AviClear and acne: clearing your skin is only half the job

Where acne actually starts

Let me begin underneath your skin, because it explains everything that follows.

Every hair follicle on your face has a small oil gland attached to it. That gland makes sebum. When it makes too much, the follicle blocks, bacteria move in, and your immune system does the rest. What shows on the surface is the last step of that sequence, not the first.

Almost everything you’ve already tried works somewhere along that chain. Acids and cleansers unblock the follicle. Antibiotics reduce the bacteria. Creams calm the inflammation. All of them useful, all of them working downstream of the source.

AviClear goes to the gland.

The idea behind it is quite elegant, and it’s worth a minute of your time. Oil and water absorb infrared light differently. At a wavelength of 1726 nanometres there’s a narrow window where sebum absorbs noticeably more than water does. Send light at exactly that wavelength into skin and the oil glands heat up faster than everything around them. A chilled tip stays pressed against your face throughout, so the surface stays cool while the gland underneath does not.

Researchers took small samples of treated skin a few days afterwards. The gland showed damage. The skin above it looked untouched.

Tap to enlarge

One detail that surprises people. There’s nothing to watch while it’s happening. With most lasers I’m reading your skin for a reaction that tells me I’ve done enough. Here the target is buried and gives nothing away, so the treatment is delivered to a set energy instead. Which is another way of saying the protocol, and who is holding the handpiece, matter more than usual.

Does it work? My honest answer

For most people, yes.

The research so far has followed people for a year after three treatments, and the pattern is consistent. Most improve, and the improvement keeps building for months after the last session rather than stopping when the treatment does. That second part is unusual, and it’s one of the reasons I like this treatment.

Like anything in medicine, it doesn’t suit everyone equally. Some people respond beautifully and some more modestly, and I can’t tell you in advance which you’ll be. That’s true of every acne treatment I’ve used, including the ones that have been around for decades.

What I can tell you is that the thinking behind it is sound, and that we’ll measure your progress properly rather than both of us guessing.

Three sessions, and three conversations

Three treatments, a month apart. Allow around 50 to 70 minutes for each appointment.

What makes it a program rather than three appointments is what happens in between.

Before we start, I photograph and analyse your skin with VISIA. It isn’t a phone camera. It captures your face under several different light sources, including ultraviolet, and breaks what it finds into eight separate measurements. You see all of it on the screen with me.

For acne, these are the ones that earn their keep:

• Porphyrins. These are by-products of the bacteria living in your pores, and they glow under UV light. It’s the closest thing we have to looking directly at bacterial activity in your skin.
• Pores. How enlarged and how congested they are, mapped across your whole face rather than the one area you keep looking at.
• Red areas. Inflammation, both the active spots and the redness left behind after they heal.
• Texture. The unevenness across your skin surface, which is where early scarring shows up before you can see it yourself.
• Brown spots and UV damage. The marks acne leaves, plus sun damage sitting below the surface that hasn’t reached the surface yet.
• Spots and wrinkles. These complete the picture and give us a baseline for everything else.

Each measurement is scored against people of your age and skin type, so you get a number as well as a picture. We repeat the whole thing at every visit.

I do this because acne is genuinely hard to judge from the inside. You’ll have a bad fortnight in the middle of a course that’s working perfectly and be convinced nothing is happening. Two matched images side by side settle that in about ten seconds, and I’d far rather show you than ask you to take my word for it.

Three is the number the research is built on. If your acne is severe or you’ve carried it a long time you may need more, and we’ll decide that together with the images in front of us rather than me deciding in advance. And if what would help you most is oral medication or a referral, I’ll say so.

What it feels like, and when things change

• On the day. Warm and prickling, occasionally sharp over bone. The chilled tip does most of the work of keeping it comfortable, and you won’t usually need numbing.
• The first week. Redness for a few hours, sometimes a day. Some people break out more in the first fortnight. It’s common, it isn’t the treatment failing, and it settles.
• Weeks two to twelve. Oiliness usually drops first, then how often you break out. Don’t judge it week to week. You’ll drive yourself mad.
• Months three to twelve. This is where most of the change happens, well after your last session. A smaller study saw the same pattern, with improvement starting in the first month and still going at the end of the follow-up. Patience is doing real work here.

What acne leaves behind

This is the part I most want you to hear, and it’s the part that tends to get skipped.

Clearing your acne does not clear the marks it made. Two things are usually still there afterwards. Redness, meaning the flat red or brown patches where spots have healed, which fade over months and often not completely. And scarring, meaning the shallow dips and uneven texture that inflammation leaves behind in the deeper layer of skin.

Neither of those responds to a treatment aimed at oil glands, because neither of them is an oil problem.

Both are treatable, and they need different tools. Here’s the short version of why each one works, so the options make sense when we talk about them.

• Laser Genesis, for redness and general texture. A 1064 nm laser delivered as thousands of rapid, low-energy pulses, with the handpiece swept just above your skin rather than touching it. Nothing is wounded. What happens is that the upper dermis is warmed in a controlled way, and that gentle heat does two jobs at once. It coagulates the many tiny vessels in the upper dermis that together create diffuse redness, and it prompts fibroblasts to lay down new collagen over the following months. This wavelength also passes through surface pigment relatively safely, which is part of why it suits a wide range of skin tones. It works as a course rather than a single visit.
• RF microneedling, for indented scarring. Fine points carry radiofrequency energy to a set depth and release it in the dermis, which is where scar tissue actually sits. The controlled heat drives remodelling and new collagen while the surface is largely spared. Radiofrequency isn’t absorbed by pigment, which is why it carries less risk of pigment problems in deeper skin tones than ablative lasers do.
• Laser resurfacing, for deeper or more established scarring. Fractional CO₂ removes microscopic columns of tissue and leaves healthy skin in between for the repair to work from. Taking damaged tissue away and forcing an organised rebuild is the most powerful option for significant texture. It’s also the one with genuine downtime and the highest pigment risk, so it’s chosen deliberately rather than by default.
• Chemical peels, for tone, congestion and marks. A peel is a controlled chemical injury taken to a known depth. Superficial peels lift the outer layer, speed up turnover and help break up pigment. Salicylic acid is oil-soluble, so it can get inside the follicle itself, which is why it earns its place in acne specifically. Peels do a great deal for colour and surface quality and comparatively little for true indented scarring.

Which of these suits you depends on what your skin is actually left with, and we’ll look at that together with your imaging rather than picking from a menu.

The order is deliberate. Resurfacing a face that’s still actively inflamed is a poor idea, and working on pigment while new spots are still forming means chasing a moving target. Acne first, marks second.

Not everyone needs that second half. Some people clear with very little to show for it. But I’d rather plan for the possibility from the beginning than let you think the finish line is closer than it is.

The unglamorous part that changes the result

None of this works as well without home care, and I know that’s the least interesting sentence in this article.

While you’re having treatment, keep it simple. A gentle cleanser and a moisturiser that supports your barrier, because irritated skin heals worse and marks more. Sunscreen every day without exception, because the marks acne leaves get darker in the sun and take far longer to fade.

Once you’ve finished the course, active ingredients stop being optional and start being the thing that holds your result. A retinoid product if your skin can tolerate one, because it keeps the follicle turning over and helps the marks fade. The right cleanser for your skin rather than the harshest one on the shelf. Oil-free moisturiser, makeup and sunscreen, so you’re not adding back what we’ve spent three months reducing. We’ll work out the specifics and the timing at your review rather than you guessing at a chemist.

Diet is worth being honest about. It doesn’t cause acne, and being told to eat differently when you’ve had it for years is exhausting. But heavily processed, high-sugar food does seem to make it worse for some people, and dairy for a smaller group. It’s worth noticing your own pattern rather than following someone else’s rules.

And please don’t pick. It’s the most reliable way to turn a spot that would have faded into a mark that won’t. I say it at every review and I’m going to keep saying it.