The Definitive Guide to Laser Skin Treatments

Lasers are some of the most powerful and versatile tools in skin treatment. They can resurface ageing skin, fade stubborn hyperpigmentation, calm the redness of rosacea and soften scars. However, laser is not a single treatment. It is a whole family of very different devices, each tuned to target something specific in the skin. Choosing the wrong one, or the wrong settings, can do real harm, especially in darker skin tones. This guide explains the main types of laser used for skin, what each one treats and what to expect. We pay particular attention to the special cases that need real caution, namely skin of colour, melasma and rosacea.

Please note, we are an online skin clinic so do not offer laser treatments. We have written this guide because we believe people deserve clear, honest information about all of their options.

How Do Lasers Work on Skin?

A laser produces a single, focused wavelength of light. The skin contains several targets that absorb light, and each target absorbs some wavelengths more than others. The three main targets are:

• Water in the skin cells.
• Melanin (the pigment behind hyperpigmentation)
• Haemoglobin (the red pigment in blood vessels).

The art of laser treatment is matching the wavelength to the target you want to hit whilst sparing everything around it. This is why there are so many different types of lasers for skin treatment. A device tuned to haemoglobin treats redness and visible vessels. One tuned to melanin treats hyperpigmentation whereas one tuned to water vaporises or heats the skin to resurface it. Get the match right and the result can be excellent. If it is the wrong type, or you use too much energy, the laser heats the wrong target. This is exactly how burns, scarring and pigment problems happen. The matching of wavelength to target also explains why skin colour matters so much in terms of effectiveness and safety. We will we come back to this later.

What are the Main Types of Laser for Skin?

Lasers for skin fall into a few broad groups based on what they target. It helps to know the named devices in each group, as clinics often market by brand rather than by laser type. The main categories of laser available for skin treatment are:

• Ablative lasers: These vaporise the surface of the skin to resurface it. The two main types are the carbon dioxide (CO2) and erbium (Er:YAG) lasers. They are the most powerful option for deep wrinkles, sun damage and scarring. However, they involve real downtime and a week or more of healing. Ablative lasers also carry the highest risk of side effects.
• Non-ablative lasers: These heat the deeper layers to stimulate collagen whilst leaving the surface intact. They have far less downtime than ablative lasers but the results are more gradual and need several sessions. Common examples include the Nd:YAG and gentle resurfacing devices like Clear + Brilliant.
• Fractional lasers: These can be ablative or non-ablative. They split the beam into thousands of tiny columns, treating only a fraction of the skin at a time and leaving the surrounding tissue to speed healing. This made resurfacing far safer. Well-known examples are Fraxel (the non-ablative Fraxel Restore and the ablative Fraxel Repair), Halo and Moxi.
• Vascular lasers: These target haemoglobin to treat redness and blood vessels. The pulsed dye laser (PDL), of which the Vbeam is the best-known device, and the KTP laser are the main types. They are the mainstay for rosacea, facial redness and thread veins.
• Pigment lasers: These target melanin to treat hyperpigmentation and tattoos. The Q-switched lasers and the newer picosecond lasers (such as PicoSure and PicoWay) deliver very short, intense pulses that shatter pigment. The Nd:YAG, alexandrite and ruby lasers all work this way.

A related device worth mentioning is intense pulsed light (IPL) which is very popular for skin treatment. However, IPL is not technically a laser, because it emits a broad spectrum of light rather than a single wavelength. Broadband light (BBL) is also another more advanced version of the same idea. Clinics use these for redness, sun damage and hyperpigmentation. We cover them in detail in our post on IPL skin rejuvenation.

What Do Lasers Treat?

Because different lasers hit different targets, the family as a whole covers a wide range of concerns. The main uses, and the lasers typically used for each, are:

• Skin ageing, lines & texture: Ablative and fractional resurfacing lasers (such as fractional CO2, Fraxel and Halo) remove damaged skin and stimulate collagen to soften lines and improve ageing skin. This is the use with the deepest evidence.
• Hyperpigmentation & sun damage: Pigment lasers (Q-switched and picosecond devices like PicoSure), along with IPL, fade sun spots and other hyperpigmentation. However, hyperpigmentation is also where lasers are most likely to backfire. We cover these special cases below.
• Redness, rosacea & vessels: Vascular lasers (the pulsed dye laser and KTP) treat the flushing and visible vessels of rosacea, thread veins and post-inflammatory erythema.
• Scars: Fractional lasers (for texture) and vascular lasers (for red scars) improve acne scars, surgical scars and keloid or hypertrophic scars, often alongside other treatments.
• Tattoo removal: Q-switched and picosecond lasers break up tattoo ink so the body can clear it.
• Other concerns: Lasers also help with enlarged pores, early stretch marks and some skin tightening.

Are Lasers Safe for Skin of Colour?

Lasers can be used safely in darker skin, but the risks are far higher, and the wrong device can cause lasting damage. The reason is that darker skin has more melanin in the epidermis, and many lasers are absorbed by melanin. So in darker skin the laser energy is absorbed by the whole surface rather than just the intended target. This can cause burns, post-inflammatory hyperpigmentation and even permanent loss of pigment.

A few principles make laser treatment safer in skin of colour. The Nd:YAG laser at 1064nm is considered the safest choice for darker skin (Fitzpatrick types IV to VI). This is because melanin absorbs this longer wavelength the least, so the beam passes the surface pigment and reaches its target more safely. Picosecond lasers are also emerging as a safer option, because their very short pulses cause less heat damage. By contrast, IPL is generally not recommended for Fitzpatrick types IV to VI, because its broad spectrum is absorbed non-selectively by surface melanin and the risk of burns and pigment problems is high.

Another important factor is the person holding the device. Treating darker skin safely takes specific training and experience, conservative settings and careful preparation. If you have skin of colour and are considering laser, choose a practitioner who is experienced in and commonly treats skin like yours. Our posts on skincare for skin of colour and treating hyperpigmentation in dark skin covers this and other tips in more detail.

Can Lasers Treat Melasma?

Melasma deserves its own warning, because it is the condition where lasers most often make things worse. This is because melasma is a chronic, relapsing form of hyperpigmentation driven by hormones, heat and UV light. Lasers can fade the pigment, but they also generate heat. Unfortunately heat is one of the things that drives melasma in the first place.

This is why lasers are a second-line or third-line treatment for melasma, never the first move. Aggressive laser treatment can trigger a rebound that leaves the melasma worse than before. Where practitioners do use laser, current practice favours a cautious, low-energy approach. The low-fluence Q-switched Nd:YAG, known as laser toning, is the most studied option. However, it works best combined with other treatments rather than alone. For most people, melasma is better managed first with prescription topical treatment and strict sun protection. Actives like hydroquinone, tretinoin and tranexamic acid can help fade pigment. Strict sun protection with sunscreen containing broad filters like iron oxide can help block the visible light that worsens melasma. For more detail on managing this condition checkout our posts on getting rid of melasma and melasma maintenance.

Are Lasers Good for Rosacea?

Here the news is more positive. Rosacea is one area where lasers are genuinely a first-rate treatment, specifically for the redness and visible vessels. Vascular lasers target the haemoglobin in blood vessels, which lets them reduce the flushing, the persistent redness and the thread veins that topical treatments cannot touch. The pulsed dye laser (PDL) and the KTP laser are the main devices used.

It is worth being clear about what laser can and cannot do for rosacea. Laser skin treatment works well for the vascular component (the redness and vessels). It does little for the spots and bumps of papulopustular rosacea, which still need medical treatment. This is why laser is best thought of as one part of a rosacea plan rather than a standalone cure. Most people still need topical or oral treatment to control the inflammatory side, with ingredients like ivermectin and metronidazole. Our guide to the best rosacea treatments covers how these fit together and our post on rosacea versus acne helps tell them apart.

Can Lasers Treat Acne?

For active acne, the evidence is lasers can help but the effect is more modest than for medical treatment. Light and photodynamic therapy (where a light-sensitising agent is applied first) can help target the bacteria and calm inflammation. More recently, a new class of laser has taken a different approach by targeting the oil glands directly. The 1726nm lasers, sold as AviClear and Accure, received FDA clearance in 2022 for inflammatory acne. They work by selectively heating and shrinking the sebaceous glands. In a trial of 104 patients, around 87% achieved at least a 50% reduction in inflammatory lesions by 26 weeks. The results also held across all skin types making this a potentially promising option for people who cannot tolerate or do not want long-term medication.

That said, laser does not replace conventional acne treatment. The established medical treatments target the causes of acne directly, and they are cheaper, better evidenced and what guidelines reach for first. Topical retinoids, benzoyl peroxide, antibiotics and hormonal treatments like spironolactone remain first-line. Laser is best seen as an option for resistant cases who do not wish to start systemic oral retinoids or for people who cannot use the usual treatments.

Where lasers genuinely shine is in their secondary use. They are one of the best treatments for acne scarring, with fractional lasers improving the texture of pitted scars and vascular lasers fading the redness of post-inflammatory erythema. For most people, the sensible order is to clear the acne first with medical treatment, then address any scarring or marks once breakouts are under control.

Is Laser Treatment Safe?

Done by an experienced practitioner on the right candidate, lasers are generally safe. The risks come from the wrong device, the wrong settings or the wrong patient. Common side effects of laser treatment are:

• Expected short-term effects: Redness, swelling, warmth and a sunburn-like feeling are normal for a few hours to days. Ablative resurfacing involves more, with peeling, crusting and a week or more of healing.
• Pigment changes: Hyperpigmentation (darkening) or hypopigmentation (lightening) can follow treatment. These are more common and longer lasting in darker skin tones.
• Burns, blistering and scarring: These are uncommon with a skilled operator and correct device but there are serious risks if too much energy is used.
• Infection and flare-ups: Resurfacing can trigger a cold sore outbreak in people prone to them, and rarely a skin infection.

Laser is not suitable for everyone, and some situations are clear contraindications or call for real caution. You should avoid laser, or proceed only with specialist advice, if you:

• Have a tan or recent sun exposure: Treating tanned skin sharply raises the risk of burns and pigment problems. Most practitioners ask you to avoid sun and self-tan for several weeks beforehand.
• Are pregnant: Laser is generally postponed in pregnancy as a precaution, since it has not been well studied.
• Take isotretinoin: Recent or current isotretinoin traditionally means waiting for several months before ablative laser though this advice is being re-examined. You will also need to stop topical retinoids before and after each session.
• Have active infection or inflammation: An active cold sore, skin infection or inflammatory flare in the area should settle first.
• Have a history of keloid scarring or a photosensitive condition: These need careful assessment, as does taking any medication that increases sun sensitivity.

Preparation makes a real difference to both safety and results. In the weeks before treatment, the usual advice is to use a daily broad-spectrum SPF 50, avoid sun exposure and self-tan, and stop any irritating actives like retinoids or exfoliants for a few days as directed. In darker skin, a prescriber may also start a pigment-suppressing treatment like hydroquinone beforehand to lower the risk of post-inflammatory hyperpigmentation. After treatment, strict sun protection and gentle skincare are essential whilst the skin recovers.

What Results Can You Expect from Laser Treatment?

Laser results depend enormously on the device, the concern and the skill of the operator, but some general principles hold. Several sessions are usually needed, not one. Non-ablative and vascular treatments in particular work gradually over a course spaced weeks apart. Ablative resurfacing gives more dramatic results in fewer sessions, but with significant downtime and weeks of redness as the skin heals.

Results are also rarely permanent, because the skin keeps ageing and the original triggers remain. Sun damage and hyperpigmentation can return with further UV exposure. Rosacea vessels tend to recur over a few years and need maintenance. Melasma almost always returns without ongoing topical treatment and sun protection. As with any skin treatment, daily broad-spectrum sunscreen is essential to protect the result, and it matters even more after laser because the skin is more vulnerable to UV.

What are the Alternatives to Laser Skin Treatment?

Laser is rarely the only way to treat a given concern, and it is often not the first choice. Depending on what you are treating, the main alternatives are:

• Prescription topical treatment: For hyperpigmentation, melasma and inflammatory rosacea, compounded prescription creams are frequently a safer and cheaper first step. Ingredients like tretinoin, hydroquinone, azelaic acid, tranexamic acid and ivermectin can target pigment and inflammation without heat.
• Chemical peels: This is a deep exfoliation that improves hyperpigmentation, texture and fine lines. There are many types of peels and strengths which can be tailored for each individual. However, they need the same caution in darker skin.
• Microneedling: This stimulates collagen and can help treat scars, texture and ageing through controlled micro-injury rather than heat. This makes microneedling a useful option in skin of colour.
• Other energy devices: Radiofrequency and similar skin-tightening treatments target laxity through heat in the deeper layers rather than light.

The right choice depends on your concern, your skin type and your tolerance for downtime. For pigment conditions in particular, a topical-first approach is often the wisest place to start. Our posts on stubborn hyperpigmentation and the different types of hyperpigmentation explain why the right treatment depends on getting the diagnosis right first.

What About Laser Hair Removal?

Laser hair removal is a different topic and outside the scope of this guide, which is about treating skin conditions. It uses lasers to target the pigment in the hair follicle rather than the skin. The same skin-colour principles apply, as the longer-wavelength Nd:YAG is the safer choice for darker skin. We cover hair removal and related treatments separately in our blog.

How to Get Laser Treatment in the UK

Laser treatment is not available on the NHS for cosmetic skin concerns. It is available through private dermatology and laser clinics which usually charge a set fee per session depending on the size of the treatment area and type of device. It is usually cheaper to buy a course. If you are considering it, the quality and experience of the practitioner matter more than anything else, particularly for darker skin or for melasma. Look for a provider who assesses your skin type properly, explains the risks honestly and can show you results in skin like yours. Be wary of anyone offering one device as the answer to every concern.

It is also worth knowing that laser is often not the right first step. Many of the concerns people seek laser for, including melasma, hyperpigmentation, rosacea and early signs of ageing, respond well to topical treatment. This is frequently a safer, cheaper place to start.

At City Skin Clinic, we do provide bespoke topical skin treatments using ingredients like tretinoin, hydroquinone, azelaic acid and tranexamic acid where appropriate. Our doctors will design a treatment plan entirely around your skin. You can read more about our custom treatments for hyperpigmentation, melasma, rosacea and skin ageing, or book a consultation to start. The journey towards great skin starts here.

This article is for general information and does not constitute medical advice. Laser treatments should only be carried out by a suitably qualified and experienced practitioner after an individual assessment. Always seek advice from a qualified medical professional about your own skin.