Skin concerns

• Fine lines and wrinkles

  4 options on our menu

  There are two kinds of lines on a face and they need completely different treatments. Dynamic lines appear when you move and disappear when you stop — those respond to neuromodulators.

  We would decline: You want a neuromodulator in an area where the lines are clearly static, and after we have explained the difference you still want us to treat it. We would rather lose the booking than take payment for a treatment we have just told you will not work.

• Volume loss

  4 options on our menu

  Faces do not simply deflate. Fat pads descend and separate, bone resorbs at the orbital rim and the jaw, and ligaments loosen — which is why a face that has lost volume often looks tired and heavier at the same time.

  We would decline: Your face already carries a significant amount of product and you are asking for more. The answer there is a year off and, sometimes, a conversation about dissolving what is there — not another syringe.

• Acne

  2 options on our menu

  Active acne is a medical condition, and the honest answer starts with an aesthetics practice not always being the right place for it. What we can do is help with congestion, mild inflammatory breakouts, and the skin-barrier problems that keep them coming back.

  We would decline: You have painful lesions under the skin, or acne that is already leaving scars. We will decline treatment and give you the name of what to search for in a dermatology practice, because starting a package here would cost you money and cost you months.

• Acne scarring

  4 options on our menu

  Acne scarring is a collagen problem, not a pigment problem, and the two get confused constantly. The brown or red marks left behind after a breakout are post-inflammatory discoloration and they fade on their own over months.

  We would decline: You still have active breakouts. Treating scars while new lesions are forming means creating new ones behind the treatment, and we will ask you to get the acne settled first even though that means you leave without booking anything.

• Hyperpigmentation

  3 options on our menu

  Brown patches come from several different mechanisms — sun damage, post-inflammatory response, and melasma — and they look similar enough that they get treated identically and then do not respond. Melasma in particular is hormonally driven, sits deeper, and gets worse with aggressive heat-based treatment, which means the wrong laser makes it worse rather than doing nothing.

  We would decline: You have melasma and you want a device treatment because it worked for a friend with sun spots. We will explain the mechanism, offer what genuinely helps, and decline the device — this is one of the treatments we say no to most often, and the reason is that the likely outcome is worse skin.

• Redness and rosacea

  1 option on our menu

  Facial redness ranges from a flush that comes and goes to fixed, visible vessels that do not. Light-based treatment can reduce the visible vessels meaningfully and it does not change the underlying tendency — rosacea is a chronic condition, it is managed rather than resolved, and anyone promising otherwise is selling something.

  We would decline: You have eye symptoms — grittiness, persistent dryness, recurrent styes, redness of the lid margins. Ocular rosacea is a medical problem with a real risk attached to leaving it, and we will send you to a physician rather than book a photofacial.

• Skin laxity

  2 options on our menu

  Skin laxity is loose skin, and it is the concern with the widest gap between what people hope non-surgical treatment can do and what it actually does. Energy-based treatment can tighten mild to moderate laxity measurably over several months.

  We would decline: You have significant jowling or neck laxity and want it treated non-surgically. We decline, explain why, and tell you what to search for — because the alternative is taking several thousand dollars for a result you will be able to see is not what you asked for.

• Skin texture

  6 options on our menu

  Texture is the catch-all — roughness, enlarged pores, dullness, uneven surface, the sense that skin does not reflect light evenly. It responds better than almost anything else on this list, and it responds to a series rather than to a single appointment.

  We would decline: Your barrier is currently compromised — stinging, flaking, reacting to things that used to be fine. We will not exfoliate that skin, and we will send you away with a repair routine and a review in a month instead of a treatment today.

What we are required to tell you, in full