Skin resurfacing is one of the most in-demand areas of aesthetics right now. With more technologies available than ever before, and clients who arrive better informed, more particular about downtime and higher in their expectations, choosing the right treatment for each person has never been more complex.
In our latest Aesthetics Business Cast webinar, Rhiannon Smith, Clinical Training Manager at Lynton, joined host Vicky Eldridge for a free, CPD-accredited hour on exactly this: the technologies, what actually works in real clinics, and how to build a clinical thought process that puts the right treatment in front of the right client, every time.
Here are some of the key takeaways.
A client walks into your clinic wanting skin resurfacing. What do you recommend?
Chemical peels? RF microneedling? CO2? Erbium YAG? IPL? Fractional laser?
As Rhiannon put it during the session: "The answer is we don't know yet, because we haven't met that client."
It sounds simple, but it cuts to the heart of where treatment selection goes wrong. Clients don't arrive asking for fractional CO2. They arrive wanting to improve fine lines, texture, scarring, sun damage, or the general quality of their skin. They may not know how to do that, and they are relying on you to advise them. That means the consultation has to come before the technology, every single time.
Before reaching for a device, it helps to understand what all resurfacing treatments have in common at a biological level.
"If we strip away all the different brand names, the devices, the technologies," Rhiannon explained, "what we're actually doing when we resurface the skin is creating a controlled injury and asking the skin to respond to it."
The depth, type and intensity of that injury determines the response. Every technology on the resurfacing spectrum, from a superficial peel to fully ablative CO2, is simply a different way of creating that controlled injury. Understanding this framework makes it much easier to compare technologies and match them to the client in front of you.
The wound healing response moves through four broad stages: inflammation (which drives vasodilation, growth factor release and the removal of damaged cells), the formation of new collagen, a remodelling phase (where type 3 collagen converts to type 1 and tissue contraction occurs), and a sustained improvement phase, with best results often seen three to six months after treatment.
Before diving into the technology comparison, Rhiannon took time to address some of the most persistent misconceptions she encounters when training practitioners.
The strongest treatment is always the best. It is not. The goal is to create the right amount of controlled injury for that patient's skin and concerns, not to cause as much injury as possible. Sometimes a course of more superficial treatments will produce a better overall outcome than a single aggressive one.
More downtime means better results. Downtime is not a direct measure of efficacy. Some modern resurfacing technologies can stimulate meaningful remodelling with relatively little recovery time.
Younger patients don't need collagen stimulation. They may be presenting with early textural changes, acne scarring or enlarged pores, and collagen stimulation can be genuinely appropriate. The treatment intensity just needs to match the indication.
One treatment can solve every concern. Different concerns sit at different depths and involve different biological processes. The best results often come from combining technologies or treatment modalities.
Every resurfacing device does the same thing. They do not. Understanding what energy is being delivered, where it is being deposited, and what biological response you are trying to stimulate is what separates a clinical decision from a guess.
Rhiannon walked through the full resurfacing spectrum during the webinar. Here is a brief overview of each.
Chemical peels work through controlled chemical exfoliation. Superficial peels are ideal for brightening, smoothing texture and minor congestion with little to no downtime. Medium peels address fine lines, pigmentation and sun damage with a few days of recovery. Deep peels target deeper wrinkles and more stubborn pigmentation, but require significant downtime and trained medical supervision.
Microneedling creates tiny puncture wounds to initiate the wound healing response, encouraging collagen and elastin production. It is well suited to younger patients with early scarring, and can help with stretch marks, open pores and hair loss, though multiple sessions are usually needed and skin tightening is limited compared to thermal devices.
Long pulsed lasers and IPL directly target haemoglobin or melanin using specific wavelengths of light, making them particularly effective for vascular irregularities, sun damage, freckles and diffuse redness. They also deliver a gentle collagen stimulation effect as a secondary benefit. As Rhiannon noted, they are not strictly resurfacing, but they are an important part of the overall treatment landscape.
RF microneedling combines the puncture wound mechanism of standard microneedling with radiofrequency energy delivered through each needle as an electrode, creating additional inflammation and thermal injury that leads to tighter, firmer skin and further collagen induction. It is particularly well suited to acne scarring and mild to moderate laxity.
Non-ablative fractional lasers deliver columns of heat into the tissue without vaporising the epidermis, triggering collagen production with minimal downtime. Different wavelengths interact with the skin differently. Erbium glass lasers at around 1540nm heat water in the skin without causing ablation, while the RedTouch PRO at 675nm is the only laser that directly targets collagen rather than triggering it as a secondary effect.
Ablative fractional lasers create microscopic columns of ablated tissue using either erbium YAG at 2940nm or CO2 at 10600nm, triggering a wound healing response while preserving healthy bridges of tissue between treatment zones for faster, more predictable healing. Erbium YAG is ideal for fine lines, enlarged pores, surface-level sun damage and scarring. CO2 is the gold standard for deeper resurfacing, covering deeper wrinkles, severe acne scarring and lax skin, but comes with more significant downtime.
Fully ablative lasers remove 100% of the skin surface and are now reserved for severe cases, including significant photoageing, deep scarring, or conditions such as rhinophyma. Downtime is intense, with erythema potentially lasting months, and the treatment carries a higher risk of infection and pigmentation changes.
Rather than starting with a device, Rhiannon described a five-question framework she applies in every consultation:
She was also clear about a question practitioners often skip: when not to resurface. Active infection, unrealistic expectations, melasma, poor compliance, a recent tan and poor wound healing are all situations where resurfacing is unlikely to serve the client well.
"Not everything needs resurfacing," she said. "Sometimes improving redness with IPL, treating pigmentation, restoring lost volume or combining different modalities will give a far better result than resurfacing alone."
The live Q&A raised some genuinely practical questions from practitioners, including how to approach clients with melasma (Rhiannon's advice: do not treat; get them on topical pigment suppressants and daily SPF first), whether there is an upper age limit for resurfacing (there is not, it depends on the individual's health and healing capacity), how to handle clients with inflammatory conditions like rosacea (address the condition first and do not focus solely on the presenting concern), and how to approach Fitzpatrick skin types 4 to 6 (all technologies can be used, but protocols need to be adjusted and topical pigment suppressants applied for at least four weeks beforehand in many cases).
This article covers some of the key themes from the session, but there is a great deal more in the full recording, including the complete technology breakdown, real case studies from clinic practice, and all of the Q&A.
Watch the recording here.
If anything in this article or the recording has prompted questions about your own cover, whether that is the treatments you offer, the devices you use, or how you are protected if something does not go to plan, the Hamilton Fraser team is always happy to help.
Get in touch with the Hamilton Fraser team
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