British Cosmetic Dermatology Group

What is ablative laser resurfacing?

Ablative fractional laser resurfacing is a treatment that removes tiny columns of skin using focused laser energy, while leaving areas of untreated skin between them to aid healing. Fully ablative laser resurfacing removes or ‘ablates’ the entire outer skin surface in the treated area. Both approaches stimulate new collagen formation and skin regeneration. Fractional ablative lasers (such as fractional CO₂ or Er:YAG) are commonly used to balance results with shorter recovery, while fully ablative treatments provide more dramatic improvement but with longer downtime and greater risk.

Why might I choose to have this procedure?

You may consider ablative laser resurfacing if you are looking for significant improvement in wrinkles, sun damage or uneven skin texture. Scars are frequently targeted with CO₂ resurfacing – including acne scars, surgical scars or hypertrophic and keloid scars.  Fractional ablative treatment can produce excellent results with reduced recovery compared to full-field ablation. Fully ablative resurfacing may be recommended for deep wrinkles, severe photodamage, or extensive scarring when the most powerful rejuvenation is desired.

What does the procedure involve?

Before treatment it is always recommended to have a consultation to ascertain your medical history, to examine your skin to determine your skin type and discuss your goals as well as how and whether they can be achieved. Potential benefits, risks and side effects and the alternative options should always be discussed by your doctor.  You may be advised to avoid sun exposure, retinoids, and certain medications in the weeks before treatment. For fractional ablative resurfacing, application of topical anaesthetic cream prior to the treatment and cooling with air or ice packs during the procedure are usually sufficient analgesia. Fully ablative procedures often require local anaesthetic injections or sedation. During treatment, protective eyewear is worn and the laser handpiece is passed over the skin, delivering controlled ablation. The session usually takes 30–90 minutes depending on the size of the area. After treatment, a wound care regimen is required. You may be prescribed antivirals, antibiotics, or pain relief where appropriate.

What are the benefits of the procedure?

Ablative lasers provide some of the most dramatic improvements in skin rejuvenation and scar remodeling available without surgery. Benefits include smoothing of deep lines and wrinkles, improved skin texture and tone, normalisation of collagen in acne and traumatic scars, resulting in improved appearance and reversal of sun damage. Fractional techniques shorten healing and reduce risks by leaving bridges of intact skin, while full-field ablation can achieve the greatest visible improvement in selected patients, but also carry the greatest risks and take longer to recover from.

What are the risks and potential side effects?

Expected short-term effects include redness, swelling, oozing, and crusting that last 5-10 days (fractional treatments) to two weeks or more (fully ablative treatments). The skin gradually repairs and after a few days, the new skin becomes visible as the older skin peels away.  Pinkness may persist for weeks. Infection, cold sore reactivation, acne flare, or slowed and prolonged healing can occur. Changes in pigmentation (darkening or lightening) are more likely in darker skin types, but can also occur in lighter skin. Scarring is rare but possible. Fully ablative resurfacing carries higher risks of infection, scarring, and prolonged redness, but with careful technique and aftercare these risks are reduced. Eye protection is mandatory during treatment to prevent laser injury.

What alternatives are available?

Alternatives include topical treatments, non-ablative fractional lasers (with less downtime but more sessions), chemical peels, microneedling with or without radiofrequency, dermal fillers, botulinum toxin, or surgical options such as facelift or fat transfer. Your dermatologist will advise on which treatment is most suitable for your individual goals.

What should I expect after the procedure?

After fractional ablative treatment, the skin will be red, swollen, and may ooze before crusting and peeling over 5-10 days. Pinkness may persist for several weeks. After fully ablative resurfacing, recovery is more intense: oozing, crusting, and raw skin for 7–14 days, with gradual healing over weeks and residual redness possibly lasting months. Strict aftercare with cleansing, ointments or emollients, and sun protection is essential. Makeup should not be applied until the skin has healed. Results develop gradually over 3 months as collagen remodels, with long-lasting improvement after a single treatment.

How many treatments will I need?

Fractional ablative resurfacing may require 1–4 sessions, spaced weeks-to-months apart, depending on the severity of the condition. Fully ablative resurfacing is usually a one-off treatment, though it may occasionally be repeated many years later if further rejuvenation is desired.

Who should not have this procedure?

You should not have ablative laser resurfacing if you have an active infection or cold sore in the area, recent suntan or sunburn, or if are unable to avoid sun afterwards. It is not recommended during pregnancy or breastfeeding. People with certain medical conditions (such as uncontrolled diabetes, immunosuppression, connective tissue disease) or those prone to hypertrophic or keloid scars may not be suitable. Recent isotretinoin use may increase the risk of scarring, so treatment may be delayed.

Who can perform this procedure?

Ablative laser resurfacing should only be carried out by Consultant Dermatologists or other appropriately trained medical professionals in a strictly regulated clinical setting. Ablative lasers, particularly, do have the potential to cause harm and permanent skin damage such as scarring if used inappropriately or by practitioners who are not adequately trained. The procedure requires advanced training, knowledge of laser physics and anatomy, and the ability to manage potential complications. Facilities should have access to resuscitation and emergency protocols.

Will I need a consultation?

Yes. A face-to-face consultation is essential to confirm that the procedure is appropriate for your skin and fits with your skin type and goals.  Having a discussion of the possible risks and benefits tailored to your skin as well as the alternatives for you is vital.  This tailored treatment plan is an important part of your care. You should be given the opportunity to ask questions and time to consider your decision and the alternatives before proceeding.

Photographs are usually taken for comparison before and after treatment.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

What are botulinum toxin injections?

Botulinum toxin injections (commonly known by brand names such as Botox®, Bocouture®, Dysport® and Azzalure®) are injectable treatments used to temporarily relax overactive muscles. In cosmetic dermatology, they are most often used to soften dynamic facial lines caused by repeated muscle movement, such as frown lines, forehead lines, and crow’s feet. Botulinum toxin is a purified protein derived from Clostridium botulinum bacteria. In cosmetic doses, it is safe and has been used in medicine for several decades.

Why might I choose to have this procedure?

You might consider botulinum toxin injections if you want to reduce the appearance of facial lines caused by repeated expressions, such as frowning or squinting. The treatment gives a smoother and often more rested appearance. Some people also use it to reduce excessive underarm sweating (hyperhidrosis) or in certain medical contexts such as migraine or jaw muscle tension, though this leaflet focuses on cosmetic use.

What does the procedure involve?

You will first have a consultation to review your medical history, discuss your goals, and assess whether botulinum toxin is suitable. The treatment itself usually takes 10–20 minutes. The toxin is injected using a very fine needle into selected facial muscles. Most people describe only mild stinging or pinprick sensations. No anaesthetic is usually required. You can normally return to normal daily activities immediately afterwards, though vigorous exercise, alcohol, and rubbing the treated area should be avoided for the rest of the day.

What are the benefits of the procedure?

The main benefit is the temporary softening of expression lines, giving a smoother appearance. Many patients report looking more relaxed and refreshed, without losing their natural ability to express emotions when the treatment is performed carefully. Results are usually visible within 3–7 days, with peak effect at about 2 weeks. Effects last on average 3–4 months, after which repeat treatment may be required to maintain the result. Some newer toxins may have a quicker onset and last longer.

What are the risks and potential side effects?

Most side effects are temporary and mild, such as redness, swelling, or small bruises at injection sites. Headache or a heavy sensation in the forehead can sometimes occur. Less common side effects include temporary asymmetry, drooping of the eyelid or eyebrow, or an unnatural appearance if excessive doses are used. These effects usually wear off as the toxin’s action fades. Rare risks include allergic reaction or unintended spread of the toxin beyond the target muscles. Botulinum toxin should only be administered by trained healthcare professionals who understand facial anatomy and dosing to minimise these risks.

What alternatives are available?

Alternatives depend on your goals. Other options include dermal fillers, chemical peels, laser resurfacing, or topical treatments such as retinoids and prescription creams. Surgical procedures such as a brow lift or blepharoplasty may provide more long-lasting improvements in selected patients. Your dermatologist will discuss what options may best meet your needs.

What should I expect after the procedure?

After treatment you may notice tiny red bumps or pinprick marks that settle within a few hours. Bruising is possible but uncommon. It is important not to rub or massage the area, and to avoid strenuous activity, alcohol, or lying flat for about 4 hours. The treatment takes several days to work, with maximum effect seen around 2 weeks.

How many treatments will I need?

Most people require maintenance treatments every 3–4 months. Some individuals find the effects last longer with repeated sessions. The exact interval will vary depending on your metabolism, the muscles treated, the toxin used, and your cosmetic goals.

Who should not have this procedure?

You should not have botulinum toxin injections if you are pregnant or breastfeeding, if you have an infection at the planned injection site, or if you have a known allergy to any component of the product. People with certain neuromuscular conditions (such as myasthenia gravis or Lambert-Eaton syndrome) should avoid this treatment. Caution is required if you are taking medications that interfere with neuromuscular function, such as aminoglycoside antibiotics. A full medical history will be taken at consultation to ensure treatment is safe for you.

Who can perform this procedure?

In the UK, botulinum toxin injections for cosmetic purposes should only be carried out by qualified, registered healthcare professionals such as doctors, dentists, or nurses with specific training in aesthetic medicine. They should practise within a regulated clinical environment, be able to manage complications, and provide access to follow-up care. Choosing a practitioner with appropriate training and credentials is vital for safe treatment.

Will I need a consultation?

Yes. A face-to-face consultation is essential before any treatment to discuss your expectations, review your medical history, explain the risks and benefits, and decide whether botulinum toxin is right for you. You should also have the opportunity to ask questions.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

What are fillers?

Dermal fillers (also called soft tissue fillers) are injectable treatments used to restore volume, smooth lines, and enhance facial contours. Most modern fillers are made from hyaluronic acid (a naturally occurring substance in the skin) which is gradually broken down by the body over time. Fillers may be used in areas such as the cheeks, lips, nasolabial folds (lines from the nose to mouth), marionette lines, jawline and under-eye hollows. Some fillers are specifically formulated for deeper lifting and structure, while others are designed for fine lines or delicate areas.

Why might I choose to have dermal filler?

You might choose dermal fillers to reduce the appearance of facial lines and wrinkles, restore lost facial volume, improve facial symmetry, or enhance features such as the lips or cheeks. Fillers can provide a relatively rapid, non-surgical option to restore or augment facial appearance. Realistic expectations are important: fillers improve appearance and may temporarily rejuvenate the skin, but they do not stop the natural ageing process.

What does the procedure involve?

Before treatment you will have a consultation to discuss your goals, medical history, allergies, and current medications. Photographs may be taken. The procedure is performed in clinic and usually takes 20–60 minutes depending on the areas treated. Topical anaesthetic or local anaesthetic injections may be used to increase comfort. The filler is injected using fine needles or cannulas into predetermined areas. After injection the practitioner may massage the area to achieve the desired contour. You may be observed briefly after treatment. Detailed aftercare instructions will be provided.

What are the benefits of the procedure?

Benefits include immediate visible improvement in volume and contour, smoothing of lines, and enhancement of facial features with minimal downtime. Results are often natural-looking when performed by an experienced clinician. When patients are not happy with the cosmetic outcome, it is possible to dissolve hyaluronic acid filler if required.

What are the risks and potential side effects?

Common temporary effects include redness, swelling, bruising, tenderness, itching, lumps or bumps at the injection site, and asymmetry. Most of these settle within days to weeks. Less common but important risks include infection, prolonged nodules or granuloma formation, allergic reaction (rare with modern hyaluronic acid fillers), and vascular complications (when filler is inadvertently injected into a blood vessel). Vascular occlusion can cause skin damage and, in severe cases, skin death or visual loss if the blood supply to the eye is affected. If you develop severe or increasing pain, significant change in skin colour (pale/white or dusky), sudden visual symptoms, or severe swelling seek urgent medical attention immediately. Your clinician will explain how risks are reduced, including technique, anatomy knowledge, and availability of hyaluronidase to reverse HA filler.

What alternatives are available?

Alternative options include no treatment, topical and energy-based skin treatments (e.g. laser, microneedling, radiofrequency), chemical peels, botulinum toxin for dynamic lines, or surgical procedures such as facelift or fat grafting for more dramatic or long-lasting changes. Your clinician can discuss suitable alternatives based on your goals.

What should I expect after the procedure?

Expect some redness, swelling and possibly bruising at the injection sites immediately after treatment. These effects typically improve over several days to weeks. You may notice mild firmness or lumps which usually settle. Avoid strenuous exercise, heavy alcohol, and heat exposure (such as hot baths, saunas, intense sun) for 24–48 hours, and follow specific aftercare given by your clinician. Results are visible immediately, with final settling over 1–2 weeks.

How many treatments will I need?

The number of treatments depends on the areas treated and the product used. Many people have a single treatment with maintenance sessions at intervals (commonly 6–18 months) as the filler gradually dissolves. Deep structural fillers may last longer. Your clinician will advise a personalised treatment plan.

Who should not have this procedure?

You should not have dermal fillers if you have an active infection in the treatment area, known allergy to a filler component, or uncontrolled medical conditions. Fillers are generally deferred in pregnancy and breastfeeding. Caution is required in patients with bleeding disorders or on anticoagulant medication (risk of bruising). A full medical history will be taken at consultation.

Who can perform this procedure?

Dermal fillers should be performed by appropriately trained, registered healthcare professionals with relevant qualifications and experience in facial anatomy and complications management. In the UK this typically means doctors, dentists, or registered nurses who have undergone specific training in cosmetic injectable treatments and work within an appropriate clinical governance framework. Choose a practitioner who is transparent about their training, complications protocol, and who offers follow-up and emergency contact.

Will I need a consultation?

Yes. A face-to-face consultation is essential to assess suitability, discuss expectations, review medical history, explain risks and aftercare, and obtain informed consent. Your practitioner will explain the likely outcome, alternatives, and what to expect in the event of complications. You should be given time to consider the information and ask questions, with a cooling off period if needed.

What to do in an emergency?

Very rarely, serious complications such as infection, vascular occlusion (blocked blood supply), or vision changes can occur after filler injections. If you develop severe or increasing pain, sudden whitening or dusky discolouration of the skin, rapid swelling, blisters, or any change in vision, you should seek urgent medical attention immediately. Contact your treating clinician or clinic without delay, and if they are not available, attend your nearest Emergency Department. Prompt treatment is essential to reduce the risk of long-term problems.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

Fractional Non-Ablative Laser Resurfacing

What is fractional non-ablative laser resurfacing?

Fractional non-ablative laser resurfacing is a cosmetic treatment that uses focused beams of light energy to create tiny columns of controlled thermal injury in the skin. Unlike ablative lasers, non-ablative devices do not remove or ‘ablate’ the top layer of the skin. Instead, they heat targeted areas beneath the surface, stimulating collagen production and natural skin repair while leaving surrounding tissue intact. This allows faster healing and minimal downtime compared to traditional ablative resurfacing.

Why might I choose to have this procedure?

Fractional non-ablative laser treatment may be considered if you would like to improve skin tone and texture, reduce fine lines, diminish pigmentation, or soften scars with a shorter recovery time. It can be a good option for people who want visible skin rejuvenation but cannot take extended time off for healing. It is also a helpful and safer laser modality to use when you have a darker skin type as the risk of dyspigmentation (lightening or darkening of the skin) is reduced compared with ablative lasers.

What does the procedure involve?

Before treatment, it is always recommended to have a consultation to ascertain your medical history, to examine your skin to determine your skin type and discuss your skin goals, including how and whether they can be achieved. Potential benefits, risks, side effects and the alternative options should always be discussed by your laser practitioner.  You may be advised to avoid sun exposure, fake tan, and certain skincare products (such as retinoids or exfoliating acids) in the weeks leading up to treatment. During the procedure, protective eyewear will be provided and a topical anaesthetic cream may be applied prior to the treatment to improve comfort. The laser handpiece is then passed across the treatment area, delivering a grid of microscopic laser beams. You may feel heat or a prickling sensation. Sessions usually take 20–45 minutes, depending on the size of the area.

What are the benefits of the procedure?

The treatment stimulates the body’s own healing processes, promoting new collagen formation. Benefits include smoother skin texture, reduction of fine lines, improved pigmentation, even skin tone and softening of scars such as those caused by acne. Because the surface skin is left largely intact, recovery time is shorter than with ablative laser treatments, and most people are able to return to normal activities within a few days.

What are the risks and potential side effects?

Immediately after treatment, redness and swelling similar to mild sunburn are common and usually last 2–5 days. The skin may feel warm or tight, and some people experience temporary darkening or bronzing and dryness before the skin peels away. Less common side effects include acne breakouts, infection, or changes in skin colour (post-inflammatory hyperpigmentation or hypopigmentation). These are more likely in people with darker skin tones. Rare but serious complications include scarring or burns. Your clinician will assess your risk factors and provide advice on how to reduce these risks.

What alternatives are available?

Alternatives include topical treatments, chemical peels, microneedling with or without radiofrequency treatments, ablative laser resurfacing (for more dramatic results with longer downtime), or simply no treatment. Surgery is also an alternative option for some people. Your dermatologist can help you decide which option best suits your skin condition, skin type and your concerns, goals and lifestyle.

What should I expect after the procedure?

You can expect redness, swelling, and a sunburn-like sensation for 2–5 days. Makeup can usually be worn after 24 hours if the skin is intact. The skin then become dry and may feel rough; gentle peeling or flaking may occur. Results develop gradually over several weeks as new collagen forms, with improvement continuing for up to 6 months after a course of treatments. It is very important to adhere to the post procedure instructions given by your doctor.  This may involve tailored gentle anti-septic washes and applying moisturisers frequently.

How many treatments will I need?

A single session may produce noticeable improvement, but for best results a course of treatments may be recommended, with sessions spaced anywhere from 2-6 weeks apart. Maintenance treatments may sometimes be advised every 6-12 months to sustain results.

Who should not have this procedure?

Fractional non-ablative laser should be avoided if you have an active skin infection, open wound, recent suntan, or are unable to avoid sun exposure before or after treatment. It may not be suitable for people with certain medical conditions such as connective tissue disorders, or those prone to keloid scarring. Pregnant or breastfeeding individuals are generally advised to defer elective cosmetic laser treatments until delivery or when they have finished breastfeeding.

Who can perform this procedure?

Laser resurfacing should only be carried out by trained healthcare professionals such as consultant dermatologists or practitioners with accredited laser training, working within an appropriate clinical setting. Proper training, knowledge of anatomy, and access to emergency protocols are essential to ensure safety.

Will I need a consultation?

Yes. A face-to-face consultation is essential to confirm that the procedure is appropriate for your skin and fits with your skin type and goals. Having a discussion of the possible risks and benefits tailored to your skin as well as the alternatives for you is vital. This tailored treatment plan is an important part of your care. You should be given the opportunity to ask questions and time to consider your decision before proceeding.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

What is IPL?

Intense Pulsed Light (IPL) is a light-based treatment that delivers broad-spectrum pulses of light to the skin. Unlike lasers, which use a single wavelength of light, IPL uses multiple wavelengths, making it versatile for targeting different skin concerns. IPL is commonly used for pigmentation problems, redness, thread veins, and overall skin rejuvenation. It is not technically a laser, but is sometimes referred to as a ‘laser-like’ treatment.

Why might I choose to have this procedure?

You may consider IPL if you want to improve uneven pigmentation, sun spots, redness, rosacea, thread veins, or overall skin tone. It is also used for hair reduction in some cases. IPL is popular as it can improve multiple concerns with minimal downtime and is suitable for people looking for gradual, natural improvement.

What does the procedure involve?

Before treatment, you will have a consultation to review your medical history, skin type, and goals. You may be asked to avoid sun exposure, self-tan, and certain skincare products (such as retinoids) for 2–4 weeks beforehand. During treatment, protective eyewear is worn and a cooling gel is applied to the skin. The IPL handpiece is placed against the skin and pulses of light are delivered. You may feel a hot flick or elastic band snap sensation. Sessions usually take 20–45 minutes depending on the size of the area. After treatment the skin may appear red or slightly swollen, like sunburn.

What are the benefits of the procedure?

IPL can improve sun spots, freckles, redness, broken blood vessels, rosacea, and uneven skin tone. It can also stimulate collagen, improving overall skin texture. Many people notice brighter, clearer, and more even-looking skin after a course of treatments. Downtime is usually minimal compared with some other laser procedures such as resurfacing.

What are the risks and potential side effects?

Mild redness and swelling for a few hours are common. Pigmented spots may darken and crust before fading over 1–2 weeks. Less common risks include blistering, temporary or permanent pigment change, scarring, or infection. IPL is not suitable for all skin types, particularly darker skin tones, due to the risk of hyperpigmentation. Eye protection is essential during treatment to prevent injury.

What alternatives are available?

Alternatives include laser treatments (such as vascular lasers or pigment-specific lasers), chemical peels, topical creams (e.g. prescription creams for pigmentation), or no treatment. Your dermatologist will help decide which approach is best suited to your needs.

What should I expect after the procedure?

Immediately after IPL, your skin may look pink and feel warm, similar to sunburn. This usually settles within a few hours. Pigmented areas may darken and flake over several days. Makeup can normally be applied the next day. Sun protection is essential after treatment to protect results and reduce risks. Improvement is usually gradual over a course of sessions.

How many treatments will I need?

Most people need a course of several treatments spaced 3–6 weeks apart for best results. Maintenance sessions may be recommended every 6–12 months depending on your skin concern.

Who should not have this procedure?

IPL should not be performed on recently tanned skin, or in people who cannot avoid sun exposure afterwards. It is not suitable during pregnancy or breastfeeding. People with active infections, cold sores, or certain skin conditions in the treatment area should avoid treatment. IPL is also not appropriate for very dark skin types. A consultation will ensure your suitability and minimise risks.

Who can perform this procedure?

IPL should only be carried out by trained healthcare professionals such as consultant dermatologists or other practitioners with accredited training, working within a regulated clinic. Appropriate knowledge of skin types, light physics, and safety protocols is essential for safe treatment.

Will I need a consultation?

Yes. A face-to-face consultation is essential before treatment to assess your goals, skin type, and medical history. A test patch is usually performed to check your skin’s response before proceeding with a full session.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

What are lasers for pigmentation?

Pigment lasers, including Q-switched and picosecond lasers, are devices designed to target areas of excess pigment in the skin. They deliver very short bursts of high-energy light that are absorbed by melanin (the pigment in skin and hair) or by tattoo ink. This causes the pigment particles to break down into smaller fragments, which are then cleared away naturally by the body. These lasers are used for treating pigmentation problems, sun spots, freckles, and for tattoo removal.

Why might I choose to have this procedure?

You may consider pigment laser treatment if you are bothered by brown spots, freckles, certain birthmarks, or unwanted tattoos. These lasers can lighten or remove areas of pigmentation and improve overall skin clarity. Picosecond lasers may achieve similar results to Q-switched lasers but often in fewer sessions and with less risk of surrounding tissue damage.

What does the procedure involve?

Before treatment, you will have a consultation to review your medical history, skin type, and goals. You may be advised to avoid sun exposure, tanning, and certain skincare products beforehand. During the procedure, protective eyewear is worn. The laser handpiece is placed against the skin, delivering very short pulses of light. You may feel a sharp snapping or stinging sensation, sometimes likened to the snap of an elastic band. Cooling may be used to improve comfort. Treatment usually lasts 10–45 minutes depending on the area. For tattoo removal, multiple colours may require different laser wavelengths in one session.

What are the benefits of the procedure?

Pigment lasers can effectively lighten or remove areas of unwanted pigmentation and tattoos with minimal damage to surrounding skin. For benign pigmentation, results are often seen after just 1–3 sessions. For tattoo removal, gradual fading occurs across multiple treatments. Modern picosecond lasers may achieve faster and more complete clearance compared to older technologies.

What are the risks and potential side effects?

Temporary redness, swelling, and darkening of pigment spots are common after treatment. The treated area may crust or scab before healing. Less common risks include blistering, scarring, and changes in skin colour (lightening or darkening). Darker skin types carry a higher risk of pigment changes. Rarely, infection can occur. For tattoos, incomplete clearance or “ghosting” of the design is possible. Eye protection is essential.

What alternatives are available?

Alternatives for pigmentation include topical creams (such as hydroquinone or retinoids), chemical peels, intense pulsed light (IPL), or no treatment. For tattoo removal, surgical excision, ablative laser or dermabrasion are alternatives but may carry greater risks of scarring. Your dermatologist will help decide the best option.

What should I expect after the procedure?

After treatment, pigmented lesions usually darken before flaking off over 1–2 weeks. Redness and swelling are common for a few days. Treated tattoos may form small scabs as the pigment fragments clear. Sun protection is essential during healing to reduce the risk of complications. Improvement is gradual, and multiple sessions are often needed for optimal results.

How many treatments will I need?

For benign pigmentation, 1–3 treatments may be sufficient. For tattoos, multiple sessions (commonly 6–10 or more) are usually required, spaced 6–10 weeks apart. The number depends on the size, colour, and depth of the tattoo and the type of laser used.

Who should not have this procedure?

Pigment laser treatment is not suitable if you have a suntan, active infection, or cold sore in the area. It is not recommended during pregnancy or breastfeeding. People prone to keloid scars, with certain medical conditions, or taking photosensitising medications may not be suitable. Your dermatologist will assess your suitability during consultation.

Who can perform this procedure?

Pigment laser treatment should only be carried out by trained healthcare professionals, such as consultant dermatologists or other practitioners with accredited training, working in a regulated clinical environment. Expertise in skin of colour and laser safety is particularly important for pigment treatments.

Will I need a consultation?

Yes. A face-to-face consultation is essential to review your goals, check your skin type, and assess the risks and benefits. A test patch may be carried out to see how your skin responds before proceeding with full treatment.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030

What is Poly-L-Lactic Acid?

Poly-L-lactic acid (PLLA) is a biostimulatory injectable treatment used to gradually restore facial volume and improve skin texture by stimulating the body’s own collagen production. Unlike dermal fillers that provide immediate volume, PLLA works progressively over several months to create a natural, long-lasting rejuvenating effect. It is commonly known by brand names such as Sculptra® or Lanluma®.

Why might I choose to have this procedure?

You may consider PLLA injections if you wish to restore facial fullness lost through ageing or illness, improve skin firmness, or soften deep lines and folds. PLLA can also be used to improve skin quality in areas such as the cheeks, temples, jawline, and sometimes the body (for example, décolletage or buttocks). The results develop gradually, offering subtle, natural rejuvenation without the sudden changes associated with volumising fillers.

What does the procedure involve?

A consultation will take place before treatment to review your medical history, discuss your goals, and ensure suitability. PLLA comes as a powder that is mixed with sterile water, and sometimes anaesthetic, before injection. The skin is cleaned and topical or local anaesthetic may be applied for comfort. The product is then injected using a fine needle or cannula into targeted areas, typically in a grid or fanning pattern. The procedure usually takes 30–60 minutes. You may be advised to massage the treated areas afterwards to help evenly distribute the product.

What are the benefits of the procedure?

PLLA stimulates new collagen formation in the skin, gradually improving facial structure and elasticity. The effects develop over several months, resulting in restoration of facial volume and improvement in skin firmness. The results are long-lasting, often maintained for 2-3 years with occasional top-up treatments.

What are the risks and potential side effects?

Common:

Uncommon:

Rare:

Extremely rare:

Your practitioner will discuss how these risks are minimised, including the use of correct technique, dilution, and massage protocols.

What alternatives are available?

Alternatives include hyaluronic acid dermal fillers (for immediate volume), collagen-stimulating injectables such as calcium hydroxylapatite, or non-injectable treatments such as radiofrequency or ultrasound-based tightening procedures. Sometimes no treatment may be required. Your dermatologist can discuss which option best suits your goals and preferences.

What should I expect after the procedure?

The skin may appear red or mildly swollen immediately after treatment, and small bumps can sometimes be felt under the skin for a few days. Bruising may occur. You will be advised to massage the treated area for several minutes, several times a day, for the first 5 days after treatment to ensure even distribution. Avoid strenuous exercise, saunas, or excessive heat for 24 hours. Results develop gradually over 8-12 weeks, with further improvement after additional sessions.

How many treatments will I need?

A series of treatments is typically recommended. Most patients require 2–3 sessions spaced about 4-6 weeks apart, depending on individual needs. Maintenance treatments may be performed every 1-2 years to preserve results.

Who should not have this procedure?

PLLA injections are not suitable if you have an active skin infection, inflammation, or rash in the treatment area, are pregnant or breastfeeding, or have a history of keloid scarring, autoimmune disease, or allergy to any component of the product. A full medical history will be taken during the consultation.

Who can perform this procedure?

PLLA injections should only be performed by trained healthcare professionals such as consultant dermatologists or other qualified practitioners with specific training in injectable biostimulatory treatments, working within a regulated medical environment.

Will I need a consultation?

Yes. A face-to-face consultation is essential before treatment to assess suitability, review your medical history, explain the procedure, discuss alternatives, and obtain informed consent. You should have time to ask questions and consider your decision before proceeding.

What to do in an emergency?

Although complications are rare, seek urgent medical attention if you experience severe pain, rapid swelling, pale or dusky skin discolouration, blisters, or visual changes after treatment. Contact your treating dermatologist immediately. If unavailable, seek help via NHS 111 or your nearest Emergency Department.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: October 2025

Planned review: October 2030

 

Radiofrequency Microneedling

What is radiofrequency microneedling?

Radiofrequency microneedling (RFMN) is a minimally invasive procedure that combines fine needles with radiofrequency (RF) energy to improve skin texture, firmness, and scarring. The device creates controlled micro-injuries while delivering heat to deeper layers of the skin, stimulating collagen and elastin production. Common device names include Morpheus8®, Secret RF®, Potenza®, Profound®.

Because the energy is targeted below the skin surface, the visible downtime is usually less than with laser resurfacing, while still producing noticeable improvements over a course of treatments.

What concerns can be addressed by RFMN?

This treatment is used to improve the appearance of acne scarring, fine lines and wrinkles, enlarged pores, uneven texture and areas of crepey or lax skin on the face and body. It can also help soften stretch marks and improve contour and firmness of areas such as the jawline, neck and lower face.

What does the procedure involve?

Before treatment, you will have a consultation to assess your skin, medical history and treatment goals. On the day of the procedure, the skin is cleansed, and a topical anaesthetic cream is applied to improve comfort. The handheld device is then passed across the skin in a systematic pattern. During treatment, you may feel a sensation of pressure, warmth or light prickling. A session typically takes between 30 and 60 minutes, depending on the area being treated. After the procedure, the skin may appear pink or slightly swollen, similar to a mild sunburn, and may feel warm or tight for a few hours.

What are the benefits of the procedure?

Radiofrequency microneedling improves the quality, texture and firmness of the skin by stimulating new collagen and elastin production. Because the radiofrequency energy is delivered beneath the skin’s surface, it can tighten and remodel deeper layers without significantly damaging the top layer of skin. This results in smoother skin, softening of acne scarring, and a gradual reduction in fine lines and early skin laxity. The results develop progressively over several weeks and continue to improve with each treatment session. One of the key advantages of radiofrequency microneedling is that it offers visible rejuvenation with minimal downtime, making it suitable for people seeking skin improvement without the recovery time associated with more aggressive treatments such as ablative laser resurfacing.

What are the risks and potential side effects?

Most side-effects of radiofrequency microneedling are mild and transient, such as redness, swelling, warmth, or a sun-burn-like sensation for one to two days, and tiny pinpoint marks where the needles entered. These effects are expected and typically resolve without intervention. Less commonly, prolonged swelling, bruising, flare of acne or rosacea, or temporary changes in skin colour (hyper- or hypopigmentation) may occur, particularly in individuals with darker skin types. Rarely, serious complications may occur, including burns, scarring, fat loss, disfigurement and nerve damage, in some cases requiring surgical repair or medical intervention..

What alternatives are available?

Other treatments that improve skin texture and stimulate collagen include fractional laser resurfacing, which may achieve more dramatic improvement but usually involves more downtime. Injectable collagen stimulators such as poly-L-lactic acid or calcium hydroxylapatite can help improve volume and skin quality, while hyaluronic acid fillers give immediate contouring. For people who prefer non-injectable options, prescription skincare such as retinoids or procedures like radiofrequency skin tightening or microfocused ultrasound can offer gradual improvement. Your dermatologist will help you choose the most appropriate option for your skin concerns and goals.

What should I expect after the procedure?

After radiofrequency microneedling, the skin usually looks pink or mildly red and may feel warm or tight, similar to a light sunburn, lasting for up to two days. Some people notice very small marks or roughness where the needles entered the skin, which flake away as the skin heals. Mild swelling or a feeling of tightness can occur, particularly around the eyes or jawline, and may persist for a short time. Makeup should generally be avoided for the first 24 hours. Over the following days, the skin may feel slightly dry before returning to normal. Improvements in skin texture and firmness develop gradually as new collagen forms, and results continue to improve over several weeks and with subsequent treatments.

How many treatments will I need?

Most people require a course of treatments to achieve optimal results. Typically, two to three sessions are recommended, spaced four to six weeks apart, although some individuals with more established scarring or skin laxity may benefit from additional sessions. Because radiofrequency microneedling stimulates the body’s own collagen production, improvements continue gradually over the following months. Your dermatologist will tailor the number of treatments to your skin concerns and goals.

Who should not have this procedure?

Radiofrequency microneedling is not suitable if you are pregnant or breastfeeding, have an active skin infection, inflammatory skin condition or open wounds in the treatment area. People with a history of keloid or hypertrophic scarring may be advised to avoid this treatment. A medical assessment is required if you have implanted metal devices or a pacemaker, as these may interfere with radiofrequency energy. Your dermatologist will advise whether the procedure is safe and appropriate for you.

Who can perform this procedure?

Radiofrequency microneedling should only be carried out by consultant dermatologists or other appropriately trained medical professionals in a regulated clinical setting. Importantly, severe risks and complications may occur when these powerful devices are used my untrained individuals.

Will I need a consultation?

Yes. A face-to-face consultation is essential to assess your skin type, goals, and medical history, and to explain the risks, benefits, downtime, and aftercare. You should have time to ask questions and consider whether this treatment is right for you. Photographs are usually taken for comparison before and after treatment.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: November 2025

Planned review: November 2030

Topical Retinoids

What are the aims of this leaflet?

This patient information leaflet is designed to help you understand the types of retinoids used in skincare and dermatology, including over-the-counter products like retinol, and prescription topical treatments such as tretinoin.

It explains how retinoids work, what conditions they are commonly used to treat, and what to expect when starting treatment. It also outlines potential side effects, how to use retinoids safely, and what alternatives are available if they are not suitable for you.

If you and your clinician are discussing incorporating a retinoid into your treatment plan, this guide will help you make an informed decision and support these discussions.

What are Retinoids and how do they work?

Retinoids are vitamin A-derived ingredients used in skincare and dermatology. They act on the cells of the skin to help increase skin cell turnover, reduce acne, fade pigmentation, and improve fine lines and overall skin texture.

There are several types of retinoids, some of which are already in their active form, and some of which need to be converted into an active form by the skin. They vary in potency depending on how many steps it takes to convert them into their active form (retinoic acid).

Cosmetic / over-the-counter retinoids (generally milder):

 

Prescription-only retinoids (stronger and more effective, but with a higher risk of irritation):

Why might I use a topical retinoid?

Retinoids may be recommended to treat a variety of skin conditions, most commonly acne (including both inflammatory and comedonal types). They are also used to improve types of hyperpigmentation, such as melasma  and post-inflammatory dark marks, due to their effect on both skin cell shedding and melanocyte activity. They can also be used to address early signs of skin ageing, including fine lines, roughness, and loss of firmness.

Retinoids may also benefit individuals with dull or uneven skin texture, supporting a brighter and more even complexion over time. A consultation with a dermatologist or qualified clinician can help determine whether a retinoid is appropriate for your specific skin needs.

What are the benefits of retinoids?

Retinoids are not a “cure” in the traditional sense, but with consistent use, they can significantly improve many common skin concerns. They can help reduce the number and severity of breakouts, fade pigmentation, improve skin texture, and soften the appearance of fine lines. These effects develop gradually over several months and tend to be most noticeable with long-term use.

How should I use retinoids?

Treatment should be prescribed following a consultation with a healthcare professional, usually a dermatologist.

Topical retinoids (in creams or gels) are applied to cleansed skin in the evening. For most people, it is best to start by using the product every second or third night, and then gradually build up to nightly use as tolerated. A thin layer of moisturiser may be applied around 15 minutes beforehand to reduce the risk of irritation.

Initial improvements are often seen after 8 to 12 weeks, but more noticeable results typically take several months of consistent use. It is important to avoid using other active ingredients or exfoliating products – such as scrubs, chemical exfoliants, or mechanical exfoliators – while your skin adjusts, unless specifically advised by your clinician.

Retinoids are typically used as a long-term treatment to maintain and support skin health. Many people continue using retinoids for years to maintain the benefits.

What are the side effects of retinoids?

It is common to experience some mild side effects when starting a retinoid, especially during the first few weeks of treatment. These may include:

The risk of side effects relates to the strength of the retinoid being used and the frequency of application. It is common to slowly increase the strength of the cream over time (such as treinoin 0.01% > 0.025% > 0.05%) and increase the frequency of application as your skin adjusts to treatment (called the retinisation period).

These effects are usually short-lived and tend to settle within four weeks as the skin adjusts. If these effects do not settle, your clinician may recommend reducing the strength or frequency of your retinoid.

Retinoids, including over-the-counter retinol, must not be used during pregnancy or breastfeeding.

Is there anything I should do or avoid whilst using retinoids?

A moisturiser can be used before application to help minimise dryness or irritation. Daily sun protection is essential, as retinoids increase the skin’s sensitivity to UV light. A broad-spectrum SPF 50 sunscreen should be applied every morning and reapplied throughout the day.

While adjusting to retinoids, it is best to keep your skincare routine simple. Use a gentle cleanser and non-comedogenic sunscreen in the morning, and apply a moisturiser followed by your retinoid in the evening. Avoid any other potentially irritating skincare products such as hydroxyacids; these can be cautiously reintroduced once your skin has adjusted after discussion with your doctor.

When should you not apply Retinoids?

Retinoids should not be used when trying to conceive, during pregnancy or when breastfeeding, as they may pose a risk to the developing baby. They should also be avoided by people with a known allergy to vitamin A derivatives.

People with very sensitive or eczema-prone skin may be more likely to experience irritation with topical retinoids. In many cases, these can still be used safely with medical advice and a personalised treatment plan.

You should also avoid procedures such as facial waxing, dermaplaning, chemical peels, or laser treatments on areas where you are using a topical retinoid, unless specifically approved by your clinician. Retinoids can make the skin more fragile and increase the risk of irritation, burns, or damage from these treatments. Always inform your practitioner that you are using a retinoid before undergoing any cosmetic or dermatological procedure.

Where can I get more information about Retinoids?

Prescription retinoids must be prescribed by a qualified healthcare professional. This is usually a dermatologist, although some GPs or prescribing pharmacists may be able to prescribe topical retinoids for acne, depending on local services.

A medical consultation is required before starting prescription retinoids. This allows your clinician to assess your skin type, medical history, and treatment goals, and to determine the most appropriate product and strength. It also ensures you receive the correct instructions for safe and effective use.

For more information, you can visit:

 

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: October 2025

Planned review: October 2030

What are vascular lasers?

Vascular laser treatment uses focused beams of light to target blood vessels in the skin. The laser energy is absorbed by haemoglobin (the red pigment in blood), heating and destroying the vessel without damaging surrounding tissue. Different types of vascular lasers exist, such as pulsed dye laser (PDL), Nd:YAG, and KTP lasers, each suited to different depths and sizes of vessels. These treatments are commonly used for redness, thread veins, rosacea, and vascular birthmarks.

Why might I choose to have this procedure?

You may consider vascular laser treatment if you are bothered by visible facial redness, thread veins (telangiectasia), rosacea-related flushing, spider angiomas, port-wine stains, or other vascular lesions. It is a safe, effective way to reduce unwanted vascular markings and improve skin appearance without surgery.

What does the procedure involve?

Before treatment, you will have a consultation to review your medical history, skin type, and treatment goals. You may be asked to avoid sun exposure, tanning, or certain skincare products beforehand. During the procedure, protective eyewear is worn. A cooling spray, gel, or device may be used to make the procedure more comfortable. The laser handpiece is applied to the skin, delivering short pulses of light energy. You may feel a stinging or snapping sensation. Sessions typically last 15–45 minutes depending on the size of the area treated.

What are the benefits of the procedure?

Vascular lasers can safely and effectively reduce or eliminate unwanted blood vessels in the skin. Results include reduced redness, improved skin tone, and clearance of visible vessels or vascular lesions. Many patients notice significant cosmetic improvement after as few as one session.

What are the risks and potential side effects?

Immediately after treatment, redness, swelling, and a sensation similar to sunburn are common. Small treated vessels may appear darker before fading. Bruising (purpura) can occur, especially with pulsed dye lasers, and usually resolves within 1–2 weeks. Less common risks include blistering, scabbing, temporary or permanent pigment change, and scarring. Rarely, infection may occur. Vascular lasers are generally not recommended for recently tanned skin, as this increases the risk of pigment changes.

What alternatives are available?

Alternatives may include intense pulsed light (IPL) for more generalised redness, camouflage make-up, topical treatments for rosacea (e.g. brimonidine or oxymetazoline creams), or no treatment. Surgical options are rarely used for superficial vascular lesions but may be appropriate in some cases. Your dermatologist will advise the best option for you.

What should I expect after the procedure?

After treatment, the skin may look red, swollen, or bruised. This usually settles within a few days, although bruising may last up to 2 weeks. Ice packs, cooling gels, and gentle skincare can help. Sun protection is essential after treatment to minimise risk of pigment change. Most people return to normal daily activities immediately, though makeup may be used to cover redness or bruising once the skin is intact.

How many treatments will I need?

The number of treatments depends on the condition and area being treated. Thread veins or small vascular lesions may clear in 1–2 sessions, while conditions like rosacea or port-wine stains often require multiple sessions (typically 3–6 or more) spaced 4–8 weeks apart. Maintenance sessions may be needed over time.

Who should not have this procedure?

You should avoid vascular laser treatment if you have a suntan, active infection, or cold sore in the area. It is not recommended during pregnancy or breastfeeding. People with certain medical conditions, those taking photosensitising medications, or individuals prone to keloid scarring may not be suitable. A consultation will assess your individual suitability.

Who can perform this procedure?

Vascular laser treatment should only be carried out by trained healthcare professionals such as consultant dermatologists or other practitioners with accredited laser training, working within a regulated clinical setting. Proper training and safety protocols are essential to minimise risks.

Will I need a consultation?

Yes. A face-to-face consultation is essential to assess your skin, review your medical history, and determine whether vascular laser treatment is appropriate. A test patch may be performed before the first full treatment to check your skin’s response.

Where can I get more information?

You can find more information from:

This leaflet has been produced by the British Cosmetic Dermatology Group (BCDG).

Leaflet version: v1.0

Date of publication: September 2025

Planned review: September 2030