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Procedure guide · Skin and non-surgical
Laser skin resurfacingLaser skin resurfacing removes or heats controlled columns of skin to smooth fine lines, sun damage, acne scars and uneven pigmentation and to tighten the surface. Ablative CO2 or erbium lasers give the strongest improvement with five to ten days of raw, weeping skin; fractional and non-ablative lasers need less downtime but several sessions. Treatment takes thirty to ninety minutes under numbing cream, local anaesthesia or sedation. Redness can last weeks after ablative treatment and strict sun avoidance is essential for months.
Resurfacing lasers work by controlled injury. Ablative lasers vaporise the surface and heat the dermis, producing the strongest tightening and smoothing; fractional delivery treats only a percentage of the skin in microscopic columns so it heals in days rather than weeks. Non-ablative fractional lasers heat the dermis without removing the surface, needing several sessions with minimal downtime.
Choice depends on the problem and skin type: deep lines and acne scars in lighter skin suit ablative CO2, while darker skin or minimal-downtime goals suit non-ablative or gentler settings with a test patch. Wound care and sun protection afterwards determine the outcome as much as the laser.
Resurfacing lasers are classified by how they interact with water in the skin, a principle known as selective photothermolysis. Ablative devices — carbon dioxide at 10,600 nanometres and erbium:YAG at 2,940 nanometres — are absorbed so strongly by water that they vaporise the epidermis and a controlled layer of the upper dermis in a single pass, physically removing damaged tissue while heating the surrounding collagen enough to trigger remodelling. This is the category suited to deep static wrinkles, thick sun-damaged skin and depressed acne scars, because outright tissue removal is what reaches that level of correction. Non-ablative lasers leave the surface intact: they are tuned to heat the dermis through the epidermis without vaporising it, using wavelengths with weaker water absorption. The improvement comes from the heat alone stimulating new collagen, not from removing tissue, so treatment is gentler but reaches shallower depths. Erbium sits between the two, ablating with less residual heat spread than CO2 and trading some tightening power for a shorter recovery. Matching the mechanism to the actual problem, rather than defaulting to the strongest available device, is the first decision a treating physician should make explicit.
Fully ablative resurfacing treats the entire surface in a continuous pass. It gives a dramatic single-treatment result but leaves the whole face as an open wound, with healing times of ten days or more and a meaningful risk of prolonged redness and pigment change. Fractional delivery, developed to reduce that burden, treats only a fraction of the surface — typically a pattern of microscopic columns separated by untouched bridges of skin. Each column reaches full ablative or thermal depth, so the remodelling signal to the dermis is comparable, but the untouched bridges act as a reservoir of healthy cells that migrate inward and resurface the treated columns within days rather than weeks. This is why fractional ablative CO2 or erbium can achieve much of the improvement of traditional full-field ablation with roughly half the downtime, and why fractional non-ablative treatment can be done with almost no visible recovery at all, at the cost of needing several sessions instead of one. The trade-off is not simply weaker versus stronger laser; it is a single aggressive treatment versus a staged course, and the right choice depends on how much downtime a patient can accept abroad and how severe the underlying damage is.
Skin type matters for laser resurfacing through a specific mechanism and with a specific risk pattern. Darker skin, scored higher on the Fitzpatrick scale, contains more active melanocytes, and the thermal injury from an ablative laser can trigger those cells to either overproduce pigment — post-inflammatory hyperpigmentation, which is common and usually fades over months — or, less often, to under-produce it permanently, leaving pale patches that do not respond to further treatment. Because the laser’s heat spreads into the dermis around hair follicles and vessels rather than simply dissolving the surface the way an acid peel does, the pigment response in darker skin can be harder to predict and, in the case of hypopigmentation, is not reversible. This is why aggressive full-depth ablative treatment is generally reserved for lighter skin types, why a test patch behind the ear or along the jawline is standard practice before a first ablative session in anyone with medium to deep skin tone, and why non-ablative or lower-density fractional settings are the usual route for patients who would carry excessive pigment risk under a traditional CO2 device.
Surgeons look for these points at the consultation.
Adults with sun damage, fine lines, acne scars or uneven texture, lighter skin types for ablative lasers, able to avoid sun for months, with no active skin infection.
Reasons a good surgeon will ask you to wait or choose something else.
Active acne or cold sores, isotretinoin in the past six to twelve months, keloid tendency, recent tanning, and darker skin types for aggressive ablative treatment.
Ask your surgeon which technique they recommend for you and why.
Columns of skin are vaporised, leaving intact skin between them for faster healing.
Shallower ablation with less heat than CO2.
Heats the dermis without removing the surface.
Step by step, from arrival to discharge.
Antiviral tablets are started; the skin is cleansed and numbed with cream, local anaesthetic or sedation for deeper treatment.
The laser treats the face in overlapping passes, adjusting depth to the area.
Ointment or a protective dressing is applied.
Instructions for cleansing, ointment and sun avoidance; a review within days.
Frequencies follow published guidance; your personal risk depends on your health and the surgeon.
Laser resurfacing causes a predictable period of visible skin disruption even when everything goes as planned, and clinicians distinguish that expected reaction from genuine complications. Redness, swelling and a weeping or crusted surface after ablative treatment are universal rather than exceptional, and most of what patients notice in the first one to two weeks falls into this normal-healing category rather than a risk in the strict sense. The risks below are the outcomes a surgeon works to avoid through correct device selection, conservative settings in higher-risk skin, antiviral cover, and strict aftercare instructions: pigment change that persists beyond the expected weeks, reactivation of a dormant cold sore virus into active infection, bacterial infection of healing skin, and, uncommonly, scarring from excessive depth or poor wound care. Because ablative lasers create an open wound for several days, infection control and sun discipline afterwards influence the outcome at least as much as the laser settings chosen on the day of treatment.
Days to weeks depending on depth.
Darkening (usually temporary) or lightening (can be permanent) of treated skin.
Prevented with antiviral tablets.
From excessive depth or infection.
Recovery after laser resurfacing follows one of two distinct patterns depending on whether the treatment was ablative or not. Ablative CO2 or erbium treatment creates an open wound: the skin weeps, crusts and looks raw for five to ten days, needs constant ointment and cannot be covered with makeup until a new surface has formed, after which it stays pink for several weeks while the deeper tightening effect continues to develop. Fractional non-ablative treatment is far gentler on the surface — redness and mild swelling for one to three days, sometimes a sandpaper-like texture as treated skin flakes off, and a return to normal activities and makeup almost immediately — but because each session reaches a shallower depth, the visible improvement builds gradually across a course of treatments rather than appearing after one visit. Either way, the final texture and pigment result is not judged until collagen remodelling finishes months later.
Days 1-5
After ablative treatment the skin weeps and crusts; keep moist, no picking.
Days 5-10
Pink smooth skin appears; makeup allowed once intact.
Weeks 2-6
Strict sunscreen; fly home after three to five days for ablative treatment.
Months 3-6
Texture keeps improving.
New skin appears at five to ten days after ablative treatment and looks pink for weeks; texture and pigmentation improve over three to six months as collagen remodels. Results last years with sun protection; non-ablative courses give gradual improvement over several sessions.
Price for laser resurfacing is driven first by the device and depth used: a single full-face ablative CO2 or erbium session costs more per visit than a non-ablative fractional session, but non-ablative treatment is rarely sold as a single visit — a course of three to five sessions is priced and should be compared as a full package, not per session, against one ablative treatment. Area treated also matters, since resurfacing limited to the lines around the eyes or mouth costs less than full-face treatment. Sedation for deeper ablative work and bundling with a facelift or eyelid surgery package change the final figure further.
Why quotes for the same procedure differ, so you can compare packages fairly.
Options to weigh before deciding, surgical and non-surgical.
A less expensive resurfacing option, especially for pigmentation.
For sagging rather than surface quality.
Milder texture improvement with minimal downtime, safer in darker skin.
Ask the same questions at every consultation so you can compare answers.
The starting point for any resurfacing consultation should be the problem being treated, not a preference for one device over another. Deep static wrinkles, thick patches of sun-damaged skin, and significant textural scarring from acne respond best to treatments that remove tissue and reach meaningfully into the dermis. For this category, fractional ablative CO2 laser is usually the first choice, because it is the only option capable of both removing visibly damaged surface layers and heating a controlled volume of collagen to the depth needed for real tightening. A single well-executed session on appropriate skin can produce a degree of improvement that would otherwise require several non-ablative visits, which is why patients travelling for a short period abroad, and prepared to accept five to ten days of visible healing, are often steered toward this option.
At the other end of the spectrum, mild to moderate sun damage, early fine lines, uneven tone without deep texture change, and patients who cannot accept any visible downtime are better matched to non-ablative fractional treatment. Because the surface is never broken, there is no open wound, no ointment phase and no period of being unable to wear makeup, but the trade-off is that each session delivers a smaller remodelling signal. The clinically honest expectation is a gradual improvement across a course of treatments rather than a dramatic single-visit change.
Erbium:YAG occupies a useful middle position. It ablates the surface in the same way as CO2, so it still physically removes damaged tissue, but it generates less residual heat spread into the surrounding dermis, which shortens healing and reduces the duration of redness at the cost of somewhat less tightening. It is frequently the laser of choice around the eyes and mouth, where the skin is thinner and tolerance for prolonged redness is lower.
Acne scarring deserves its own mention because it behaves differently from wrinkles and sun damage. Scars that are bound down to deeper tissue respond best to the dermal remodelling that ablative fractional treatment provides, and several sessions spaced months apart are often planned from the outset rather than promised as a single fix.
Pigment change is the complication that most influences whether, and how, laser resurfacing should be offered to a given patient, and it is more central to the decision for laser than for most other resurfacing options. The reason sits in the mechanism: an ablative laser’s thermal injury extends into the dermis around hair follicles, sebaceous glands and small vessels, structures that sit close to the melanocytes responsible for skin colour. Heating this zone can switch melanocyte activity up or down in ways that are harder to predict than the more uniform chemical exfoliation produced by an acid peel of equivalent depth.
The more common outcome is post-inflammatory hyperpigmentation — patches of skin that turn darker than the surrounding area as melanocytes overreact to the injury. It affects darker skin more often, is usually temporary, and typically fades over weeks to months, though it can take longer than patients expect. The less common but more serious outcome is hypopigmentation: pale patches where melanocytes have been damaged enough to stop producing pigment, which can appear months after treatment and, once established, is largely permanent and does not reliably respond to further treatment.
Fitzpatrick skin type — a classification based on how skin tans and burns, running from type I to type VI — is the standard way clinicians estimate this risk before treatment. Types IV to VI carry a materially higher risk of both hyperpigmentation and delayed hypopigmentation with aggressive, full-depth ablative treatment, which is why reputable clinics either decline full CO2 resurfacing in this group or scale the approach down substantially.
In practice this means several concrete adjustments rather than a blanket refusal to treat darker skin. A small test patch, assessed over several weeks before a full treatment is scheduled, is standard good practice. Settings are adjusted toward lower density and shallower depth, erbium is sometimes favoured over CO2, and many clinics use a pigment-suppressing skincare routine in the weeks before an aggressive session. For patients where the risk still looks too high for ablative treatment, non-ablative fractional or other energy-based options that spare the epidermis entirely offer a genuinely safer route to improvement.
Patients researching skin resurfacing options abroad are usually choosing between three technologies that can address overlapping problems through fundamentally different mechanisms.
A chemical peel works by applying an acid at a chosen strength and leaving it in contact with the skin for a controlled time, causing the outer layers to denature and eventually shed. Depth is governed by the acid, its concentration and contact time, so a peel treats the entire area evenly in one application. This makes peels particularly effective for diffuse pigment irregularity and overall dullness, and they are generally the least expensive of the three options, but they do not deliver the same collagen-heating effect that tightens skin or the same precision for treating a discrete scar.
Laser resurfacing works through light energy absorbed as heat, either vaporising tissue or heating it without removing the surface, and fractional delivery allows that energy to be aimed at a defined percentage of the surface in a repeatable pattern. This gives laser two advantages over a peel: more controllable depth, and a genuine tightening effect from the heat delivered into the dermis, which makes laser the stronger option for established scarring and skin laxity in addition to tone and texture. The cost of that precision is a more expensive device, more highly trained operators, and, for ablative settings, a more involved recovery.
Microneedling creates mechanical micro-injuries with fine needles, triggering a wound-healing and collagen response without removing the epidermis or applying heat or acid at all. Because it does not rely on a chromophore like water or melanin to work, it is the safest of the three options across all skin tones, including the darkest, and causes the least downtime. Its limitation is that the improvement is typically milder than ablative laser or a medium-depth peel. Radiofrequency microneedling, which adds controlled heat delivered through the needles, narrows this gap by giving some of laser’s thermal tightening effect while keeping the needle’s safety profile in darker skin.
In practice, clinics do not treat these three as strictly competing choices. It is common to recommend a peel or microneedling course for pigment and overall tone, reserve laser specifically for scarring or deeper lines that need real tissue remodelling, and sequence treatments months apart.
The days immediately after ablative laser treatment are not simply cosmetic downtime; they are an active wound-healing process with specific biological requirements. When an ablative laser vaporises the epidermis, the new surface re-forms from epidermal cells that survive deeper down, inside hair follicles and sweat gland ducts that reach into the dermis below the treated zone. This is why five to ten days are needed even for a controlled, well-executed treatment: new skin has to migrate outward from these surviving structures and knit together across the treated area. Fractional delivery speeds this considerably because the untreated bridges of skin between columns act as an additional, nearby source of healthy cells.
The skin that forms during this process is immature: it is thinner than normal, its barrier function is not yet fully restored, and its melanocytes are in a reactive, unsettled state rather than their normal regulated pattern. Ultraviolet exposure during this window stimulates those melanocytes unpredictably, which is the direct mechanistic reason sun exposure in the weeks after treatment causes a disproportionate amount of the pigment change seen after laser resurfacing — more than the same sun exposure would cause on undamaged skin.
This is also why the aftercare is specific rather than a generic “wear sunscreen” instruction: strict avoidance of direct sun for about four weeks while the new skin matures, followed by daily broad-spectrum sunscreen of at least SPF 50 for a further three months while pigment regulation stabilises, with a wide-brimmed hat and avoidance of tanning beds treated as part of the same instruction. Lapses are not easily corrected after the fact — pigment that darkens because of early sun exposure can take many months of dedicated lightening skincare to fade, and in some cases does not fully resolve.
A related but distinct healing issue is prolonged redness. Because ablative and higher-intensity non-ablative lasers heat the blood vessels in the treated dermis, some patients experience erythema that persists for longer than the typical few weeks. When redness is unusually persistent, it is a vascular problem rather than a pigment one, and some clinics address it with a vascular-targeted laser rather than simply waiting it out.
A facelift repositions sagging tissue and removes excess skin, and blepharoplasty removes excess skin and fat around the eyes, but neither procedure changes the quality of the skin’s surface. A patient can have an excellent, well-executed lift and still be left with the fine lines, mottled pigmentation and rough texture that come from decades of sun exposure. This is the practical reason laser resurfacing is one of the most commonly combined add-on treatments with facelift and eyelid surgery: it treats the problem the lift was never designed to solve, in the same anaesthetic and the same trip abroad.
In practice, the areas most often treated are the fine lines around the mouth and the skin around the eyes, both regions where sun damage and fine wrinkling are disproportionately visible and where a lift alone leaves the texture unchanged. Full-face resurfacing alongside a facelift is also done, but it is a bigger undertaking for both surgeon and patient and is planned more deliberately than a localised touch-up.
The technical consideration that governs how this is done safely is blood supply. A facelift works by lifting and repositioning a flap of skin, and that flap’s blood supply is altered by the surgery itself, at least temporarily. Applying an aggressive ablative laser directly onto freshly undermined, lifted skin adds a second insult on top of a flap that is already working harder than usual to stay viable. For this reason, surgeons performing combined procedures typically reserve the most aggressive ablative settings for skin that was not undermined in the lift, and use more conservative laser settings, or non-ablative treatment, on or near the lifted tissue itself. Some surgeons prefer to stage more aggressive resurfacing to a second, later visit rather than combine it in the same operation.
For the patient, combined recovery is real but not simply additive: swelling and redness from both procedures overlap during the same one to two weeks rather than requiring two separate recovery periods, which is part of why the combination is popular for patients travelling from abroad.
The number of sessions needed depends heavily on whether the fractional treatment is ablative or non-ablative, because the two are intentionally built around different trade-offs between strength per session and downtime per session. Non-ablative fractional lasers are deliberately gentle on any single visit, so meaningful improvement comes from cumulative heat injury across repeated treatments rather than one strong hit. A course of three to five sessions, usually spaced around four to six weeks apart, is the typical pattern, with the final appearance assessed some months after the last session.
Fractional ablative treatment works the opposite way. Because each column reaches a genuine ablative depth and the dermal heating per session is far greater, a single well-matched treatment often achieves a substantial share of the improvement realistically available for problems like static wrinkles or sun damage, and many protocols are built around one ablative session rather than a repeated course. Deeper or more extensive acne scarring is something of an exception: surgeons sometimes plan a second ablative session several months after the first once the skin has fully recovered.
Several factors push the number of sessions up or down within these general patterns. More severe damage or more ambitious correction goals need either more sessions of non-ablative treatment or a stronger single ablative setting. Lower-density, more conservative settings — the choice often made deliberately in darker skin or thinner periorbital skin — reduce the effect delivered per visit and therefore raise the number of sessions needed to reach a given result.
For patients travelling abroad specifically for treatment, this difference has practical consequences. A non-ablative course spread over several months does not fit naturally into a single short medical trip, so clinics handle this in different ways: some compress a shortened course into one visit, others recommend a single stronger ablative or erbium session specifically because it concentrates the benefit into one visit, and some plan a first session abroad with follow-up sessions arranged locally. Whichever path is chosen, sun protection afterwards does more to determine how long the result lasts than the number of initial sessions does.
Depends on skin type and the problem: ablative CO2 for deep lines and scars in lighter skin, erbium for a lighter peel, non-ablative fractional for darker skin or minimal downtime. A test patch is sensible in darker skin.
Yes, many surgeons treat the skin around the mouth and eyes with laser during a facelift, taking care over lifted skin.
Strict avoidance for four weeks and daily high-factor sunscreen for at least three months to prevent pigmentation.
Neither is universally better; they work differently. A peel uses acid to exfoliate evenly and suits diffuse pigment and dullness well at lower cost. Laser uses light energy that can be aimed more precisely and heats the dermis enough to tighten skin, making it the stronger option for established scarring, deeper wrinkles and skin laxity. Many patients benefit from a peel or microneedling course for tone, with laser reserved for localised scarring or deeper lines.
It depends on the laser type. Fractional ablative CO2 or erbium often achieves most of the realistic improvement in a single session, with a second session sometimes planned months later for deeper acne scarring. Non-ablative fractional treatment is intentionally gentler per visit and is sold as a course, typically three to five sessions spaced four to six weeks apart.
Aggressive full-depth ablative CO2 carries a meaningfully higher risk of pigment change, including permanent lightening, in darker skin types, so reputable clinics either avoid it in this group or scale settings down substantially. A test patch before full treatment, lower-density settings, erbium instead of CO2, or non-ablative fractional treatment altogether are the usual safer routes.
Ablative CO2 or erbium treatment leaves the skin raw and weeping for five to ten days, with redness persisting for several weeks afterwards. Non-ablative fractional treatment causes redness and mild swelling for one to three days and allows a return to normal activities almost immediately, though it needs several sessions to reach a comparable result.
Yes, fractional ablative laser is one of the more effective options for textural acne scarring, because the dermal heating it produces helps remodel the collagen that holds depressed scars down. Deeper or more extensive scarring is sometimes treated with more than one session spaced months apart. A clinician should assess scar depth and type before promising a specific result.
Yes, this is a common combination because a lift repositions tissue but does not change surface quality, while laser treats fine lines and sun damage that the lift leaves untouched. Surgeons usually reserve the strongest ablative settings for skin that was not surgically undermined in the lift and use gentler settings on or near the lifted flap.
Discomfort depends on depth. Non-ablative fractional treatment with topical numbing cream is generally described as a hot, prickling sensation that is tolerable without further anaesthesia. Ablative CO2 or erbium treatment involves more intense heat and is usually done under local anaesthetic blocks, or sedation for full-face treatment.
Early results for ablative treatment appear once the new skin has formed, around five to ten days, though it stays pink and the deeper tightening effect continues to develop for three to six months. Non-ablative fractional treatment improves more gradually across a course of sessions, with the fullest effect usually visible some months after the final treatment.
Both are ablative, meaning they physically remove a layer of skin, but CO2 generates more heat spread into the surrounding tissue, giving stronger tightening at the cost of longer healing and higher pigment risk. Erbium ablates with less residual heat, which shortens recovery and reduces redness but produces somewhat less tightening.
Not fully. Non-ablative treatment heats the dermis without removing the surface, so it reaches shallower depths and works best for fine lines, mild pigment change and overall texture. Deep static wrinkles and significant sun damage generally need the tissue removal and stronger dermal heating that ablative treatment provides.
Visible pink or red skin typically continues for several weeks after the raw, weeping phase has healed, and can occasionally persist longer in naturally reactive skin or after stronger CO2 settings. If redness is unusually prolonged, it is usually a vascular response rather than a sign of poor healing, and some clinics treat it directly with a vascular-targeted laser.
Yes. Makeup should wait until the treated skin is fully intact. Strict sun avoidance for about four weeks, followed by daily broad-spectrum SPF 50 for a further three months, is standard, because new skin lacks its normal pigment protection and sun exposure during this window is the main preventable cause of pigment change after laser.
True scarring is an uncommon complication rather than an expected outcome, and it is generally linked to excessive treatment depth, infection during healing, or poor aftercare rather than the laser itself at correct settings. Choosing a qualified practitioner and following wound care instructions exactly are the main ways this risk is kept low.
For established, textural acne scarring, fractional ablative laser generally produces a stronger single-treatment effect because it reaches deeper and removes tissue rather than just creating a mechanical micro-injury. Microneedling is gentler, safer across all skin tones including the darkest, and causes far less downtime, which makes it a reasonable choice for milder scarring.
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