Lasers renew the skin – but what do they do to the microbiome? A new expert commentary urges aesthetic practitioners to consider how laser treatments may disrupt skin microbes and influence healing.
In their April 2025 review article published in the Journal of Cosmetic Dermatology, researchers Dr Diala Haykal and Dr Marco Rocha have made a compelling case for deeper investigation into how laser therapies may impact the skin microbiome – an essential yet often overlooked factor in post-treatment recovery and long-term skin health.
Lasers are among the most effective and widely used modalities in aesthetic medicine, capable of addressing concerns ranging from acne scarring and pigmentation to skin laxity and texture. However, many of these procedures, particularly ablative or fractional lasers, achieve results by intentionally disrupting the skin’s architecture. Haykal and Rocha suggest that these disruptions may have unintended effects on the skin’s microbial balance.
The skin microbiome comprises trillions of microorganisms, including bacteria, viruses, fungi and mites, that coexist on the skin’s surface. This ecosystem plays an essential role in maintaining immune balance, modulating inflammation, regulating barrier function and preventing pathogenic overgrowth. Disruption to this balance – known as dysbiosis – has been implicated in a wide range of dermatologic conditions, including acne, rosacea, seborrhoeic dermatitis and wound-healing disorders.
While the gut microbiome, which has been the subject of mainstream research and public interest for over a decade, the cutaneous microbiome has only recently stepped into the spotlight. As more dermatologists and researchers recognise its role in skin health, questions are emerging about how common cosmetic procedures, including lasers, might be impacting this fragile microbial harmony.
The review highlights that while laser therapies focus on visible and structural improvements –such as resurfacing, collagen stimulation and pigment reduction – their potential impact on microbial homeostasis remains largely underexplored.
Mechanisms of microbial disruption
Haykal and Rocha delve into the mechanisms by which different types of laser devices may affect the skin microbiome. Ablative lasers, such as CO₂ lasers, resurface the skin by removing its outer layers, offering dramatic improvements in tone and texture but also significantly disrupting the physical and microbial environment. In contrast, non-ablative lasers heat the deeper layers of the skin without breaching the surface, making them less likely to disturb the skin barrier or its resident microbiota. Fractional lasers offer a middle ground, creating tiny zones of controlled injury surrounded by intact tissue, which promotes faster healing but may still influence local microbial balance.
‘Non‐ablative and fractional modalities, though gentler, could still disrupt microbial habitats, particularly with repeated or high‐intensity use,’ the authors note. ‘Additionally, the inflammatory response triggered by laser treatments could exacerbate microbial imbalances, especially in patients with pre‐existing conditions like rosacea, where inflammation and dysbiosis are already intertwined.
‘The microbial impact of these technologies is largely understudied.’
Beyond bacteria: Phages, fungi & viruses
The review expands the discussion beyond bacteria. The authors note that the skin microbiome includes bacteriophages (viruses that infect bacteria), fungal organisms (such as Malassezia species) and latent viruses (notably herpes simplex virus or HSV). Laser-induced inflammation and stress may shift the balance of these organisms as well.
“While much focus has traditionally been placed on bacteria within the skin microbiome, the implications of laser treatments on phages and the broader microbiome may be even more significant.”
‘Beyond bacterial populations, the impact of lasers on the skin microbiome may extend to interactions with physiological skin phages,’ they write. ‘Potential interactions between skin phages and external factors, such as temperature changes induced by laser treatments, are emerging as an area of growing interest.
‘While much focus has traditionally been placed on bacteria within the skin microbiome, the implications of laser treatments on phages and the broader microbiome may be even more significant. Physiological skin phages, particularly those targeting Cutibacterium acnes, play a crucial role in maintaining microbial homeostasis on the skin. These phages help regulate bacterial populations, preventing overgrowth and reducing the risk of inflammation associated with conditions like acne. Dysbiosis of these phages, whether due to an imbalance in their abundance, loss of diversity or genetic changes, can disrupt this equilibrium, potentially leading to pathogenic bacterial overgrowth and exacerbating inflammatory skin disorders.’
The paper highlights a complex interplay between laser-induced physiological changes and the skin’s microbial environment, noting that thermal shifts, moisture retention under dressings and even the overuse of antimicrobial cleansers in post-treatment care may all contribute to dysbiosis.
Combined technologies & microbiome-friendly protocols
Emerging combination therapies that integrate lasers with other modalities, such as photobiomodulation, offer promising potential to reduce microbiome disruption during aesthetic treatments. By allowing for lower energy settings without compromising results, these approaches may help preserve microbial balance. For instance, pairing fractional lasers with LED therapy can stimulate collagen production while supporting a healthier skin environment.
Timing and frequency of treatments is also important. Spacing sessions appropriately allows the skin’s microbial and structural systems to recover fully, reducing the risk of cumulative damage.
“Advances in laser technology have already made it possible to achieve significant aesthetic results with reduced invasiveness, but further refinements are needed to minimise collateral damage to the microbiome.”
Recent research suggests that laser treatments can support microbial recovery when used alongside microbiome-conscious protocols. Athanasiou et al found that fractional CO₂ laser treatments combined with postbiotic-enriched moisturisers helped maintain microbial diversity, reduced dysbiosis and supported skin barrier repair. Similarly, De Sica et al demonstrated that non-ablative fractional lasers, such as Erbium glass lasers, offer dermal remodelling benefits without significantly disrupting the epidermal barrier, enabling quicker microbial recovery when paired with supportive skincare. Manolis et al reported that applying probiotic-enriched serums after CO₂ laser resurfacing significantly reduced infection risk and accelerated restoration of microbial balance.
Although early findings are encouraging, current clinical evidence is limited. Further studies, including randomised controlled trials, are needed to confirm these benefits and guide the development of microbiome-conscious treatment protocols.
‘Incorporating microbiome‐conscious strategies into laser protocols is both a scientific necessity and an ethical imperative. Advances in laser technology have already made it possible to achieve significant aesthetic results with reduced invasiveness, but further refinements are needed to minimise collateral damage to the microbiome,’ the authors write.
Haykal and Rocha say that AI-supported diagnostics will play a future role in this space, helping clinicians assess microbial trends, predict risks and recommend tailored treatment plans that support both skin structure and skin ecology.
They suggest that next-generation sequencing techniques should be incorporated into aesthetic research, allowing practitioners to monitor microbial diversity before and after interventions. This would enable the development of personalised protocols based not just on skin type and Fitzpatrick phototype, but also on microbial resilience and risk factors for dysbiosis.
‘Personalised medicine is the future of aesthetic care, and microbiome analysis is a key tool in this evolution. By sequencing a patient’s microbiome prior to treatment, clinicians can identify vulnerabilities, such as low microbial diversity or the presence of pathogenic species. These insights can inform decisions about laser parameters, post‐treatment care and follow‐up schedules, ensuring that interventions are both effective and microbiome friendly,’ the authors explain.
Post-laser care for microbial support
The role of post‐treatment care, including microbiome‐supportive regimens featuring probiotics, prebiotics and barrier‐protective products, could facilitate faster recovery and reduce complications.
‘For instance, topical probiotics can help recolonise the skin with beneficial bacteria, while prebiotics provide nourishment that encourages their growth. Postbiotics, which are metabolic byproducts of microbial activity, offer additional benefits by directly modulating inflammation and promoting skin barrier repair,’ the authors write.
Protecting the skin barrier itself is also important. Ceramide-rich moisturisers and gentle occlusives help protect the skin barrier while maintaining hydration levels conducive to microbial recovery. During the post-treatment period, patients should avoid harsh cleansers, alcohol-based toners and other potentially disruptive products that may interfere with microbiome balance.
While lasers remain a reliable and transformative tool in aesthetic practice, practitioners must not overlook their biological impact beneath the surface. The skin microbiome is an integral part of the skin’s healing response and immune defence – and its preservation should be seen as a key part of post-procedure care.
‘As our understanding of the skin microbiome deepens, its integration into aesthetic practices will likely become the norm rather than the exception. Hybrid treatments that combine lasers with microbiome‐enhancing therapies, such as LED photobiomodulation, represent one exciting avenue for innovation. Similarly, advancements in biotechnology may soon yield post‐treatment products that are specifically designed to support microbial recovery, such as bioactive serums containing live bacteria or their beneficial metabolites,’ the authors note.
‘The ultimate goal is to move beyond treating the skin in isolation and adopt a holistic perspective that considers its symbiotic relationship with the microbiome. By doing so, practitioners can achieve results that are aesthetically refined yet biologically sustainable, fostering long‐term patient satisfaction and trust.’
