Skin texture
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. It also responds to what you do at home more than any other concern here, which is why our first recommendation for texture is frequently a routine change and a single treatment rather than a package of six.
Why this happens
Most of what reads as poor texture is happening in the top fraction of a millimeter. Corneocytes at the surface are meant to shed continuously; as cell turnover slows with age and with barrier disruption, they accumulate unevenly. Light hits an irregular surface and scatters instead of reflecting, and the skin looks dull and feels rough.
Pore appearance is a different mechanism dressed as the same one. Pore size is largely inherited and is not adjustable, but a pore looks larger when it is filled with oxidised sebum and keratin, and when the dermal support around its opening has thinned enough for it to lose definition. Clearing the contents and thickening the surrounding dermis both change how large it looks; neither changes how large it is.
Underneath, dermal collagen density is what gives skin the plumpness that makes a surface look even. That falls with age and with ultraviolet exposure. So the same complaint — my skin looks rough — can be a surface-turnover problem in one person and a dermal-density problem in another, and they need different treatments and different timeframes.
The home routine matters more for this than for anything else we treat, because turnover is a daily process. A treatment resets the surface; what you do for the following six weeks decides whether it stays reset.
What actually helps
Each of these does something specific about the mechanism above. The sentence under each one is what it does for this, which is not the same as what its own page says it does in general.
- Microneedling
Thickens the dermis over a series, which is what changes pore definition and surface evenness rather than simply clearing the top layer.
- Radiofrequency microneedling
The heavier version, worth it where texture sits alongside laxity and one course can reasonably address both.
- Chemical peels
Removes accumulated surface layers in a controlled way, so light reflects evenly again — the fastest visible change available for surface roughness.
- Laser resurfacing
For textural change that goes deeper than exfoliation reaches, where the trade is real downtime for a result nothing lighter produces.
- Dermaplaning
Immediate smoothness by removing dead surface cells and fine hair — maintenance between the treatments that do the structural work.
- Medical facials
Where we usually begin, because it treats what is on the surface today and shows us how your skin behaves before anything with downtime is booked.
What won’t work
- Anything, for making pores smaller in any lasting sense. Pore size is inherited. Their appearance changes considerably; their diameter does not, and a treatment sold on that basis is selling something that cannot be delivered.
- Scrubs with hard particles. They abrade unevenly, they provoke inflammation, and the smooth feeling afterwards is a barrier that has been stripped rather than a surface that has been improved.
- Stacking every active you own. Retinoid, acid, vitamin C and an exfoliating cleanser used together produce an irritated, compromised barrier that looks exactly like the texture problem you were treating.
- A single treatment with no routine behind it. Cell turnover happens every day; a monthly appointment against a daily process is fighting on the wrong timescale.
- Treating texture while the barrier is already damaged. If your skin is stinging, flaking, or reacting to products it used to tolerate, the first job is repair, not exfoliation, and adding a peel to that is how people end up worse.
Where we’d start, and why
- 1With your routine, in order, including the frequency of everything in it. In this category a meaningful share of consultations end with us removing two products and adding one, and no treatment booked at all.
- 2A medical facial first, usually. It treats the surface today, it has no downtime worth planning around, and it tells us how reactive your skin is before we commit you to anything with a recovery.
- 3If the picture is surface-dominant, a short course of light peels spaced two to four weeks apart does most of the work. If it is dermal-density-dominant — visible pores, fine crepiness, skin that looks thin — microneedling is the better lever and it takes longer.
- 4Resurfacing is the last resort rather than the first, because it is the only option here with downtime you have to plan your life around, and a substantial proportion of people get what they wanted without it.
- 5We book a review rather than a package. Six sessions bought in advance is a commitment made before anybody knows how your skin responds to one.
What would make us decline
These are the answers we actually give in the room, and they are the reason the practice is called what it is called.
- 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.
- You want a package of six booked at the consultation. We will do one, then decide. A pre-paid course is a commercial instrument rather than a clinical one, and it removes the point at which either of us can change our mind.
- You are asking for resurfacing for surface roughness that a peel and a corrected routine would resolve. The heavier treatment would work; it is also more downtime and more money than the problem requires, and we will say so.
- You want your pores made smaller and you are not satisfied with an improvement in how they look. That gap does not close, and we would rather not take the booking than take it knowing the outcome will disappoint.
What this is not
Rough patches that are fixed, scaly, persistent and confined to sun-exposed skin can be actinic damage that a physician should look at rather than a texture concern. So can any single area of roughness that will not resolve, bleeds, or crusts and returns. Widespread texture change accompanied by itching or a rash is a dermatological condition, and exfoliating it makes it worse.
Questions about skin texture
Will treatment make my pores smaller?
It will make them look smaller — emptier, better defined, less shadowed — and it will not change their diameter. That is the whole honest answer, and the difference between the two is where most disappointment in this category comes from.
How often should I exfoliate at home?
Less often than most people do. For the majority of skin, a well-chosen chemical exfoliant two or three times a week is plenty, and daily use plus a retinoid plus a scrub is the combination that produces the compromised barrier we see most.
How many in-office treatments will I need?
For surface roughness, often two or three, plus a routine that maintains it. For dermal density and pore appearance, a series of three to six with the result assessed at three months. We would rather book one and reassess than sell a course before we know how your skin responds.
When is this something I should see a dermatologist about instead?
A rough patch that is fixed in one place, feels scaly, and does not resolve with anything. Anything that bleeds or crusts and comes back. Sudden widespread texture change, particularly with itching. Those are medical findings, and a peel is the wrong response to all of them.
Does dermaplaning make hair grow back thicker?
No. Cutting the fine vellus hair at the surface gives it a blunt end that can feel coarser for a few days, and it does not change the follicle, the growth rate or the diameter of the hair. It is the most persistent myth attached to any treatment on our menu.