Uneven skin texture

Uneven texture is skin that feels or looks rough, bumpy, coarse or dull rather than smooth - the surface catching the light unevenly instead of reflecting it cleanly.

It is one of the most common reasons people come to a skin clinic, and one of the most responsive to treatment, because most of what causes it sits in the outer layers.

What causes it

Slowed cell turnover. Skin renews itself by shedding dead cells and replacing them from below. That process slows with age, and dead cells accumulate on the surface.
Sun damage - the leading cause in Australia. UV damages collagen and thickens and roughens the surface. See sun damage.
Acne and acne scarring - see acne scars
Enlarged pores - see open pores
Dryness and a compromised skin barrier - see dry skin
Genetics
Environment - pollution, wind, low humidity
Smoking
Skincare - both too little and too much; over-exfoliation damages the barrier and worsens texture

Have rough patches looked at

Most uneven texture is cosmetic. But a persistent rough, scaly patch on sun-exposed skin can be a solar keratosis, which is precancerous, or a squamous cell carcinoma. Those need medical assessment - and, if removed, need to be removed in a way that leaves tissue for pathology rather than lasered off.

A patch that is persistently scaly, tender, bleeding or not healing is worth having examined before any cosmetic treatment.

Matching treatment to the kind of unevenness

What the skin is doing	What tends to work
Dull, flaky, surface build-up	Microdermabrasion, epidermal levelling, superficial peels, retinoids
Rough with sun damage	Medium peels, fractional laser, resurfacing; sun protection
Bumpy from congestion	Salicylic peels, extraction, acne management
Depressed scarring	Skin needling, fractional or ablative laser, individual scar treatment
Crepey, thin, fine lines	Skin needling, laser, collagen-stimulating treatments
Rough and dry	Barrier repair first - moisturiser and gentle cleansing - then resurfacing

Treatments

Microdermabrasion - mechanical exfoliation, minimal downtime, in a course
Epidermal levelling - removes surface dead cells and vellus hair
Chemical peels - depth chosen to match the problem
Skin needling - collagen stimulation for texture and shallow scarring
Laser resurfacing - erbium and CO2 for deeper resurfacing, Fraxel fractionally
Cosmeceutical skincare - retinoids and appropriate exfoliating actives, used consistently
Platelet-rich plasma (PRP) therapy, where indicated
Daily sun protection - which prevents the main cause continuing

What results are realistic

Surface texture usually improves substantially - this is one of the more rewarding things to treat. Skin generally feels smoother within a few weeks of starting a proper routine, with further improvement over a course of in-clinic treatments as collagen remodels, which takes months rather than days.

Deeper structural unevenness - established scarring, significant collagen loss - improves partially rather than completely.

Maintenance is needed: cell turnover keeps slowing, and sun exposure keeps accumulating. Individual results vary with age, skin type, cause and consistency.

Risks

Redness, swelling, peeling and crusting after treatment
Temporary breakout as congestion clears
Changes in pigmentation - darker or lighter - which can persist and are more likely in darker skin types
Blistering or burns with energy-based and deeper chemical treatments
Scarring, uncommon but possible with deeper treatments
Infection, including cold sore reactivation after facial resurfacing
Barrier damage and increased sensitivity from over-treatment
Increased sun sensitivity after treatment
Incomplete improvement

See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. Ask for the cost of the whole course rather than a single session. Not covered by Medicare.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.