When the Right Answer Is Not Yet
There is a particular kind of good medical advice that feels like being turned away: come back in three months, let this settle first, treat the inflammation before we treat the mark it left. It rarely feels satisfying, and it is often the difference between a good result and a permanent one you did not want. These are the situations where waiting is the treatment.
There is a kind of good medical advice that feels like being turned away. Come back in three months. Let this settle first. Let us treat the inflammation before we treat the mark it left behind. It rarely feels satisfying, and it is often the difference between a good result and a permanent one you never wanted. These are the situations where waiting is the treatment.
When the Right Answer Is Not Yet: the essentials
The short version
Treating on top of inflamed skin risks making the pigment worse, not better
Treating on top of angry skin can make the discolouration worse, not better.
Light-based treatment on tanned skin raises the risk of burns and pigment change
Anything using light is riskier on tanned skin: more chance of burns and of patchy colour.
Scars remodel for months; judging or treating one too early misreads it
Scars keep changing for months. Judging or treating one too early misreads it.
Wound healing is altered for a period afterwards; timing is a clinical judgement
Your skin heals differently for a while afterwards. How long to wait is a judgement your doctor makes.
Most elective treatments are deferred; the reason is usually absent evidence
Most treatments you have chosen to have are put off, usually because nobody has the safety evidence.
Anything changing, bleeding or unusual is diagnosed before it is treated cosmetically
Anything changing, bleeding or unusual gets a diagnosis before anyone treats it for looks.
Treat the fire before the smoke
Put the fire out before you clear the smoke
The commonest version of this is pigment. A brown mark left behind by acne, by eczema, or by an injury is post-inflammatory pigmentation, and the inflammation that caused it is frequently still going on. Treating the mark while the process that produces it is active is treating the smoke.
The commonest version of this is a brown mark. A brown mark left behind by acne, by eczema or by an injury is your skin’s response to inflammation, and very often that inflammation is still going on. Treating the mark while the thing making it is still active is treating the smoke.
Worse, many of the treatments for pigment are themselves inflammatory. Laser, peels and needling all work by controlled injury, and in skin that is already inflamed, and particularly in skin that pigments readily, the treatment can produce more of exactly the thing it was meant to remove. This is the single most common way a pigment treatment makes things worse.
Worse, most of the treatments for brown marks cause inflammation themselves. Lasers, peels and needling all work by injuring the skin in a controlled way. On skin that is already inflamed, and especially on skin that darkens easily, the treatment can produce more of exactly the thing it was supposed to remove. This is the single most common way a treatment for pigment makes things worse.
So the sequence is settle the condition, then wait for the pigment to fade on its own, which much of it will, and only then treat what remains. That takes months and it is the right order. A practitioner who agrees to laser an actively inflamed area is agreeing to something rather than advising you.
So the order is: settle the condition, then wait while the mark fades on its own, which a lot of it will do, and only then treat whatever is left. That takes months, and it is the right order. A practitioner who agrees to laser an area that is currently inflamed is agreeing with you rather than advising you.
The suntan problem
The suntan problem
A tan is extra pigment sitting in the layer above every target a light-based device is aiming at. It absorbs energy meant for something else, which both reduces the effect and raises the risk of a burn, a blister or a lasting change in skin colour.
A tan is extra colour sitting in the layer above every single thing a light based machine is aiming at. It soaks up energy meant for something else, which both weakens the effect and raises the risk of a burn, a blister, or a lasting change in your skin colour.
This is why practices ask about recent sun exposure and holidays, and why the answer is sometimes to wait several weeks. It is not administrative caution. The same settings that were safe in February can cause a burn in August on the same person, and the person cannot see the difference in the mirror well enough to judge it.
That is why practices ask about recent sun and holidays, and why the answer is sometimes to wait several weeks. It is not box ticking. The same settings that were safe on you in February can burn you in August, and you cannot tell the difference well enough in the mirror to judge it yourself.
The same logic applies in reverse to planning. Starting a course of light-based treatment just before a summer holiday means either interrupting the course or risking the result, and it is worth raising at the consultation rather than discovering halfway through.
The same thing works in reverse when you are planning. Starting a course of light based treatment just before a summer holiday means either breaking the course or risking the result. It is worth raising at the consultation rather than discovering halfway through.
When the body is already busy
When your body is already busy
Several situations change how skin heals, and treating during them is treating a different organ from the one you assessed. Recent isotretinoin is the best known: it alters healing for a period afterwards, and the appropriate interval before certain procedures is a clinical judgement rather than a fixed rule.
Several situations change the way your skin heals, and treating during one of them means treating a different organ from the one that was assessed. The best known is having recently taken the strong acne tablet, which changes healing for a period afterwards. How long to leave it before certain procedures is a judgement, not a fixed number.
Active infection is another, including a cold sore anywhere near a treatment area, because several procedures can spread it or trigger a widespread outbreak. Anyone with a history of cold sores is usually given antiviral cover before facial resurfacing for exactly this reason.
An active infection is another, including a cold sore anywhere near the area, because several procedures can spread it or set off a widespread outbreak. Anyone who gets cold sores is usually given antiviral medicine before facial resurfacing for exactly that reason.
A new scar is a third. Scars remodel for many months, and a scar assessed at six weeks is being assessed mid-process. Many improve substantially on their own in the first year, and intervening early can mean treating something that was going to resolve, or misjudging what it will become.
A new scar is a third. Scars carry on changing for many months, so a scar looked at after six weeks is being judged halfway through the story. Many improve a great deal on their own in the first year. Stepping in early can mean treating something that was going to sort itself out, or misjudging what it will end up looking like.
The one that is not about timing
The one that is not about timing at all
Anything that has changed, bled, failed to heal, grown quickly or simply looks unlike your other spots is diagnosed before it is removed for appearance. This is not a delay; it is a different appointment altogether.
Anything that has changed, bled, refused to heal, grown quickly, or simply looks unlike your other spots gets diagnosed before it is removed for appearance. That is not a delay. It is a different appointment altogether.
Removing a lesion cosmetically without a diagnosis destroys the evidence. If it turns out to have been something that needed identifying, the tissue that would have identified it has gone, and the record of how it looked has gone with it. This is the single firmest rule in the field, and a practice that will remove anything on request without examining it first is not applying it.
Removing something cosmetically without a diagnosis destroys the evidence. If it turns out to have been something that needed identifying, the tissue that would have identified it is gone, and so is the record of how it looked. This is the firmest rule in the whole field, and a practice that will remove anything you point at without examining it first is not following it.
Questions patients ask
Why can I not have laser while my acne is active?
Why can I not have laser while my acne is active?
Because laser is an inflammatory stimulus and active acne is already inflammation. Treating on top of it risks worsening pigment and, in some cases, the acne itself. Settling the condition first usually produces a better and safer result.
Because a laser causes inflammation, and active acne is already inflammation. Treating on top of it risks worse discolouration and, in some cases, worse acne. Getting the condition settled first usually gives a better and safer result.
How long after a holiday can I be treated?
How long after a holiday can I be treated?
It depends on how much colour you have taken and on the treatment. Several weeks is common for light-based procedures, and the practitioner should assess your skin rather than work from a fixed number.
It depends how much colour you picked up and on the treatment itself. Several weeks is common for anything using light, and the practitioner should look at your skin rather than work from a fixed number.
Why wait a year before treating a scar?
Why wait a year before treating a scar?
Not all scars need that long, and some benefit from early intervention, particularly to prevent thickening. But scars remodel for months, and many improve considerably on their own, so treating too early can mean treating something that was resolving.
Not every scar needs that long, and some do better with early treatment, particularly to stop them thickening. But scars carry on changing for months, and many improve a lot by themselves, so treating too early can mean treating something that was already getting better.
Can I have treatment while pregnant?
Can I have treatment while pregnant?
Most elective cosmetic treatments are deferred during pregnancy and breastfeeding. The reason is usually that the safety evidence does not exist rather than that harm is established, and deferring is the reasonable response to absent evidence.
Most cosmetic treatments you have chosen to have are put off during pregnancy and breastfeeding. The reason is usually that the safety evidence simply does not exist, rather than that harm has been proven. Waiting is the sensible response to not knowing.
Is being told to wait a sign the clinic does not want my business?
Does being told to wait mean the clinic does not want my business?
It is usually the opposite. Declining to treat at the wrong moment costs the practice an appointment and protects your result. A practitioner who never says wait is not making a judgement each time.
Usually the opposite. Turning down an appointment at the wrong moment costs the practice money and protects your result. A practitioner who never says wait is not making a fresh judgement each time.
Where to go next
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
