Lasers & Peels

Indications

The most common reasons I use laser or peels in clinical practice:

 

• Skin optimisation - In rhinoplasty, thick or sebaceous nasal skin can limit the visibility of underlying cartilage work. CO2 laser resurfacing before/after surgery can improve skin texture, reduce thickness, and enhance definition. It is an adjunct that makes a meaningful difference in the right patient.
   

• Scar refinement - For hypertrophic or uneven scars following surgery, trauma, or acne, fractional CO2 laser and selected chemical peels promote remodelling of the scar matrix and can significantly improve texture and pigmentation over a defined course of treatment. 
  
  In patients currently taking or recently completing isotretinoin (Accutane), the timing of CO2 laser treatment requires careful consideration. The traditional guidance of waiting 6-12 months after stopping isotretinoin before such ablative treatment remains the prevailing standard, though the evidence on this is evolving.
   

• Skin resurfacing - For patients with photodamage, uneven texture, or fine surface lines where skin quality itself, rather than volume loss or muscle activity, is the primary concern. Resurfacing achieves surface renewal that injectables cannot reliably replicate.
   

• Tattoo removal - Laser tattoo removal works by delivering short pulses of energy that fragment tattoo ink particles into smaller fragments, which are then cleared by the body's immune system. The choice of laser (Q-switched Nd:YAG, picosecond, or others) depends on the ink colours present and the specific tattoo. Dark inks (black, dark blue) respond most predictably; multicoloured tattoos require different wavelengths for different pigments and may need a combination approach. The number of sessions required depends on ink density, colour, depth, and the patient's skin type and immune response. Realistic expectations are discussed at consultation rather than a fixed session count promised upfront.
   

• Vascular lesions - Vascular lasers target oxyhaemoglobin in blood vessels, causing selective destruction of abnormal vasculature while leaving surrounding tissue unaffected. Indications include telangiectasia, cherry angiomas, facial redness and rosacea, port wine stains, and selected vascular birthmarks. The choice of laser, pulsed dye, Nd:YAG, KTP, or others, depends on the specific lesion, vessel depth, and skin type. Not all vascular lesions are the same, and treatment is only offered where the indication is appropriate and the expected outcome is realistic.
   

• Sebaceous hyperplasia and benign mole removal - CO2 laser ablation is a precise and effective method for removing sebaceous hyperplasia, the enlarged oil gland bumps that commonly appear on the face in middle age, as well as clearly benign pigmented lesions and moles. The laser vaporises the lesion with minimal surrounding tissue damage and good cosmetic outcomes. 
  
  An important caveat: laser ablation destroys tissue, which means histological examination is not possible. For this reason, laser removal is only appropriate for lesions that are clinically unambiguous - clearly benign on examination, with no features of dysplasia or malignancy. Any lesion where there is clinical doubt should be excised surgically so that the tissue can be sent for histology. Patient selection is therefore critical, and I apply the same diagnostic rigour here as I do in my skin cancer practice.
  
  In patients with significant photodamage and actinic keratoses, precancerous lesions that carry a risk of progression to squamous cell carcinoma, CO2 laser resurfacing removes the actinic ally damaged epidermis and superficial dermis, replacing it with healthy re-epithelialised skin. A review published in Journal of Cutaneous Medicine and Surgery (2021) found that fully ablative CO2 and erbium resurfacing were more effective than fractional techniques for actinic keratosis treatment, and a more recent review (2025) confirmed that ablative fractional lasers reduce and delay the development of actinic keratoses and keratinocyte carcinoma. This is particularly relevant for patients I manage for skin cancer, where resurfacing and surgical excision can be part of a complementary long-term management strategy.
   

Technique
 

• CO2 Laser - Used for resurfacing and scar work. Settings are calibrated carefully, especially for Asian skin, where the risk of post-inflammatory hyperpigmentation is higher and conservative parameters are appropriate. Device selection and treatment depth are guided by the specific indication rather than a fixed protocol.
   

• Q-Switched and Picosecond Lasers - Q-switched lasers deliver energy in nanosecond pulses, generating a photoacoustic effect that shatters pigment and ink particles without significant thermal damage to surrounding tissue. Picosecond lasers deliver even shorter pulses, in the trillionths of a second, producing a more powerful photoacoustic wave with less heat, which translates to more efficient ink fragmentation, potentially fewer sessions, and a lower risk of post-inflammatory hyperpigmentation, particularly in Asian skin types.
  
  In practice, the choice between Q-switched and picosecond platforms, and the wavelength used (532 nm for red and warm-toned inks, 1064 nm for dark inks, 694 nm or 755 nm for blue-green pigments), is guided by the specific indication - whether tattoo removal or pigmented lesion treatment. No single wavelength clears all ink colours or pigment types, and a considered approach to device and parameter selection is more important than the platform itself.
   

• Chemical Peels - The choice of peel - glycolic, TCA, Jessner's, or others depends entirely on the indication, depth of treatment required, and individual skin type. Superficial peels are appropriate for mild texture irregularity and maintenance; medium-depth peels for more significant photodamage and scar work. No single peel is applied uniformly to all patients. 
   

• Phenol Peels (Croton Oil) - At the deeper end of the spectrum, phenol-based peels incorporating croton oil represent one of the most powerful resurfacing agents available, and is capable of achieving significant improvement in deep rhytides, photodamage, and certain scars that do not respond to lighter treatments. Due to their depth of penetration and systemic absorption, phenol peels require a theatre setting with cardiac monitoring. They are typically indicated for patients with significant photodamage and Fitzpatrick skin types I-III. In practice, this means the patient population is predominantly Caucasian. They are not appropriate for Asian skin types due to a high risk of permanent pigmentary complications.

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Why Not Melasma Packages

Melasma is a chronic, relapsing condition driven by hormonal, UV, and inflammatory triggers. A recent review in Dermatologic Surgery (2025) found that current laser treatments carry meaningful risks of disease recurrence and post-inflammatory pigmentary changes - the very outcome patients are trying to avoid. Aggressive laser energy can paradoxically worsen melasma by triggering post-inflammatory hyperpigmentation, particularly in Asian skin types.

 

Selling melasma patients into repeated laser or peel sessions is not only ineffective as a long-term strategy; in susceptible patients, it can cause harm. Where pigmentation is a concern, I will discuss the evidence-based options honestly, which may or may not include laser or peels, and may appropriately involve topical therapy, sun protection, or a referral to a dermatologist as the primary intervention.

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Results & Recovery

Recovery depends on treatment intensity. Light resurfacing or a superficial peel may involve 3 to 5 days of redness and peeling. More intensive treatment for scar work or significant photodamage requires a longer recovery of 1 to 2 weeks.

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Results develop progressively as the skin remodels over 4 to 8 weeks. Where multiple sessions are indicated, these are planned with a clear endpoint in mind.

Suitability

Laser and peels are appropriate for patients with a specific, defined concern where these modalities are the most appropriate tool. An honest assessment at consultation will determine whether they are right for your situation, and if they are not, I will say so.