Extractions involve the manual or mechanical removal of impacted material from a pore or a skin lesion. This procedure clears clogged follicles, which are often filled with sebum, dead skin cells, and other debris. Dermatologists are fully trained and licensed to perform skin extractions. These medical professionals integrate extractions into a comprehensive treatment plan for various dermatological conditions.
When Extractions Become Medically Necessary
A dermatologist views an extraction as an integrated part of a broader medical strategy for managing skin disease, not a standalone cosmetic treatment. Extractions become medically necessary when persistent lesions fail to respond adequately to conventional topical or systemic medications. The physical removal of the follicular plug, or comedone, can accelerate the resolution of breakouts stubborn to prescription creams or oral antibiotics.
The primary medical justification for a professional extraction is to reduce localized inflammation and prevent the lesion from progressing into a more severe state. When a pore remains clogged, the buildup of material can rupture the follicle wall, spilling inflammatory contents into the surrounding skin tissue. This rupture triggers a deeper, more painful inflammatory response, increasing the risk of infection and long-term tissue damage.
Removing the impacted material through a sterile procedure helps decompress the follicle and interrupt the inflammatory cascade. This action directly reduces the likelihood of developing permanent skin changes, such as atrophic or pitted scars, which result from deep tissue destruction. Extractions performed in a medical setting offer immediate physical relief and are a targeted intervention to minimize the cosmetic sequelae associated with severe or prolonged acne.
What Dermatologists Extract
Dermatologists are trained to identify and safely extract a range of lesions, focusing on those that pose a risk of infection or scarring if left untreated. The most common targets are non-inflammatory lesions, specifically open and closed comedones (blackheads and whiteheads). An open comedone, or blackhead, is a hair follicle clogged with oxidized sebum and keratin, appearing dark due to surface exposure to air.
A closed comedone, or whitehead, is a similar blockage covered by a thin layer of skin, appearing as a small, flesh-colored or white dome. These non-inflamed lesions are the safest to extract, as their contents are sealed and localized. Dermatologists also routinely address milia, which are small, dome-shaped white cysts composed of trapped keratin located just beneath the skin’s surface. Milia often require a sterile lancet or needle to create a micro-opening before the contents can be gently expressed.
Dermatologists are also equipped to handle certain deeper, non-resolving lesions, such as small epidermal inclusion cysts that are not acutely inflamed. While large, painful, or deeply inflamed nodules and cystic acne are treated with intralesional corticosteroid injections or incision and drainage, smaller, stable cysts may be extracted to prevent future flare-ups. Distinguishing between extractable and non-extractable lesions is a core element of the dermatologist’s medical training, ensuring only appropriate lesions are targeted to avoid worsening the condition or causing unnecessary scarring.
The Professional Distinction: Dermatologists Versus Estheticians
The roles of a dermatologist and an esthetician in performing extractions are distinct, defined by their respective levels of training, licensure, and scope of practice. A dermatologist is a medical doctor who completes four years of medical school, followed by a three- to four-year residency focused on diagnosing and treating conditions affecting the skin, hair, and nails. This extensive medical background permits them to diagnose underlying skin disease and perform procedures that are medical or minor surgical in nature.
Dermatologists utilize strictly sterile medical-grade tools, such as specialized surgical lancets or fine-gauge needles, to create a micro-incision for the removal of deeper or more resistant lesions. They are also licensed to administer local anesthesia, like lidocaine injections, which may be necessary when treating deeper cysts or sensitive areas. Extractions are performed in a sterile clinical environment to mitigate the risk of introducing bacteria and causing a secondary infection.
In contrast, an esthetician is a licensed skin care professional whose focus is primarily on cosmetic treatments, skin appearance, and general skin maintenance. Estheticians perform extractions on superficial comedones (less severe blackheads and whiteheads) using non-prescription tools such as metal comedone extractors. They are not medical professionals; they cannot diagnose skin disease, prescribe medication, or use invasive techniques like a surgical scalpel or local anesthesia.
The fundamental difference lies in the depth and complexity of the lesion being treated and the level of risk involved. An esthetician’s extraction is limited to the superficial layers of the skin. In contrast, a dermatologist is qualified to treat lesions that are deeper, more inflamed, or carry a higher risk of complication, scarring, or infection if improperly manipulated. For any lesion that is painful, severely inflamed, or suspected of being more than a simple clogged pore, the medical expertise of a dermatologist ensures the safest and most appropriate intervention.