Which Facial Treatment Do You Actually Need
Almost every disappointing facial treatment is the right treatment applied to the wrong problem. Facial ageing has three separate components. Skin quality, meaning texture, thickness and tone. Volume, meaning fat and support that has been lost. And structure, meaning bone and the position of tissue. Each responds to a different category of treatment, and no amount of skill rescues a mismatch.
Key points
Skin quality problems respond to bio-stimulators such as PRP and polynucleotides, which improve the tissue itself and add no volume.
Volume loss responds to volume replacement, and no bio-stimulator will fill a hollow however many sessions you have.
Structural change is largely surgical, and injectables used to chase it produce a heavy, altered look rather than a refreshed one.
Most faces have a combination, which is why sequencing matters and why a single-treatment clinic tends to see a single problem.
Not sure which you have? Message a GMC-registered doctor on WhatsApp or email team@thewellnesslondon.com.
The three components, and how to tell them apart
Skin quality
This is the surface and the layer immediately beneath it. Thin, crepey skin. Dullness and uneven tone. Fine lines that are visible at rest rather than only on movement. Enlarged pores, rough texture, and skin that no longer bounces back the way it did.
The test. Look at your face in flat, even light with no expression, and ignore the shape entirely. If what bothers you is how the skin looks and feels rather than where it sits, this is your category.
Volume
This is the fat, and the support it provides. Hollowing at the temples and under the eyes. Flattening of the cheek. A face that looks tired or gaunt rather than lined.
The test. Tilt your face upward toward a light source. Shadows that largely disappear when the angle changes are volume shadows rather than pigment or texture, and they will not respond to anything that improves the skin.
Structure
This is bone, ligament and the position of tissue. Jowling, a heavy lower face, laxity that pulls downward, and changes in the underlying framework that come with time.
The test. Lie down or lift the skin gently upward at the temples. If the thing that bothers you improves substantially when tissue is repositioned, no injectable will reproduce that, and a surgical opinion is the honest answer.
Want this assessed properly? Ask our doctors on WhatsApp.
What each category responds to
For skin quality
PRP uses growth factors concentrated from your own blood to improve the tissue itself. Because it is autologous, allergic reaction is very unlikely, and it suits people who want an improvement in how their skin behaves rather than a visible change in shape.
Polynucleotides, sometimes called salmon DNA, are purified DNA fragments that act as bio-stimulators, improving hydration, firmness and the quality of thin skin. They suit the under-eye area particularly well, where the skin is the thinnest on the body and where volume treatments frequently look heavy.
Both work as a course with maintenance, and both build progressively over months rather than appearing immediately. Neither adds volume. That is the point of them, not a limitation.
Alongside these, the unglamorous things matter more than most people accept. Daily sun protection, a retinoid where tolerated, sleep, and not smoking will out-perform any injectable over 10 years.
For volume
Volume replacement is the answer, and it works quickly. Under the eyes it carries real risks including puffiness from water retention, a bluish tinge when placed too superficially, migration over time, and rarely vascular complications. It is reversible with hyaluronidase, which is a prescription-only medicine that non-medical practitioners cannot legally hold or inject, and that alone is a strong argument for having any under-eye work done by a doctor.
For structure
Surgery. We do not perform it and we have no commercial interest in recommending it, which is exactly why our view on whether you need it is worth having. Where the honest answer is a surgical opinion, we will say so and explain why an injectable would disappoint.
The mismatches we see most often
Skin-quality treatment used for a structural hollow. Someone has 3 sessions of a bio-stimulator under the eyes, sees a mild improvement in texture and concludes the treatment does not work, when the shadow was always a volume shadow.
Volume used for a skin-quality problem. Filler placed into thin, crepey under-eye skin, producing puffiness and a heavier look while the crepiness remains.
Injectables used to chase structure. Progressive volume added to compensate for laxity, which is how faces end up looking altered rather than rested. This is the most common route to needing filler dissolved.
Treating the face while ignoring the rest. Fatigue, poor sleep, low ferritin and thyroid dysfunction all show in the face, and correcting them sometimes achieves more than any procedure.
Why sequencing matters
Where you have more than one component, and most people do, the order changes the result.
Improve skin quality first where it is a significant part of the picture, because a bio-stimulator works on the tissue itself and a better canvas makes everything else look more natural. Correct volume second, and conservatively, because it is far easier to add than to remove. Consider structure last and separately, because surgery changes the baseline for everything else.
Doing it the other way round, which is the common pattern, means volume is added to compensate for poor skin quality, more is added when that does not satisfy, and the face drifts away from looking like itself.
The honest limits
PRP and polynucleotides improve tissue that is still there. They do not lift, they do not fill, and the evidence base for polynucleotides, while promising, is smaller than for longer-established treatments. We say that rather than presenting everything as equally proven.
Results build over months, require maintenance, and vary between people. Anyone offering a guaranteed outcome in a defined number of weeks is describing marketing rather than biology.
What treatment costs in London
Doctor-led under-eye and facial regenerative treatment in central London generally runs £400 to £850 per session or course at flagship clinics. Tear trough filler at leading London clinics runs £450 to £800 per session and up to £950. London practices typically charge 50 to 70 percent more than clinics outside the capital.
At the lower end of the market you will find facial PRP advertised from around £120 to £300. That usually reflects a smaller volume of plasma, a different preparation protocol, a shorter appointment and, most importantly, no medical assessment of which of the three components you actually have.
Our care is doctor-led and priced below flagship central London rates, with the figure for your plan confirmed after your free suitability review.
Ask what your plan would cost. Message us on WhatsApp.
The suitability review
Every enquiry begins with a free doctor-led suitability review rather than a booking. A GMC-registered doctor assesses your face against the three components, identifies which are contributing and in what proportion, and gives one of two answers.
Approved for treatment, with what is being treated, what is not, how many sessions and what a realistic result looks like. Or not approved, in which case we explain what would serve you better, including when that is volume, surgery, or simply better skincare and sleep.
We decline a meaningful share of facial enquiries. The face is where mismatched treatment does the most damage to a person's confidence, and turning someone away is cheaper for both of us than a disappointing course.
Why people choose The London PRP Clinic by The Wellness
The London PRP Clinic by The Wellness is a doctor-led clinic treating from 10 Portman Square in Marylebone and the Light Centre in Belgravia. Every treatment is performed by GMC-registered doctors, and no clinician treats a patient here until they have completed 100 supervised treatments, which matters more around the eyes than anywhere else on the face.
We offer the full regenerative range including PRP, polynucleotides and combination protocols, so the recommendation follows your assessment rather than the single product a clinic happens to sell. Across our work we report more than 187 five-star reviews.
Book your free suitability review. Message us on WhatsApp, email team@thewellnesslondon.com, or call +44 20 3951 3429.
Frequently asked questions about choosing a facial treatment
How do I know if I need PRP or filler?
PRP improves skin quality and adds no volume. Filler replaces lost volume. Tilt your face toward a light. Shadows that disappear when the angle changes are volume, and they will not respond to a skin treatment.
Does PRP tighten or lift the face?
No. It improves the quality and thickness of the tissue. Laxity and structural change are not treated by injectables, and a surgical opinion is the honest answer where that is the issue.
What is best for thin, crepey under-eye skin?
Bio-stimulators such as PRP and polynucleotides, because they improve the tissue rather than filling it. Volume treatments in that area can look heavy and carry specific risks.
Can I have more than one treatment?
Usually yes, and most faces have more than one component. Sequencing matters, generally improving skin quality first and correcting volume conservatively second.
Why did my last facial treatment not work?
Most often because it addressed the wrong component. A skin-quality treatment used for a volume shadow, or volume used for crepey skin, will disappoint regardless of how well it was performed.
Do I need treatment at all?
Frequently not. Sun protection, sleep, a retinoid where tolerated and correcting anything found on blood tests will out-perform most procedures over a decade, and we will say so when that is the answer.
This article is for information and does not replace personal medical advice. Individual results vary and no outcome is guaranteed. The evidence base for polynucleotides is still developing. All treatments at The London PRP Clinic by The Wellness are performed by GMC-registered doctors. Reviewed by [GMC-REGISTERED DOCTOR NAME, GMC NUMBER TO CONFIRMM], The London PRP Clinic by The Wellness. Last updated July 2026.
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