Dr Rakesh Patalay is a Consultant Dermatologist and Dermatological Surgeon who works privately at Dr Sam Bunting + Associates in London. He trained at University College London and holds a PhD in dermatology, with sub-specialist expertise in laser surgery and procedural dermatology. He is on the GMC Specialist Register (GMC number: 4626136) and has worked with the full range of medical-grade laser devices throughout his career.
Laser Treatments for Skin: Which One Do You Actually Need?
If you've been looking into laser treatment, you've probably hit a wall of acronyms: PDL, Nd:YAG, IPL, pico, CO2, Q-switch. Clinics tend to display their devices like a trophy cabinet without explaining what any of them actually do, or why one matters for your concern and another doesn't.
I use over ten different devices, and the single most important thing I can tell you is that they are not interchangeable. The right laser for the right concern produces excellent results. The wrong one produces disappointment, and occasionally harm. This blog cuts through the noise: what we have, what each device treats, and how we decide.
How Do Lasers and Light Treatments Actually Work?
Every laser and light device works on the same principle. Light energy is absorbed by a specific target in the skin and turned into heat, which either destroys that target or stimulates the skin's own repair response. There are three main targets: haemoglobin (in blood vessels), melanin (in pigment) and water (in tissue).
Different wavelengths of light are absorbed by different targets. This is the principle of selective photothermolysis, and it's why choosing a device is a clinical decision rather than a marketing one.
It's also why skin tone matters so much. In darker skin, the higher level of background melanin can absorb laser energy unintentionally. That changes which devices are safe to use and what settings are appropriate, which is why an accurate assessment of your skin tone comes first.
Which Laser Is Right for Your Concern?
It's more useful to start with what you actually want to change than with a list of machines. Almost every concern we treat falls into one of three jobs: calming redness, fading pigmentation, or smoothing texture. Here's what we tend to use for each, in plain terms.
If your concern is redness or visible vessels
This covers rosacea, general facial redness, thread veins, and the lingering red marks left behind by old spots. These respond to lasers that target the blood inside the vessel and gently seal it.
For most people we use a laser called PDL (you may see it branded as V-Beam), with KTP as an option for fine surface veins. If the vessels are deeper, or if you have a darker skin tone, a longer-wavelength laser (Nd:YAG) is the safer, more effective choice. Expect a few days of redness afterwards, and occasionally some short-lived bruising.
If your concern is pigmentation or sun damage
This covers sun spots, uneven tone, melasma, and the dark marks that can linger after a breakout.
For general sun damage and uneven tone on lighter skin, IPL (a broad light rather than a single laser) works well. For more targeted pigment, or for darker skin tones, we use Q-switched or pico lasers. These deliver energy in ultra-short bursts that shatter the pigment with very little heat, which makes them gentler on surrounding skin. Downtime is usually short, around a couple of days. Melasma is treated cautiously because it can return if pushed too hard.
If your concern is texture, acne scarring or ageing
This covers acne scarring, enlarged pores, fine lines, and skin that has become rough or crepey. These need "resurfacing" lasers, which work deeper to remodel the skin and stimulate fresh collagen.
Think of these on a scale. At the gentler end are non-ablative fractional lasers, with only a couple of days of redness. At the stronger end are ablative lasers such as fractional CO2 and Er:YAG, which achieve more in fewer sessions but need roughly one to two weeks to heal. HALO is a hybrid that combines a gentle and a strong wavelength in a single treatment. As a rule, the stronger the laser, the bigger the result and the longer the recovery, so we match the intensity to your scarring and to how much downtime you can realistically take.
A note on skin tone
This is the most important safety point, and it runs across all three groups. In darker skin tones, some devices carry a higher risk of leaving marks (post-inflammatory hyperpigmentation), because the natural pigment in your skin can absorb the laser's energy along with the intended target. It does not mean laser is off the table. It means the choice of device and settings matters more. As a general rule, longer-wavelength and pico lasers are the safer options for deeper skin tones, and the strength is always dialled down accordingly.
Whatever your concern, the specific device and settings are decided after a full assessment of your skin, your history and your goals, not from a list.
What Does a Laser Consultation Involve?
A good laser consultation is a diagnostic conversation, not a sales one. When I see a patient at Dr Sam Bunting + Associates, I'm working through several things before any device is even discussed.
First, I want to understand what the concern actually is, and whether laser is the right tool for it at all. Some concerns are better served by injectables, topicals or a different class of procedure entirely, and I'll say so if that's the case.
I then assess your Fitzpatrick skin type clinically. This determines which devices are appropriate, which settings are safe and what risk management is needed. For patients with darker skin tones this part of the conversation is especially important. Many have been told laser isn't possible for their skin tone. That's often not accurate, but it does require the right device and the right preparation, and I won't skip that conversation.
I also review your medical history and medications, discuss realistic expectations and the likely number of sessions, and go through downtime so the treatment fits around your life. Photographs are taken before treatment and at each review, because changes that develop over months are easy to underestimate without a side-by-side comparison.
How to Tell If You've Had the Wrong Laser Treatment
Many patients come to me for a second opinion after a course of laser that didn't work, or made things worse. There are two clear warning signs that the wrong device or the wrong settings were used.
Patchiness, pale spots or darkening after treatment.
If your skin looks lighter in patches, or developed new dark marks after laser, this usually means the settings were too aggressive for your skin tone, or the wrong device was used. It's worth finding out who treated you and with which device before you have anything further done.
The same device for every concern.
No single machine can properly treat redness, pigmentation and textural scarring, because each of those needs a different wavelength. If a clinic reaches for the same device whatever you come in with, that reflects the equipment they own, not what your skin needs.
If either of these sounds familiar, a second opinion from a consultant with access to the full range of devices is worthwhile. In many cases the original concern is still treatable with the right approach.
How Much Does Laser Treatment Cost in London?
Cost depends on the device, the area being treated and how many sessions your concern needs, so we confirm it at consultation rather than beforehand.
Most concerns need a course rather than a single session, so we set out the likely total at your first appointment.
Frequently Asked Questions
Is laser treatment painful?
It varies by device and by patient. IPL and non-ablative fractional laser feel like a warm snap, uncomfortable but tolerable without anaesthesia. Ablative CO2 laser on a full-face setting is done under topical anaesthesia applied about an hour beforehand, and most patients manage it well with that in place. I always explain what to expect physically before we start.
How many laser sessions will I need?
It depends on the concern. Vascular redness and thread veins typically need three to five sessions of PDL or KTP. Sun damage on lighter skin usually responds within two to four IPL or Q-switch sessions. Acne scarring treated with non-ablative fractional laser typically needs three to five sessions for meaningful improvement. I review at each stage and adjust the plan accordingly.
Can people with darker skin tones have laser treatment safely?
Yes, with the right device and preparation. The risk in darker skin is unintended absorption by background melanin, which can trigger post-inflammatory hyperpigmentation. We manage this by choosing longer wavelengths (long-pulse Nd:YAG for vascular concerns, pico laser for pigmentation) and using conservative, carefully chosen settings. I discuss this explicitly with every patient in that category.
When to See a Consultant Dermatologist
Laser is the right choice when your concern is genuinely in procedure territory: vascular lesions that won't respond to topicals, pigmentation that has proved resistant, acne scarring with structural depth, or texture and photoageing that has plateaued despite a well-maintained routine.
It's also worth a formal assessment if you've already had laser that underdelivered, if your skin reacted badly to a previous course, or if you've been told treatment isn't suitable for your skin tone without a proper explanation of why. A second opinion from a consultant with access to the full range of technologies often changes what's possible.
At Dr Sam Bunting + Associates, our London clinic starts every laser consultation with an honest clinical assessment. We match the device to the patient, not the other way around. To book, contact us at clinic@drsambunting.com or visit our Book an Appointment page.
