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Skin Concerns
This is your central resource for the main skin concerns we treat at Thames Skin Clinic, our award-winning, doctor-led medical aesthetic clinic in Twickenham.
Here, you’ll find clear, clinically informed guidance on rosacea, acne, wrinkles, pigmentation and sun damage. This includes what causes them, how they affect the skin as well as the safe and effective treatment options available at our CQC-registered clinic. All of our injectables and laser treatments are carried out by medically qualified practitioners, using CE‑marked devices and evidence‑based protocols.
Explore our skin concern pages or book a consultation with Dr Anna Hemming for a personalised skin assessment and treatment plan.
Award-Winning Skin Clinic
Thames Skin Clinic is a CQC‑registered, doctor‑led medical aesthetic clinic in Twickenham, South West London. We treat patients from Richmond, Teddington, Kingston, Wimbledon, Chiswick and across London, Surrey and the UK.
Our clinic is led by , a nationally recognised, multi-award-winning medical doctor and former GP to Buckingham Palace. We specialise in natural skin restoration, treating concerns such as acne, rosacea, pigmentation, ageing skin, scarring, redness, skin laxity and overall skin health.
Dr Anna’s passion for skin began as a personal journey. Having experienced rosacea and difficult skin herself, she understands how skin concerns can affect confidence, comfort and wellbeing. This is one of the reasons she has dedicated her career to helping patients restore healthier, stronger and more resilient skin.
Her expertise has been recognised at the highest level of the medical aesthetics industry. Dr Anna was named Best Medical Practitioner (Doctor Category) at the Aesthetic Medicine Awards 2025 and Best Medical Practitioner (Doctor, Dentist or Surgeon) at the Aesthetics Awards 2026. She is also a Key Opinion Leader for Cutera and and an AviClear ambassador.
Acne
Understand the causes of acne, breakouts and acne scarring, and explore medical-grade skincare, AviClear, acne scarring treatments, microneedling and ZO Skin Health programmes for acne-prone skin.
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Rosacea
Learn more about redness, flushing, visible vessels and sensitive skin, and how rosacea can be managed with skincare, lifestyle support and advanced laser treatments including Excel V+ and Laser Genesis where appropriate.
Read More
Ageing Skin, Lines & Wrinkles
Explore how fine lines, wrinkles, collagen loss, volume changes and skin laxity develop, and how we use natural, medically led treatment plans to restore skin quality and facial balance.
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Pigmentation & Photodamage
Find out what causes pigmentation, melasma, uneven skin tone, sun damage and photodamage, and how we treat these concerns with skincare, peels, laser and tailored skin programmes.
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What Are the Common Skin Concerns We See?
The skin is the body’s largest organ and our protective shield. Every day, it defends us against the environment, repairs damage, regulates hydration and adapts to internal and external changes.
Over time, ageing, genetics, hormones, sun exposure and lifestyle factors can all affect how the skin looks, feels and functions. At Thames Skin Clinic, we regularly assess and treat concerns including:
Some concerns appear on the surface of the skin, while others begin deeper within the dermis, blood vessels, pigment cells, sebaceous glands or underlying facial structures. Understanding the root cause is an essential part of how we assess and treat skin at Thames Skin Clinic.
Many skin concerns overlap. Redness may be rosacea, sensitivity, barrier damage or visible vessels. Pigmentation may be melasma, sun damage, post-inflammatory pigmentation or age-related changes. Breakouts may be acne, hormonal acne, rosacea-related spots or congestion.
At Thames Skin Clinic, we assess the skin medically before recommending treatment, so your plan is based on the cause of the concern rather than the visible symptom alone.
Ageing
As we age, our cells slow down, and fibroblasts, the cells responsible for producing collagen and elastin, become less active. Collagen provides structure and firmness and elastin supports flexibility and bounce.
Over time, the epidermis becomes thinner, the skin barrier may become weaker and the skin gradually loses its ability to retain moisture. These changes contribute to fine lines, wrinkles, dryness, dullness, laxity and uneven skin tone.
Sun Exposure
Sun exposure is one of the biggest contributors to to premature skin ageing and pigmentation.. Ultraviolet (UV) rays break down collagen and elastin, weaken the skin barrier and stimulate excess melanin production.
This can lead to pigmentation, uneven skin tone, redness, visible vessels, rough texture, fine lines and deeper wrinkles. Protecting the skin from UV exposure is one of the most important steps in any long-term skin health plan.
Genetics
Genetics influence how your skin behaves, reacts and ages. Your genetic makeup can affect oil production, sensitivity, pigmentation, collagen quality and your likelihood of developing conditions such as acne, rosacea or melasma.
Although genetics cannot be changed, the right treatment plan can help manage these concerns, strengthen the skin and reduce visible symptoms.
Hormonal Changes
Hormonal changes can have a direct impact on skin function, particularly oil production, inflammation, pigmentation and hydration.
Puberty, pregnancy, perimenopause and menopause can all trigger or worsen concerns such as acne, melasma, sensitivity, dryness and loss of skin firmness. For this reason, we always consider hormonal history as part of your consultation.
Lifestyle Influences
Our lifestyle choices, such as stress, sleep, nutrition, smoking, alcohol, exercise and skincare habits can all affect skin health.
Having poor sleep and high stress levels may increase inflammation, while smoking and excess alcohol can accelerate collagen breakdown and impair skin repair. This is all reflected in our skin.
A balanced and healthy lifestyle supports the skin barrier, improves resilience and helps treatment results last longer.
When To Seek Medical Advice for Moles, Lesions or Pigmentation
Some pigmentation concerns are cosmetic, such as sun damage, melasma or post-inflammatory pigmentation. However, any new, changing, bleeding, itching, irregular or unusual mole, mark or skin lesion should be medically assessed before cosmetic treatment is considered.
At Thames Skin Clinic, patient safety comes first. Dr Anna Hemming is a medical doctor and former GP, and offers medical skin lesion and mole assessments, including mole checks and lesion removals where appropriate. If a lesion requires further investigation, dermatology referral or histology, this will be discussed as part of your assessment.
How We Treat Skin Concerns at Thames Skin Clinic
At Thames Skin Clinic, we treat skin concerns through medical assessment, skin restoration and carefully planned combination treatments, rather than isolated procedures.
Your treatment plan may include:
Some patients need a simple plan focused on one concern. Others may benefit from a more structured skin restoration journey, combining skincare, laser, injectable, regenerative and maintenance treatments over time.
The aim is always to improve skin health, restore confidence and achieve natural-looking results.
Acne Concerns
Thames Skin Clinic is a CQC‑registered, doctor‑led medical aesthetic clinic in Twickenham, South West London. We treat patients from Richmond, Teddington, Kingston, Wimbledon, Chiswick and across London and Surrey.
We are a leading acne clinic in Twickenham using AviClear laser, medical skincare and scar treatments.
Acne is a chronic inflammatory skin condition affecting the hair follicles and oil glands, causing blackheads, whiteheads and inflamed spots. In more severe cases, It causes deep painful cysts that, if left untreated, can result in long-term scarring.
Acne rarely looks the same for everyone. Your breakouts might cluster on the chin and jaw, flare without warning in your 30s, run deep and painful or keep coming back despite everything you’ve tried. For many people, it’s not just the skin that’s affected; it’s confidence and how you feel day to day.
As an award-winning doctor-led clinic that specialises in , we look at what’s driving it beneath the surface. We often see patients of all ages for acne, ranging from teenagers to adults. Using , bespoke skincare plans and scar treatments, we treat acne at every stage.
Hormonal
Breakouts on the chin and jawline that track your cycle in women or are linked to hormonal changes and stress in men
Adult Acne
Adult acne in your 30s and 40s is more common than most people realise. It is a multifactorial condition.
Cystic Acne
Cystic acne is a more severe form of acne. It’s deep, swollen, red and painful breakouts beneath the skin that are tender to touch.
Teen Acne
Teen acne is driven largely by surging hormone levels during puberty. Teen acne often affects the face, chest and back. Having treatment early reduces the risk of long-term
Persistent Acne
Acne that keeps coming back despite creams, antibiotics or previous treatments. If nothing has lasted, the root cause of your oil gland overactivity hasn’t been properly addressed yet.
Acne Scarring
Pitting, textural changes and dark marks left behind once acne clears. Scarring and active acne are different problems that need different treatments, but we manage both as part of one plan.
Most acne starts in the sebaceous glands (the skin’s oil-producing glands), which are sensitive to normal hormone levels. Hormone fluctuations cause these glands to produce excess oil, which blocks your pores. The result is the blackheads, whiteheads and congestion that we see in acne.
Bacterial multiplying within blocked pores is what causes inflammation, producing the deeper, painful lesions that many people with cystic acne know well. Left untreated or inadequately treated, these deeper breakouts can damage the collagen beneath the skin, leaving behind the pitting and dark marks we see in .
Acne rarely has a single cause, which is why the same prescription cream or oral acne medications can work for one person and do nothing for another.
If you’re searching for a hormonal acne clinic near Twickenham or South West London, we can help. We regularly treat adult acne and hormonally driven breakouts at our medical skin clinic.
Oil Gland Overactivity
The sebaceous glands are over-sensitive to normal hormone levels, producing excess oil that blocks pores and creates the conditions for breakouts. Bacteria multiply within this build-up of oil, leading to inflammation and the formation of red, swollen or pus-filled spots, commonly known as pustules.
Hormonal Fluctuation
Androgens stimulate oil production, which explains why acne breakouts along the chin, cheeks and jawline flare up before the menstrual cycle, worsen under stress or appear for the first time in the 30s. External triggers like diet, friction and certain medications layer on top of this hormonal foundation.
Inflammation and Scarring
When bacteria multiply within blocked pores, inflammation develops, leading to the red, painful spots of cystic acne. Deeper lesions damage collagen over time, leaving pitting and dark marks. Active acne and scarring are different stages of the same problem and are treated in sequence.
FAQs
Your acne is likely hormonal if it clusters along the chin and jawline, flares predictably before your period and produces cyst-like, painful spots rather than surface blackheads.
The underlying cause of hormonal acne is androgen sensitivity. Most women with hormonal acne have skin that reacts to normal testosterone levels, which is why standard spot treatments rarely work. They address the surface, not the trigger. Hormonal acne can also return after Roaccutane and often doesn’t respond fully to topicals or antibiotics alone. Triggers include coming off the pill, perimenopause, stress and conditions like PCOS.
At Thames Skin Clinic, Dr Anna Hemming is experienced in identifying and treating acne in Twickenham with a hormonal root cause. If your acne is accompanied by irregular periods or excess hair growth, we factor this into your plan from your very first consultation.
For hormonal and PCOS-related acne, a combination of AviClear, medical-grade skincare and targeted in-clinic treatments can deliver lasting improvement even when other approaches have failed.
Yes. in their 30s and 40s, and it is extremely common, with around 15 to 20% of adults aged between 25 and 40 experiencing it. There is a higher rate in women due to hormonal fluctuations.
Teen acne is mainly driven by puberty and tends to appear across the T-zone, forehead, nose and chin. Adult acne is often seen on the lower part of the face, particularly along the jawline, chin and neck, and spots are often inflamed and cystic. Acne breakouts in adults are influenced by stress, lifestyle, skincare habits and hormonal shifts.
Yes. Roaccutane is an oral acne treatment often used for cystic acne. The best alternative is AviClear, an FDA-approved laser treatment that uses laser energy to suppress oil production. The main benefit of AviClear is that this treatment has no prescriptions, blood tests or systemic side effects.
< is our Roaccutane alternative because it is:
AviClear delivers longer-lasting results than Roaccutane as improvements are maintained for over two years.
Yes. At Thames Skin, treating both active acne and within one personalised plan is exactly how we work. Active acne and scarring are different stages of the same problem.
Active acne needs to be controlled first because ongoing breakouts can create new scars while older ones are being treated. Once active acne is stabilised, we can begin scar treatments.
For active acne, Thames Skin offers AviClear, active acne plans, HydraRadiance and Obagi Blue Peel Radiance. For scarring and redness left by spots, we offer acne scar laser and microneedling in Twickenham. This includes , , Laser Genesis and .
All of our acne treatments in Twickenham and South West London are customised to your skin health.
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Rosacea Concerns
Thames Skin Clinic is a CQC‑registered, doctor‑led medical aesthetic clinic in Twickenham, South West London. We treat patients from Richmond, Teddington, Kingston, Wimbledon, Chiswick and across London and Surrey.
We provide rosacea treatment in Twickenham and South West London, combining Excel V+ vascular laser with medical skincare.
Rosacea is a chronic inflammatory skin condition that often shows up as persistent redness, flushing and visible thread veins, usually across the cheeks and nose. Rosacea is a pattern, not just a reaction. Maybe your face flushes at the smallest thing, you’ve been treating spots that appear like acne, or your skin reacts to almost everything.
At Thames Skin Clinic, rosacea is one of our core specialisms. Dr Anna Hemming has managed rosacea personally and clinically for over two decades. We assess your skin type, your triggers and your rosacea phenotype before putting together a personalised treatment plan. Papulopustular, vascular and phymatous rosacea are each driven differently, and each type needs a different plan.
The best treatments include for thread veins and for persistent redness, AviClear for oily breakout-type rosacea and exosome therapy for the most reactive skin. We have a pathway for all types of rosacea. Find out which one is yours.
Which Type of Rosacea is Yours?
Flushing & redness
Your face flushes easily, which is a symptom pattern of vascular rosacea. Maybe it’s after a glass of wine, a hot shower or stepping outside. The redness doesn’t always settle, and it seems to be staying longer each time.
Spots that aren’t acne
(Papulopustular rosacea)
Papulopustular rosacea is acne-like bumps that often appear in clusters. You might have been treating it like acne, but nothing works, or it gets worse. The bumps are red, they burn rather than itch, and there are no blackheads. This is papulopustular rosacea.
Thread veins and vessels
You can see the vessels on your cheeks and nose. They’ve been there a while, and no skincare makes a difference. Laser is the only thing that treats these effectively.
Reactive, sensitive skin
(vascular rosacea)
Persistent redness, flushing and visible dilated blood vessels across the cheeks and nose. Your skin reacts to almost everything. Products that work for others sting or flush you. You’ve been labelled ‘sensitive,’ but nothing has actually helped you manage it. This is vascular rosacea.
Menopause-triggered
Your skin was fine for years. Then in your 40s or 50s, during perimenopause or menopause, you’ve started noticing persistent redness and flushing that doesn’t settle. Hormonal changes are one of the most common rosacea triggers.
Phymatous rosacea
Skin thickening and texture changes, most commonly affecting the nose in more advanced cases.
The exact cause of rosacea isn’t fully understood, but it appears to result from a combination of genetics and environmental triggers.
The immune system overreacts to certain triggers, which causes the blood vessels in the face to swell and become more visible. , including:
For some people, rosacea presents as a constant background redness. For others, it comes and goes in flare-ups, sometimes alongside sensitivity, dryness or acne-like breakouts. It can feel unpredictable.
We provide rosacea treatment in Twickenham and for these types of rosacea, supporting patients with persistent redness and sensitive skin. If you think your rosacea is linked to your perimenopause or menopause or need a skincare routine for rosacea-prone skin, book a consultation with Thames Skin Clinic.
Vascular overreactivity
In rosacea, the small blood vessels in the face overreact to everyday triggers, such as heat, , alcohol and stress, causing them to dilate more than they should and stay dilated. Over time, this repeated flushing leads to permanently visible redness and, in some cases, broken thread veins that won’t resolve on their own.
Inflammatory response
In papulopustular rosacea, chronic inflammation produces bumps and pustules that look like acne but behave differently. They burn rather than itch, have no blackheads and don’t respond to acne treatments. Using the wrong products, particularly acids or benzoyl peroxide, strips the barrier and significantly worsens inflammation.
Barrier dysfunction & triggers
Rosacea-prone skin has a weakened barrier, which makes it more reactive to products, temperature, food, stress and UV. Identifying and managing personal triggers is a core part of any rosacea plan. At Thames Skin, trigger mapping is part of your first consultation.
FAQs
Sensitive skin reacts when the barrier is disrupted, then settles. Redness caused by rosacea has a pattern. It is persistent redness across the cheeks and nose, flushing that takes longer to resolve each time and often visible thread veins. If your redness is becoming more constant rather than occasional, rosacea is the more likely explanation. A proper skin assessment is the only way to be certain because treating rosacea as sensitivity isn’t effective.
Yes. Visible thread veins and persistent redness don’t respond to skincare alone – but they respond well to vascular lasers. At Thames Skin, we use the , a medically regulated laser that targets the blood vessels causing redness without damaging surrounding skin. A course of three sessions, spaced one month apart, produces a significant visible reduction in most patients, with Laser Genesis used for ongoing maintenance.
Yes. This is exactly the type of rosacea Thames Skin sees most. Highly reactive rosacea needs a different starting point: a desensitisation phase that calms the inflammatory response and rebuilds the skin barrier before any active treatment begins. This typically involves plant-derived exosomes, a gentle and a structured plan.
Yes. onset or worsening in women over 45. Oestrogen decline affects the skin’s vascular tone and barrier function, making blood vessels more reactive and the skin more susceptible to flushing. At Thames Skin, we factor hormonal context into every rosacea consultation we have at our Twickenham-based skin clinic. This is particularly important for patients who’ve noticed symptoms developing alongside other menopausal changes.
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Ageing Skin, Lines & Wrinkles Concerns
Thames Skin Clinic is a CQC‑registered, doctor‑led medical aesthetic clinic in Twickenham, South West London. We treat patients from Richmond, Teddington, Kingston, Wimbledon, Chiswick and across London and Surrey.
For wrinkles and facial ageing, we offer anti‑wrinkle injections and regenerative injectables to patients across Twickenham, Richmond and wider London.
The process of our skin ageing is gradual. You may first notice fine lines that deepen when you smile but won’t quite fade anymore or a dullness that skincare isn’t shifting. At Thames Skin Clinic, we approach skin ageing the same way we approach every skin concern by diagnosis before recommendation. Facial ageing has three distinct components: changes in the skin surface itself, loss of volume in the fat and structural layers beneath and tissue laxity. Each needs a different response.
We have a suite of treatment options to address wrinkles and fine lines at our Twickenham skin clinic. This includes
Our results speak for themselves. Our founder, Dr Anna Hemming, has been recognised for Best Injectable Results at the Aesthetics Awards 2025. She was also named Best Medical Practitioner at the Aesthetic Medicine Awards 2025 and Best Medical Practitioner (Doctor, Dentist or Surgeon) at the Aesthetics Awards 2026. These accolades reflect our commitment to safe and natural-looking injectable treatments.
Which Type of Wrinkle is Yours?
Expression lines
These are forehead, frown lines and crow’s feet. The lines around your eyes or between your brows show more at rest now, not just when you’re animated.
Sun damage lines
These are surface texture, pigmentation and finer lines. Your skin has a rougher texture, uneven tone and fine lines that feel accelerated, particularly on areas that get the most sun.
Crepey skin
These are around the neck, décolletage, under-eye and inner arms. The skin on your neck, chest or under eyes has taken on a thin, papery quality that no moisturiser seems to reach.
Volume-related lines
These are nasolabial folds, marionette lines and hollowed cheeks. The lines running from your nose to the corners of your mouth or the hollowing under your eyes are about the structural volume loss beneath it.
As we get older, our skin loses collagen and elastin becomes less flexible, reducing the skin’s ability to bounce back. Fibroblast cells, which are responsible for producing collagen, become less effective, meaning the skin cannot repair itself as efficiently. As a result, fine lines and wrinkles begin to form, and the overall structure of the skin becomes less firm and more fragile.
When the skin barrier is compromised, external environmental factors can have a greater impact on the skin, including:
These factors accelerate the ageing process and further contribute to the formation of wrinkles.
All injectable and laser treatments at Thames Skin Clinic are carried out by medically qualified practitioners, using CE-marked devices and evidence-based protocols. Injectable treatments at Thames Skin Clinic include a short consultation and treatment within the same appointment, so there’s no need for a separate pre-consultation visit. If you’d prefer to take more time to explore your options and discuss what’s right for you, we also offer a full . After a consultation we can put together a personalised treatment plan to address wrinkles and any other skin concerns you have.
Collagen + elastin loss
From our mid-20s, the fibroblast cells responsible for producing collagen become progressively less active. Collagen (the protein that gives skin its structure and firmness) breaks down faster than it’s replaced. Elastin, which allows skin to spring back after movement, loses its flexibility. The result is skin that no longer bounces back and lines that stay rather than fade. This is the foundational cause beneath almost all other ageing changes.
Repetitive facial movement
Every time you squint, frown, smile or raise your brows, the underlying muscles contract and fold the skin above them. As collagen declines, these folds gradually etch themselves into the skin and become visible at rest as well. These are the types of wrinkles most effectively addressed by , which relax the muscles rather than adding volume to erase the wrinkle.
Sun damage
UV radiation is the single biggest external cause of premature skin ageing. UV breaks down collagen and elastin at a cellular level and causes the uneven pigmentation and rough texture that compound the appearance of lines. Medical-grade SPFs and biostimulators that stimulate collagen are treatments used to address this.
Lifestyle
Smoking restricts blood flow to the skin, dramatically reducing the oxygen and nutrients that support collagen production. Smokers show accelerated skin ageing and more pronounced lines, particularly around the mouth. Chronic stress elevates cortisol, which breaks down collagen and impairs the skin’s ability to repair. Poor or inadequate sleep is when the skin does the majority of its cellular repair work. Therefore, consistently disrupted sleep means consistently disrupted regeneration.
Skin dehydration
When the skin is dehydrated, cells become less plump and more compressed and fine lines appear more pronounced. Dehydration also compromises the skin barrier, allowing environmental damage to penetrate more easily and accelerating the ageing process from the outside in. Hydration at the dermal level, through treatments such as Profhilo as well as the right skincare, improves the appearance of fine lines and skin quality overall.
Regenerative injectables can be used alongside both anti-wrinkle injections and dermal fillers to reduce wrinkles and overall skin quality.
FAQs
will not make you look frozen if they are administered by a qualified medical professional. At Thames Skin Clinic in Twickenham, anti-wrinkle injections are always administered conservatively and after thorough discussion about how much movement you want to retain. The goal is lines that are softened, not a face that’s stopped moving. Dr Anna has been described as
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