment when it's a medical or functional issue, things like significant acne, scarring or problematic hair growth.
Those in their late 20s and early 30s start going to see her for early correction and prevention. "This is where smart, gentle laser work comes in," she says. "If you’re seeing early sun damage, pigment, mild redness, dullness, visible capillaries or the first signs of texture change, then light resurfacing, from non-ablative rejuvenation, can support collagen. Think of this phase as setting up a maintenance rhythm—periodic, targeted treatments that keep systems calm and collagen ticking over."
Finally, those in their late 30s and beyond can use facial laser treatments to add support and next-level rejuvenation. "When wrinkles, laxity and deeper texture changes appear alongside more prominent pigmentation and redness, more focused options are often needed," she says. "But if you’ve been maintaining pigment, redness and collagen earlier, the job is often lighter and more focused. The aim is strategic reinforcement, not repeated “resets” that your skin has to recover from every few years.
Who is not a good candidate for facial laser treatment?
It all comes down to the consultation again. Thomas says that it's not 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 speak to a practitioner. However, she says that if you have infections like cold sores or impetigo, or areas of deep tan or sunburn, then you will be turned away until these subside.
Those with a history of keloids, bad scarring or repeated post-inflammatory hyperpigmentation are a slight red flag 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 stabilise the issue, whereas others can make things dramatically worse. This is specialist territory, she says.
If you are pregnant or breastfeeding, many clinics will not treat you. If you're on photosensitising medication (certain antibiotics, isotretinoin protocols, antifungals, some acne and pain meds), this can increase your risk of a burn.
If you are currently receiving medical treatment for an autoimmune disease, cancer, or are taking strong immunosuppression or systemic drugs that affect healing or clotting, this will all need to be declared to ensure that you get a safe treatment recommendation.
People with medium to very dark skin tones should be wary; however, they should be questioned about their past reactions to light. If there are cases of post-inflammatory hyperpigmentation, then that will be taken into consideration. This typically means that certain wavelengths should be avoided, but there are melanin-safer options with the correct settings.
What are the risks of facial laser treatments?
As with all treatments, there are risks, but Thomas was eager to highlight the difference between an expected post-treatment reaction and a complication.
It is perfectly normal, she says, to experience redness, warmth, mild swelling, slight dryness or a sandpapery texture, crusting, temporary flare-up of breakouts or cold sores (if you are prone to them). These are all part of the healing process and should settle after a couple of days.
If you have redness that lingers for longer than a couple of weeks, or have temporary darkening or lightening of pigment (especially on darker skin tones) or bruising or grazes, you should call your clinic for advice, as these can be treated at home.
What she considers risks, or longer-term complications, are burning and scarring, persistent texture change, long-lasting or permanent pigment changes or an infection that leaves marks or scarring.
A good clinic will be just as brilliant at the aftercare as they are 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 vascular/pigment settings and soft fractional treatments, to two weeks for a punchier ablative resurfacing, full-field or high-energy fractional.
