I went through an entire year of Photofacials followed by microdermabrasions with little effect on the spots. Turned out the settings that were used were quite low. I am now going through the whole process again at a more "aggressive" (their word, not mine) level. OMG the photofacial hurt SO much that I screamed and jumped after most pulses that they had to almost restrain me. My face was on FIRE but I thought "no pain, no gain". I was given an ice pack immediately afterwards but it helped very little. I was in so much pain during the procedure and many hours later. Well, I have another photofacial this week and I am going to take two shots of tequilla before just to help ease "some" pain. I am afraid. As I typed that last sentence, I think I am going to ask for a refund. It hurt THAT bad. Be careful and be prepared...it DOES hurt.