In short. The preventable and the unavoidable risks after resurfacing: antiviral cover for cold sores, infection, and pigment change that is managed, not prevented.

Key points

  • Skin that is open can become infected, and an infection that is not treated promptly can lead to scarring, which is a permanent consequence of a temporary problem.
  • That is why the aftercare schedule matters as much as the treatment: washing, dressing, avoiding contamination and reporting changes early.
  • A fever or a change in the discharge is not something to wait out.

The risks of resurfacing divide into two groups, and the division is worth understanding because it changes what you should expect. Some are preventable with planning, and some are managed after the fact. Cold sores belong to the first group. Pigment change belongs largely to the second.

The preventable risk

The virus that causes cold sores lies dormant in the nerve supply to the face in most adults who carry it, and it can be woken by injury to the skin. Resurfacing is exactly that kind of injury, so an outbreak can follow treatment, and an outbreak on skin that is already open and healing is a genuine complication. Antiviral cover started before the treatment and continued afterwards reduces the risk substantially. It is why the question is asked at every assessment, and why a patient who answers yes is not being excluded from treatment but having it planned differently.

Infection is the other preventable risk

Skin that is open can become infected, and an infection that is not treated promptly can lead to scarring, which is a permanent consequence of a temporary problem. That is why the aftercare schedule matters as much as the treatment: washing, dressing, avoiding contamination and reporting changes early. A fever or a change in the discharge is not something to wait out.

The risk that is managed rather than prevented

Pigment change can follow any injury to the skin, and the risk rises with depth and in darker skin tones. It is not fully preventable, because it is the injury itself that provokes it. It is managed instead: sun protection first and always, review at intervals, and further treatment only if it is conservative, because treating pigment with another injury is a strategy with its own risk. It may fade over months, and it may not fade completely.

Scarring, and what makes it more likely

Scarring after resurfacing is uncommon, and it is more likely after a deeper treatment, after an infection, or in a patient with a keloid tendency. It is improved, not removed, once it has formed, and the treatment for it is a separate plan with its own timeline. The most effective thing that can be done about scarring is to identify the patients at higher risk before treatment rather than after.

Report these rather than waiting

  • Increasing pain, spreading redness, warmth, swelling or discharge, particularly with a fever.
  • A cold sore outbreak, which needs antiviral treatment rather than time.
  • A treated area becoming darker or lighter than the surrounding skin, or a firm area that is thickening.

Asked plainly, the risk profile of resurfacing is that some complications can be prevented with planning and others can only be managed, and that the depth chosen determines how much of each you are taking on. The skin infection pages describe what an infection looks like, the pigment pages cover discolouration, and the aftercare pages set out the routine that reduces both.

Related reading

Frequently asked questions

Why is antiviral treatment given before resurfacing?

Because the injury can wake the virus that causes cold sores in anyone who carries it, and an outbreak on skin that is already healing from resurfacing is a complication rather than an inconvenience. Antiviral cover started before treatment and continued afterwards reduces that risk substantially. It is one of the few risks here that can be prevented rather than managed, which is why the question is asked at every assessment.

How do I tell an infection from normal healing?

Normal healing after resurfacing is uncomfortable but it follows a pattern: weeping that reduces, crusting that settles, redness that gradually fades. Infection tends to move the other way: increasing pain, spreading redness, warmth, swelling, discharge that changes or smells, or a fever. Any of those needs to be reported the same day rather than waited out, because an untreated infection on healing skin can lead to scarring.

Will pigment change settle on its own?

Sometimes. Post-inflammatory pigment change may fade over months without treatment, particularly if the skin is protected from the sun. It may also persist, and it may not settle completely. That is why it is managed rather than simply observed: sun protection is the first measure, further treatment is conservative when it is used at all, and prevention is far more effective than correction.

Risks & Limitations

  • Both options work by injuring the skin deliberately, and pigment change is the risk they share. The risk rises with depth and is materially greater in darker skin tones, and conservative settings there are the clinical plan rather than a compromise.
  • Post-inflammatory pigment change may take months to settle and may not settle completely. Treating it is harder than preventing it, and treating it with a further injury carries its own risk.
  • Deeper treatment leaves skin open rather than flaking. Infection is a real risk while the skin is open, and an untreated infection can lead to scarring that is permanent.
  • A cold sore flare can be triggered by either option in a patient who carries the virus. Antiviral cover before treatment reduces the risk rather than treating an outbreak that has already begun.
  • Scarring after resurfacing is uncommon and is more likely after a deeper treatment, after an infection, or in a patient with a keloid tendency.
  • Healing takes as long as it takes. Redness after resurfacing lasts for weeks and fades over months, and no clinician can shorten it or promise a date at which the skin will look unremarkable.
  • Neither option reverses sun damage permanently. Pigment can return, the skin continues to age, and a result that is not protected with sun avoidance and sunscreen will not hold.
  • Neither option tightens loose skin or repositions tissue that has descended. Those are surgical findings, and a plan that promises them with a peel or a laser has promised something the depth cannot deliver.

When to Seek Care

  • Increasing pain, spreading redness, warmth or swelling in the treated area, particularly with a fever.
  • Discharge that changes in colour or smell, or a wound that is not closing as expected.
  • A cold sore outbreak after treatment, which needs antiviral treatment rather than time.
  • A treated area becoming darker or lighter than the surrounding skin, because early pigment change is easier to manage.
  • A firm, raised or thickening area in the treated skin, or a scar beginning to overgrow.
  • Blistering, crusting or a burn that is not healing — contact the treating team the same day.

References & Further Reading

  • American Academy of Dermatology (AAD) — chemical peeling and laser resurfacing guidance
  • International Society of Aesthetic Plastic Surgery (ISAPS) — global standards of practice
  • National Institute for Health and Care Excellence (NICE, UK) — relevant guidance
  • Cochrane Library — systematic reviews in skin resurfacing and pigment disorders

Medically reviewed by Ke He, MD (何锞), Deputy Director & Head of Skin & Laser Aesthetics. Last reviewed: 19 September 2026.

This page is patient education, not medical advice, and it does not cite individual studies. Discuss your own case with a qualified clinician. To arrange an assessment at Chongqing West District Hospital, see Contact & Consultation.