Procedures




Reconstructive Plastic Surgery

 
 
 
 
 
Intense Pulsed Light and Laser skin treatments


Two treatment modalities that are extremely useful in the treatment of various skin conditions are Laser and Intense Pulsed Light (IPL).  Both involve harnessing energy from light waves but they differ in how the light waves are 'packaged' and delivered to the skin.  For a light treatment to be effective in this way, the energy from the light must be absorbed by some component of the skin.  Different wavelengths of light (equivalent to different colours of light) have different absorption characteristics and we utilise this property to treat different conditions.  We select IPL or Laser wavelengths so that we can target different components of the skin depending on what we want to achieve; so when wanting to rejuvenate the skin we target the protein collagen in the deeper (dermis) layer of the skin; whereas for hair removal we target the pigment melanin in the hair shaft and for treating vascular blemishes, such as Rosacea or thread veins, we target the red pigment called haemoglobin that carries oxygen in blood cells.  In this way we can use the heat or mechanical energy produced by the light to damage selectively one component of the skin, without, hopefully, damaging the others.

It is important that these treatments are carried out only on those pigmented blemishes which have a negligible risk of cancerous change and so you should ensure you are either treated by someone who is medically qualified and has the expertise to assess these blemishes, or that you have had an examination by an expert first.  I am a Consultant Plastic Surgeon with a special expertise in melanoma and other skin cancers, working in partnership with Dermatologists and Oncologists in a regional centre for these cancers.  I will always assess your skin clinically before considering any treatment.

Vascular Skin Blemishes

Vascular skin blemishes such as Port Wine Stains; Thread Veins; Telangectasiae; Spider Naevi and Rosacea can be treated with either laser or IPL.  I use a state-of-the-art system that allows me to treat you with either modality, and to switch between them as required.

How does IPL or Laser work on vascular blemishes?

The wavelength of the light used is chosen so as to be absorbed by haemaglobin in the cells within blood vessels travelling in the epidermis and dermis preferentially.  Inside a vascular skin blemish, the blood vessels are overgrown or in higher concentrations than surrounding “normal skin”.  When these blood vessels absorb the light, they heat up and are destroyed, whilst minimal collateral damage is caused to the surrounding skin.  Following successful treatments, the damaged blood vessels are absorbed by the body, and little or no trace of the blemish remains.

Exactly the same principle applies to treatment with a laser.  The laser can give a more powerful and selective treatment, but over a smaller surface area each time, and so is not usually my first choice because it will take me longer to achieve a finished result for you, involving you in more expense, time and treatments.  I tend to use the laser therefore, on blemishes that are resistant to treatment with IPL or on people with darker skins because it is very gentle on dark skin types, so almost all skin types can be treated with the NdYAG laser.

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How is the treatment carried out?

First the skin being treated is cooled using a jet of refrigerated air.  Then for IPL treatments, a thin layer of gel is applied to the skin prior to treatment, which both cools the skin further and optimises transmission of light from the applicator to the skin.
Your first treatment will occur at the end of your consultation, and will consist of several treatment 'test patches' which will allow me to assess the response of the blemish to the treatment and to ascertain at which power to treat your blemish subsequently.  During treatment you must wear protective eye goggles.

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Which patients can be treated?

In everyone, the outer layer of the skin, the epidermis, contains melanin which is a very good absorber of light, which is why it is utilised by our bodies as the skin’s natural defence against harmful ultraviolet radiation from the sun. The concentration of melanin in the skin is greater in darker skinned people and increases in light skinned people when the skin is exposed to UV light.  The light emitted by the IPL system or Laser is absorbed to a certain extent by melanin in your skin as well as the blood vessels; and the portion of the light that is absorbed by melanin will produce unwanted, incidental heat in the skin.   So the more melanin in the skin, the more heat will be produced, which could produce a burn.  Therefore, it is not possible to treat very dark-skinned individuals with IPL (although they may be suitable for treatment with a Laser) or patients who have recently gained a sun tan (although they can subsequently be treated once their tan has faded).
If you have any areas of broken skin, treatment will be delayed until the area is healed completely.
Some vessels are not suitable for laser treatment: very large bore blood vessels and varicose veins cannot be treated.  Some deep lying or blue veins can be treated, but will usually require more treatments than smaller red veins.

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Will it hurt me?

When light energy is absorbed in the skin, it heats it up, and creates a sharp sensation like a hot pinprick.  Most patients describe the discomfort as moderate and acceptable.  No anaesthesia is required, but to ease the discomfort I use a cold gel for IPL treatment in combination with a refrigerated air jet that you control during your treatment.  For Laser treatments, the refrigerated air jet, followed by a cooling gel after treatment usually suffices.

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What should I expect after the treatment?

Redness and a slight burning sensation in the skin are normal after treatment.  A cooling pack will be applied to the skin to ease these symptoms.  You may see a temporary grey colouration in the vessels.  Some vessels disappear immediately, so you won't see them again!

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What are the side effects?

The visible light used in IPL is completely safe so no special precautions are needed apart from wearing protective glasses during treatment.
The skin of some patients becomes quite red immediately after treatment and in rare cases some bruising may be seen.  However, most patients experience no side effects and any redness or bruising usually disappears over a period of hours to a few days.  Very rarely the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent.  If you have been exposed to sun a day or so before treatment and have not yet developed a tan, you may still have enough extra melanin in your skin to burn, and then your skin will blister and scab after treatment and this may scar ultimately ' so avoidance of the sun and tanning before treatment is vital.

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How do I prepare for treatment?


You must avoid the sun, or using either a tanning salon or any fake tan for 6 weeks before, or during the entire treatment period to avoid burns from light absorption in the epidermis.
Also, immediately after the treatment, the skin is particularly sensitive to UV light, and strong sunlight should be avoided for 1-2 weeks.

How long does treatment take?

The length of each treatment will depend on the type and size of lesion present, but a typical session for Rosacea might take 15 - 30 minutes.

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How many treatments are necessary?
The length and number of treatments will depend on the type and size of lesion present, but typically 1-5 treatments will be needed.  Treatments should take place approximately every 4 to 6 weeks for IPL and every 6-8 weeks for laser.

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Hair Removal

In order to remove hair I will use either IPL at a wavelength of 650nM or a long-pulse NdYAG laser depending on how dark your skin is.  Both methods are targeting melanin in your hair shaft in order to heat up and kill the hair follicle and neighbouring cells responsible for re-growth of the hair.

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How is the treatment carried out?
The skin will be cooled down prior to treatment, to prevent unwanted heating of the epidermis. The IPL or laser will be placed directly over the skin bearing the unwanted hair and fired. During treatment you must wear protective goggles.

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Which patients can be treated?

Black hairs are most easily treated due to the large concentration of melanin in these hairs, which gives the most absorption and creates the most heat.  Fair hair has less melanin and consequently less heat is produced with less certainty of permanent destruction of the hair follicles.  Grey (white) hair has almost no melanin and cannot be treated effectively.  The light emitted by Nd:YAG laser is especially gentle to dark skins, which means that it is the laser best suited for the treatment of Afro-Caribbean and the darker Asian skin types.

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Does it hurt?

As the light energy is taken up by melanin, any discomfort depends upon the combined concentration of melanin in the epidermis and the hairs.  No anaesthesia is required.  Most patients describe the discomfort as moderate and acceptable, and liken it to a rubber band being flicked against the skin.

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Do I need to shave prior to treatment?

Hair should be shaved just before, or on the morning of treatment ' in many ways, it is easier to leave it for me to do just before treatment as that will allow me to see what needs treating!  The guiding principle for successful treatment is that as many hair follicles as possible should contain a hair on the day of treatment in order to be destroyed by the light.

Do not pluck, wax or bleach hairs for at least 4 weeks before treatment or the treatment will fail and you will waste your money!

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Why do hairs “grow” after treatment?

They don’t really, but they do appear to grow.  The hairs are not always evaporated by this particular treatment in the way that some other light treatments do.  Although the hair follicles are killed by the heat generated during the treatment, the hair shafts may remain in the follicles.  They will fall out after 1-3 weeks as the epidermis is renewed.  During this period it will seem that the hairs are growing because they are being pushed out of the epidermis.

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How can you tell if the treatment has worked when the hairs are not removed immediately?


After treatment the hairs are loose in the follicle and can sometimes be pulled out easily and painlessly with tweezers.  A red ring around each follicle is often seen a few minutes after treatment, along with reddening of the skin.  These end points indicate that sufficient heating of the follicles has taken place, however they are not always seen.  Many patients have successful treatment results without these positive post-treatment signs.

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What are the side effects?

The skin of some patients becomes quite red immediately after treatment.  However, most patients experience no side effects and the described skin reactions usually disappear within hours to a few days.  Rarely the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent.  Occasionally the treated skin may form blisters and then scab following treatment.  These areas should be left alone to heal naturally.  It is important to avoid scratching or picking scabs or blisters as this could result in scarring.

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How many treatments are necessary?

Of all the hairs on your body a variable number (10- 70%) are growing at any one time; the remainder are either resting or are about to fall out.  Only hair that is growing when treatment occurs can be killed and removed permanently.  Because the number of hairs in the growing phase varies, as does the length of the growth cycle of each hair, you will notice that a significant reduction in hair density occurs after the first treatment, but that not all of the hair in the area treated will have gone.  More treatments will be needed to get the hairs that were resting or about to fall out last time.  With each successive treatment, a smaller proportion remain and those that do tend to be finer.  To achieve satisfactory results, treatment sessions are recommended every 4-6 weeks and the number of sessions needed varies, according to individual factors, but the usual number is 8-10.

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How do I prepare for treatment?

You must avoid the sun, sun lamps or the use of any fake tan 6 weeks ahead of and during the entire treatment period to avoid discomfort from light absorption in the epidermis and the risk of burns and permanent scarring.
Immediately after the treatment the skin is particularly sensitive to UV light, and strong sunlight should be avoided for 1-2 weeks.

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How long does treatment take?

A facial treatment usually takes 15 minutes, whereas treating both legs or an entire back takes approximately 2 hours.

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Is permanent hair removal possible?
Currently-used technology is only a few years old, so we do not know definitively for how long these treatments are effective, but they seem to be lasting years.

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Tattoo Removal

For removing tattoos I use a Q switched NdYAG laser which will remove most tattoo pigments effectively except green.

How does a laser remove a tattoo?

The short answer is that it doesn’t - the laser allows the body to remove the tattoo.  Tattoos are made of ink contained in layers throughout the skin.  The ink particles are recognised by the body as foreign material, but they are too large for the cells that digest foreign material to tackle, so instead, the body encapsulates the tattoo ink in a collagen protein coating to wall it off.  The laser works by breaking down the collagen wall and fragmenting the ink particles till they reach a small enough size for the body’s defence cells to digest and excrete them.

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How many treatments will I need?

Many variables will determine this and I never make a prediction; I just give you the facts and you can see for yourselves that your individual circumstances may mean a shorter or longer treatment span:

The number of treatments required to remove a tattoo will depend on:

1: The amount of pigment present and the variability of the depth of the pigments in the skin (for instance professional tattoos, made with an electric needle, tend to place pigments at the same level in the skin, whereas amateur tattoos are more haphazardly distributed in the skin’s layers)

2: The colours and constituents of the tattoo pigments

3: The density, type and age of the tattoo

4: The skin’s reaction to laser light

5: The presence of other skin conditions

Generally you can expect a gradual fading after each treatment as the body digests the shattered ink particles at its own speed until, after enough treatments, no ink remains.  It is not possible to assess exactly the depth and density of a tattoo prior to treatment and therefore any estimate of the number of treatments required will always only be an educated guess.

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Which colours are best to treat?

The treatment of colours other than blue and black can be difficult.  The colour that is hardest to treat is green and I do not have a laser that will treat green ink. 
Certain new types of fluorescent tattoos do not respond to laser treatment and will be left behind after the rest of the tattoo is removed and this is not predictable before we start treatment!  Moreover, some modern pigments may change colour after treatment and again, this is impossible to predict.  But as a rule of thumb, if a tattoo is particularly dense or brightly coloured it is likely that some pigment will remain after the course of treatment is complete.

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What should you expect from treatment?

Tattoo removal is a medical process relying in part on your body’s cellular defence mechanisms, so it is essential that you advise me of all relevant information regarding both your tattoo and any other medical conditions from which you suffer.

During the healing process, the treated area might feel itchy, but you must resist scratching because it may lead to infection and scarring of the treated area.

The normal interval between treatments is 8 weeks to allow sufficient time for the skin to heal and the treatment to be most effective. 

I recommend that you use a moisturising cream on the treated area between treatments.

Suitable eye protection is essential so that your eyes are kept safe from the laser.

The possibility of scarring is increased in areas where the tattoo ink is particularly dense.  There is a risk that the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent, but equally, increased or decreased pigmentation may resolve after six months but cannot be guaranteed and sometimes a “ghost” of your tattoo may remain on the skin, because the skin where the tattoo once was remains paler than the skin surrounding it.

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Removing brown pigmented skin blemishes

IPL of a suitable wavelength for absorption by the melanin contained within freckles and sun (also called liver) spots, can be used to decrease or remove these skin blemishes.  IPL uses heat energy to damage the blemishes whilst causing minimal damage to the surrounding skin. Following treatment, the damaged lesions turn darker first, and may crust, and then over a period of weeks they will gradually flake away from the skin leaving little trace of the original mark.

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How is the treatment carried out?

A thin layer of gel is applied to the skin being treated after first cooling it with a stream of refrigerated air. This helps to cool the skin, as well as ensuring optimal transmission of light from the applicator to the skin.
Your first treatment will occur at the end of your consultation, and will consist of several treatment “test patches” which will allow me to assess the response of the blemish to the treatment and to ascertain at which power to treat your blemish subsequently.  During treatment you must wear protective eye goggles.

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Who can be treated?

Almost everyone can be treated, apart from very dark skinned or tanned individuals. 

Not all pigmented lesions can be treated.  Large, dark moles should not be treated, nor should lesions covering a large part of the body.  The pigmented marks that respond the best are superficial lesions such as those caused by sun damage (sun spots) and freckles. 

It is important that these treatments are carried out only on pigmented blemishes which have a negligible risk of cancerous change and so you should ensure that you are either treated by someone who is medically qualified and has the expertise to assess these blemishes, or that you have had an examination by an expert first.  I am a Consultant Plastic Surgeon with a special expertise in melanoma and other skin cancers, working in partnership with Dermatologists and Oncologists in a regional centre for these cancers.  I will always assess your skin clinically before considering any treatment.

Back to top

Will it hurt me?

As the light energy is absorbed in the skin, it heats it up, and creates a sharp sensation like a hot pinprick.  Most patients describe the discomfort as moderate and acceptable.  No anaesthesia is required, but to ease the discomfort I use a cold gel for IPL treatment in combination with a refrigerated air jet that you control during your treatment. 

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What should I expect after the treatment?

Redness and a slight burning sensation are normal after treatment.  A cooling pack will be applied to the skin to ease these symptoms. The lesions will darken after treatment and may appear more obvious at first, but gradually the marks will flake away.  However, if you expose yourself to sunlight you may get a recurrence of the original mark, so you should always wear a sunscreen with a SPF of 15 or higher.

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What are the side effects?

The visible light used in IPL is completely safe so no special precautions are needed apart from wearing protective glasses during treatment.
The skin of some patients becomes quite red immediately after treatment and in rare cases some bruising may be seen.  However, most patients experience no side effects and any redness or bruising usually disappears over a period of hours to a few days.  Very rarely the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent.  If you have been exposed to sun, a day or so before treatment and have not yet developed a tan, you may still have enough extra melanin in your skin to burn, and then your skin will blister and scab after treatment and this may scar ultimately ' so avoidance of the sun and tanning before treatment is vital.

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How do I prepare for treatment?

You must avoid the sun, or using either a tanning salon or any fake tan for 6 weeks before or during the entire treatment period to avoid burns from light absorption in the epidermis.

Also, immediately after the treatment, the skin is particularly sensitive to UV light, and strong sunlight should be avoided for 1-2 weeks.

Back to top

How long does treatment take?

The length of each treatment will depend on the type and size of lesion present, but a typical session for Rosacea might take 15 - 30 minutes.

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How many treatments are necessary?

The length and number of treatments will depend on the type and size of lesion present, but typically 1-5 treatments will be needed.  Treatments should take place approximately every 4 - 6 weeks.

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Acne Treatment

IPL treats acne using yellow, green and red light. The yellow light destroys the bacteria that live in the skin and cause acne, while the red light targets the overactive sebaceous glands directly so lessening outbreaks of pustules.

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How is the treatment carried out?

A thin layer of gel is applied to the skin being treated after first cooling it with a stream of refrigerated air. This helps to cool the skin, as well as ensuring optimal transmission of light from the applicator to the skin.
Your first treatment will occur at the end of your consultation, and will consist of several treatment “test patches” which will allow me to assess the response of the blemish to the treatment and to ascertain at which power to treat your blemish subsequently.  During treatment you must wear protective eye goggles.

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Who can be treated?


Almost everyone can be treated, apart from very dark skinned or tanned individuals. 
People with mild to severe acne should see an improvement.
Pregnant women or people taking the acne treatment Roaccutane should not be treated.

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Will it hurt me?

As the light energy is absorbed in the skin, it heats it up, and creates a sharp sensation like a hot pinprick.  Most patients describe the discomfort as moderate and acceptable.  No anaesthesia is required, but to ease the discomfort I use a cold gel for IPL treatment in combination with a refrigerated air jet that you control during your treatment. 

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What should I expect after the treatment?

Redness and a slight burning sensation are normal after treatment ' this generally dies down within 30 minutes, but some people remain red for up to 24 hours.  A cooling pack will be applied to the skin to ease these symptoms. The lesions will darken after treatment and may appear more obvious at first, but gradually the marks will flake away.  However, you should avoid sun exposure and wear a sunscreen with a SPF of 15 or higher for 2 weeks after treatment.

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What are the side effects?

The visible light used in IPL is completely safe so no special precautions are needed apart from wearing protective glasses during treatment.
The skin of some patients becomes quite red immediately after treatment and in rare cases some bruising may be seen.  However, most patients experience no side effects and any redness or bruising usually disappears over a period of hours to a few days.  Very rarely the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent.  If you have been exposed to sun a day or so before treatment and have not yet developed a tan, you may still have enough extra melanin in your skin to burn, and then your skin will blister and scab after treatment and this may scar ultimately ' so avoidance of the sun and tanning before treatment is vital.
It is possible that some hair loss will occur, and it could be permanent, so men should consider this possibility before agreeing to treatment of their beard area.
There are some positive side effects as well as acne reduction, many people find that their skin texture and tone improve dramatically.

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How do I prepare for treatment?

You must avoid the sun, or using either a tanning salon or any fake tan for 6 weeks before or during the entire treatment period to avoid burns from light absorption in the epidermis.
Also, immediately after the treatment, the skin is particularly sensitive to UV light, and strong sunlight should be avoided for 2-3 weeks.

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How long does treatment take?

A typical treatment session will last 15 - 45 minutes.

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How many treatments are necessary?

The number of treatments necessary varies from person to person, but typically 1-5 treatments will be needed to get a lasting result, and each treatment should have an interval between it and the next of 2 - 4 weeks.

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Combined Facial Therapy

This is a skin rejuvenation treatment that combines a skin peel with IPL of a suitable wavelength and power to produce very mild, reversible, thermal damage to the epidermis. When the body repairs this damage subsequently, the rate of production of collagen in the dermis of the skin is increased which, to a variable degree, effaces fine lines and wrinkles and improves the appearance and texture of your skin.  It may also improve your complexion and make the pigmentation of your skin more uniform. 

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How is the treatment carried out?

The skin is thoroughly cleansed, and then a mild, relaxing skin peel is
applied and left on the face for 5 - 8 minutes.  The peel is then removed, along with the top layers of dead skin, leaving the skin feeling smoother and refreshed.  The skin is then cleansed again and a cool, soothing gel is applied to the face.  The gel also ensures optimal transmission of the IPL to the skin.
The IPL is pulsed through the skin, after which the skin is cleansed and moisturised.

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Who can be treated?

The ideal patient is fair skinned but darker skin types can derive benefit too.

If there are any areas of broken skin, the treatment should be delayed until the area has completely healed.

Will it hurt me?

As the light energy is absorbed in the skin, it heats it up, and creates a sharp sensation like a hot pinprick.  Most patients describe the discomfort as moderate and acceptable.  No anaesthesia is required, but to ease the discomfort I use a cold gel for IPL treatment in combination with a refrigerated air jet that you control during your treatment.

What are the side effects?

The visible light used in IPL is completely safe so no special precautions are needed apart from wearing protective glasses during treatment.
The skin of some patients becomes quite red immediately after treatment and in rare cases some bruising may be seen.  However, most patients experience no side effects and any redness or bruising usually disappears over a period of hours to a few days.  Very rarely the natural pigment in the skin may increase or decrease as a result of treatment, and this may be permanent.  If you have been exposed to sun a day or so before treatment and have not yet developed a tan, you may still have enough extra melanin in your skin to burn, and then your skin will blister and scab after treatment and this may scar ultimately, so avoidance of the sun and tanning before treatment is vital.
It is possible that some hair loss will occur, and it could be permanent, so men should consider this possibility before agreeing to treatment of their beard area.

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How do I prepare for treatment?

You must avoid the sun, or using either a tanning salon or any fake tan for 6 weeks before or during the entire treatment period to avoid burns from light absorption in the epidermis.
Also, immediately after the treatment, the skin is particularly sensitive to UV light, and strong sunlight should be avoided for 2-3 weeks.

How long does treatment take?

A facial treatment, with skin peel, usually takes about 30 minutes

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How many treatments are necessary?

Treatment sessions are recommended every 2-3 weeks. The actual number of sessions needed varies from person to person, but usually about 6 treatments are sufficient, with top-up sessions as required.

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