Why Isn’t My Skincare Working Any More?

September 2026
Written by Dr Geeta Moor, MBBS MRCP FRCA MD(Res) — Medical Director, The Selborne Clinic

There is a particular moment that brings people to a consultation. You have been using good products, properly, for months. At the start something was happening. Now nothing is, and the obvious conclusion is that you need something stronger.

Sometimes that is right, and resurfacing is genuinely the answer. More often it is one of five other things, and it is worth working through them before you spend money on any of it.

1. You have not given it long enough

This is the commonest reason by a wide margin.

Skin turns over across roughly a month in a young adult, and more slowly as you get older. Anything acting on pigment production has to work through several of those cycles before the result surfaces.

Realistic timelines: a retinoid needs twelve weeks before you can judge it. Pigment needs three to six months. Texture and pore appearance, three months at minimum.

Most people abandon a product at six weeks — roughly the point at which it is starting to work and has not yet shown you anything. Then they start something new and restart the clock.

If you have changed your routine more than twice this year, you have not yet given anything a fair trial.

2. You are treating pigment without daily sun protection

If you are using anything for pigmentation and you are not wearing SPF every day, all year, you are bailing out a boat without plugging the hole.

UVA reaches you in January, through cloud, and through window glass. It doesn’t just exist in the summer. 

A topical that reduces pigment production a little, against a daily stimulus that increases it, produces a stalemate — and a stalemate looks exactly like a product that has stopped working.

3. Your barrier is damaged, and you have mistaken that for a plateau

More actives is not more result.

If your skin stings when you apply things that never used to sting, if you are flushing, flaking, feeling tight, or reacting to products you have used for years, your barrier is compromised. Skin in that state does not respond well to anything, and adding something stronger makes it worse.

Strip back to a gentle cleanser, a simple moisturiser and sunscreen for two to four weeks, then reintroduce one active at a time.

This also matters if you are considering a laser. An irritated barrier is a reason to delay treatment, not to escalate to it, and it is one of the things I look for at consultation.

4. The product may not contain what you think it does

"Contains vitamin C" tells you almost nothing. Concentration, formulation, pH and stability all determine whether an ingredient does anything, and none of those appear on the front of the bottle.

Cosmetic products are also formulated to limits designed for safety in unsupervised use, which is appropriate — but it means there is a ceiling on what a product bought without advice can achieve.

Price correlates poorly with formulation quality. Be sceptical of any claim that names an ingredient without a concentration.

5. What you are treating may not be what you think it is

Not all marks are the same, and they do not respond to the same treatment.

Superficial sun-induced pigment behaves quite differently from melasma, which behaves differently again from post-inflammatory pigmentation left behind by spots or an injury. Melasma in particular is hormonally driven, chronic and relapsing — a product failing to clear it is not a product failure, it is the condition behaving as it always does.

And some marks are not pigmentation at all. If something on your face is changing in size, shape or colour, is asymmetrical, has an irregular border, bleeds or will not heal, no skincare routine is the answer and no aesthetic clinic should be your first stop. See your GP.

So which of these can a laser actually fix?

This is the useful question, and the honest answer is: two of the five.

The problem: Not enough time.
Will resurfacing help? No. You need patience, not a device.

The problem: No sun protection.
Will resurfacing help? No, and treatment will not hold without it.

The problem: Damaged barrier.
Will resurfacing help? No. This is a reason to delay treatment.

The problem: Week formulation.
Will resurfacing help? Partly. See below.

The problem: Wrong target.
Will resurfacing help? Only once you know what the target is.

Where resurfacing genuinely changes things is in the last two, and for a specific reason.

The absorption problem

The stratum corneum — the outermost layer of your skin — is an effective barrier, which is its job. It limits how much of any topically applied agent gets in. A large proportion of what you apply never reaches the depth at which it could act. That is the ceiling most people hit, and no amount of buying a better serum moves it.

This is where energy devices change the arithmetic. Imaging work using optical coherence tomography compared the cutaneous channels created by different devices and found that microneedling and radiofrequency microneedling produced no demonstrable channels at all, while a fractional non-ablative 1927nm thulium fibre laser created channels that were still closing at 24 hours.

That is a measurable window during which a topical agent reaches depths it otherwise never would. It is the principle behind laser-assisted delivery, and it is why what goes onto your skin immediately after treatment is a clinical decision.

Why 1927nm specifically

The wavelength determines the depth, and the depth determines what you can treat.

At 1927nm the target chromophore is water, and water absorption at this wavelength is high — considerably higher than at 1550nm, the older workhorse of fractional resurfacing. The energy is therefore absorbed fast and shallow, depositing in the epidermis and uppermost dermis, roughly the top 200 microns.

That is precisely where the pigment, the sun damage, the uneven tone and the rough texture live. It is the same territory your topicals have been trying to reach, treated directly and at a depth a cream cannot achieve.

The evidence sits mainly in pigmentation and photodamage: a multicentre prospective study of facial photopigmentation found moderate to marked improvement after two treatments, and instrumented studies have shown measurable changes in melanin index, elasticity and epidermal thickness. There is also a retrospective series of 100 patients using this wavelength in melasma, though melasma remains a condition of control rather than cure.

This is the 1927nm thulium laser I use, and the evidence behind it, which I have set out in full here.

What I would check first

In order:

1. Have you used it consistently for at least twelve weeks?

2. Are you wearing sunscreen every day, including in winter?

3. Is your skin irritated rather than unresponsive?

4. Do you actually know what you are treating?

If the answer to any of the first three is no then a laser will not fix it, and I will tell you that at a consultation rather than sell you a course. If the answer to the fourth is no, that is the thing to establish first, and it is what a proper assessment is for.

If you have worked through all four and the answer is still that your routine has taken you as far as it can, then resurfacing is a reasonable next step — and I would read how the wavelength works before you book anything, with me or with anybody else.

Consultations at The Selborne Clinic, Hampshire.

Assessment includes a Fitzpatrick assessment, standardised photography and a discussion. 

Book a consultation

References

1. Wang JV, Mehrabi JN, Zachary CB, Geronemus RG. Evaluation of device-based cutaneous channels using optical coherence tomography: impact for topical drug delivery. Dermatol Surg. 2022;48(1):120–125.

2. Nonablative 1927nm fractional resurfacing for the treatment of facial photopigmentation. J Drugs Dermatol. 2014;13(11):1317–1322.

3. Li X, Qin S, Shi S, et al. Prospective study of efficacy and safety of non-ablative 1927nm fractional thulium fiber laser in Asian skin photoaging. Front Surg. 2023;10:1076848.

4. Efficacy and safety of 1927nm fractional thulium fiber laser for the treatment of melasma: a retrospective study of 100 patients. 2019.

5. Li et al. Progress of clinical research on fractional laser treatment of androgenetic alopecia: a review. J Cosmet Dermatol. 2024.

Why is my hair thinning? A Consultant’s honest answer

September 2026
Written by Dr Geeta Moor, MBBS MRCP FRCA MD(Res) — Medical Director, The Selborne Clinic

Most people who come to me about their hair have already spent somewhere between two hundred and two thousand pounds on things that were probably not going to work. Supplements. Shampoos. A scalp massager. And I completely understand the reasons why that money was spent. 

It is a completely rational response to a problem nobody will properly explain to you. You noticed more hair in the shower, or a photograph caught the light on your crown, and when you looked it up, it came up with stress, or hormones, your age, and maybe a biotin tablet would help.

So here is the explanation. It is long, because the answer genuinely is not simple, and because the first thing you need is a diagnosis rather than a product.

Is it shedding or is it thinning?

These are two different problems and they need different answers. Getting this wrong is the most common reason people waste money.

Shedding means more hair is coming out than usual. You see it on the pillow, in the plughole, on the brush. It comes on fairly suddenly, and — this is the important part — it is usually triggered by something that happened two to three months earlier. An illness. A general anaesthetic. A crash diet. A bereavement. Childbirth. Starting or stopping a medication.

That delay is why almost nobody makes the connection. Your hair is telling you about what happened.

The medical term is telogen effluvium, and in most cases it recovers on its own once the trigger has passed. It does not need a laser-assisted delivery. It needs the cause found, and the reassurance that this is not going to continue indefinitely.

Thinning is different. The number of hairs coming out may not have changed at all. What has changed is the hair itself. With each growth cycle, individual hairs emerge finer, shorter and lighter, until eventually they stop reaching a length you would notice. That process is called miniaturisation.

This is pattern hair loss, and it does not recover on its own. It progresses slowly, over years.

You can have both at once, and often a shedding episode is simply what makes someone notice a pattern loss that has been quietly progressing for a decade.

Is male and female pattern loss the same condition?

It is related, but not the same, and this matters because it changes what works.

Both are driven by follicles becoming sensitive to androgens, principally dihydrotestosterone, which is converted from testosterone by the enzyme 5-alpha reductase. In men that androgen pathway is the dominant mechanism. In women it is one part of a more complicated picture, which is why the treatments that work best in men are less reliable in women.

The patterns are different too.

In men, loss typically begins at the temples and at the crown, and the two areas gradually meet. It often starts in the twenties or thirties. It can move quickly.

In women, the frontal hairline is usually preserved while the parting widens progressively from the front backwards. It more often becomes noticeable around the perimenopause, though it can start much earlier.

How can I tell which I have?

Look at your hair dry, in daylight, with a mirror.

If you are a woman: compare your parting at the front with the parting at the back of your head, near the nape. In pattern loss the front is wider, and the hairs along it are visibly finer and more variable in thickness — some thick, some wispy. That variability is the way to tell. In telogen effluvium the thinning is even all over, and the remaining hairs are all roughly the same calibre.

If you are a man: photograph your crown from above, in overhead light, and compare it with a photograph from a few years ago. The crown is the area you never see and the area that goes first. Temporal recession you will already have noticed. What people underestimate is how much has changed on top.

I do this with a trichoscope — a magnifying camera that shows hair calibre and follicular density at 20 to 70 times magnification — and I photograph it, so that in four months we are comparing images rather than memories. 

What blood tests actually matter?

If you take one thing from this article, take this. Before anyone treats your hair, someone should have checked:

• Ferritin. Iron stores, not haemoglobin. You can be comfortably non-anaemic and still have iron stores low enough to affect hair growth. Standard lab reference ranges are set for anaemia, not for hair.

• Thyroid function. Both underactive and overactive thyroid cause hair loss, and both are easily missed.

• Vitamin D.

• Full blood count.

• A hormonal screen — testosterone, DHEAS and related tests — if you are a woman with irregular periods, acne, or unusual hair growth on the face or body, which together may point to polycystic ovary syndrome.

Your GP can do all of these. If you have not had them and someone is selling you a treatment course, that is the wrong order of events.

I will not start a hair course at The Selborne Clinic without seeing recent bloods. Treating androgen-driven miniaturisation in someone whose actual problem is a low ferritin is taking money for nothing.

What actually works — in men

The evidence here is better than most people assume, and better than it is in women.

A 2025 network meta-analysis of monotherapies found dutasteride 0.5mg daily to be the most effective option overall. Among approved treatments, topical minoxidil 5% was the most effective topical monotherapy and finasteride 1mg daily the most effective oral one.

These work in different ways. Finasteride and dutasteride are 5-alpha reductase inhibitors, so their effect depends on the androgen pathway. Minoxidil appears to work largely independently of androgen metabolism, which is why the two are often used together rather than instead of one another.

All of these are prescription decisions in the UK. I can prescribe private prescriptions to you.

The point men most need to hear is about timing. These treatments hold ground far better than they regain it. A follicle that has miniaturised beyond a certain point does not come back. If you are in your late twenties and you have noticed your crown, the useful action is now, not when it bothers you enough to do something.

What actually works — in women

The picture is thinner, and I would rather say so.

Topical minoxidil is the only topical agent approved specifically for female pattern hair loss and the only therapy with genuinely strong clinical evidence behind it. It shortens the resting phase, extends the growing phase, and enlarges follicles that have begun to shrink.

It also has a problem: roughly 40% of women do not respond to it. That figure is not printed on the box, and it is the honest reason people go looking for something else.

Beyond it, low-dose oral minoxidil, spironolactone and finasteride are all used in women, with varying evidence and varying suitability. 

What about the laser treatment you offer?

Fair question, and I will answer it the way I would want it answered if I were the patient.

The service I run uses a non-ablative 1927nm thulium fractional laser followed immediately by a topical growth factor serum.

The mechanism is well established. The stratum corneum is a barrier that limits how much of any topical agent gets in. Fractional laser creates microscopic channels through it. Imaging work has shown that the 1927nm thulium laser creates channels still closing at 24 hours — a genuine, measurable window during which a topical agent reaches depths it otherwise would not. Laser-assisted drug delivery is a well-supported principle across dermatology.

The specific combination has pilot data, not large trials. A pilot study of fractional thulium laser with a topical growth factor serum reported increased hair density and thickness in both men and women with androgenetic alopecia. A separate pilot combined a non-ablative 1927nm thulium fractional laser with platelet-rich plasma in male pattern loss. Pilot studies are how evidence begins. They are not randomised controlled trials. 

So the delivery mechanism is sound and well evidenced, the specific protocol is supported by early data, and I photograph and trichoscope every patient at every stage precisely.

What doesn't work

• Biotin, unless you are genuinely deficient, which is rare. Worse, biotin supplements interfere with several common blood assays, including thyroid function and troponin — the test used to diagnose a heart attack. Tell any doctor taking your blood that you take it.

• Thickening shampoos. They coat the hair shaft. They change nothing about the follicle.

• Scalp massage on its own.

• Anything promising results in four weeks. Hair cycles in months. Any treatment that genuinely works takes four to six months to show, and anything visible faster than that is cosmetic rather than biological.

When should you see a doctor rather than a clinic?

Go to your GP, not an aesthetic clinic, if you have:

• Hair loss in defined patches with smooth, empty scalp

• Redness, scaling, pain, itching or burning of the scalp

• Any area where the scalp looks shiny and the follicular openings have disappeared

• Sudden, dramatic loss

• Loss of eyebrows, eyelashes or body hair alongside scalp hair

• Hair loss in a child

Some of these are scarring alopecias, in which follicles are permanently destroyed. There the priority is stopping the process urgently, and cosmetic treatment is not only useless but may delay a diagnosis that matters. I will refer you, and I will not treat you.

Why I do it this way

I have spent more than twenty years in the NHS as a doctor. The job trains you to understand that the most important part of any procedure is the conversation you have before it.

Hair loss is an area where people feel quietly distressed and rarely say so, and where distress is easy to sell to. I would rather assess you properly, send you for bloods, and tell you honestly that your best evidence-based first step is something I do not sell — than take a course payment for something that was never going to work.

If your hair is changing and nobody has explained why, that is where we would start.

Consultations at The Selborne Clinic, Hampshire. Assessment includes trichoscopy, standardised photography and an honest conversation. 

Book a consultation

Thulium 1927nm laser for the face: What it Actually Does, and Who I Turn Away

September 2026
Written by Dr Geeta Moor, MBBS MRCP FRCA MD(Res) — Medical Director, The Selborne Clinic

I have spent more than twenty years in the NHS as a doctor. The job trains you to understand that the most important part of any procedure is the conversation you have before it.

That instinct, and the need to make women and men feel confident about their skin, is the reason The Selborne Clinic exists in the form it does. It is also why I want to write about the 1927nm thulium laser. It is the device I use most on the face and it is the one patients ask about most.

What the wavelength actually does

LASER is an acronym: Light Amplification by Stimulated Emission of Radiation.  Which is not especially helpful! In practice, a laser is a device that produces a narrow, focused, and coherent beam of intense light. That beam of light has a wavelength and each wavelength is chosen because of what absorbs it.

At 1927nm, the target is water. Water absorption at this wavelength is high — considerably higher than at 1550nm, the older workhorse of fractional resurfacing — which means the energy is absorbed fast and shallow. It does not travel deep into the dermis. It deposits its heat in the epidermis and the very uppermost dermis, roughly the top 200 microns of your skin. That is not a limitation. It is, in fact, the entire point!

The epidermis is where the pigment lives. It is where the sun damage, the freckling, the dull uneven tone, the rough patches and the enlarged-looking pores are. If your complaint is "my skin looks tired and blotchy", the problem is almost certainly sitting in the first fraction of a millimetre. Sending energy deep would be missing the target and buying yourself downtime you don't need.

The laser is also fractional. Rather than treating the whole surface at once, it delivers thousands of microscopic columns of thermal injury — microthermal treatment zones — surrounded by untreated skin. That untreated skin is your reservoir of healthy cells, and it is what makes recovery days rather than weeks. Recent imaging work using optical coherence tomography has shown that the effect at 1927nm sits on a spectrum from genuinely non-ablative to frankly ablative depending on the pulse energy and the tip used, which is exactly why settings matter and why "a thulium facial" is not one standardised thing.