Skin extractions involve the manual removal of material clogging a pore, such as the hardened oil and dead skin cells that form blackheads (open comedones) or whiteheads (closed comedones). Dermatologists perform these extractions, integrating them into a broader, medically-focused treatment plan rather than offering them as a standalone cosmetic service. The goal is to safely clear persistent blockages and improve the skin’s response to topical and oral acne medications. Professional extraction minimizes the risks of infection, scarring, and hyperpigmentation common with self-extraction attempts.
When Professional Extraction is Indicated
Dermatologists consider extractions a specific therapeutic tool reserved for lesions that have proven resistant to other forms of treatment. This method is particularly beneficial for clearing comedonal acne, which includes non-inflamed blackheads and whiteheads that do not resolve with prescription topical agents. Large, deeply embedded comedones that create significant congestion and are unlikely to clear naturally are prime candidates for professional removal. Clearing these stubborn blockages can prevent them from progressing into more inflamed, painful acne lesions like pustules or cysts.
Extractions are also necessary for treating milia, which are small, firm, white bumps that are essentially keratin-filled cysts trapped beneath the skin’s surface. Milia cannot be extracted with simple squeezing and require a medical professional to make a tiny incision to release the contents. By physically removing these plugs, the dermatologist immediately improves the skin’s appearance and allows topical treatments to penetrate the pores more effectively. This focused manual clearing is often used as preparation before starting more aggressive acne therapies, such as certain chemical peels or laser treatments.
The Dermatologist’s Extraction Process
The professional extraction process is performed under strictly sterile conditions to ensure patient safety and minimize complications. The procedure begins with thoroughly cleansing the skin, sometimes followed by mild exfoliation or steam to soften the pore contents. Dermatologists use focused lighting and magnification to precisely identify and target each comedo or milium.
To access the blockage, a fine, sterile instrument, such as a lancet or a small surgical blade, may be used to gently puncture the surface of the whitehead or milium. The core material is then carefully extracted using a specialized metal tool called a comedone extractor. This device applies focused, gentle pressure around the pore to push out the contents without causing trauma to the surrounding tissue.
The emphasis is always on minimizing damage and preventing post-inflammatory changes like scarring or discoloration. For deeper or more painful lesions, a dermatologist can use topical or injected numbing agents to enhance patient comfort. After removal, the area is cleaned again, and an antiseptic or anti-inflammatory agent is applied to soothe the skin and prevent secondary infection.
Distinguishing Dermatologists from Estheticians
The primary difference between a dermatologist and an esthetician performing extractions lies in their training, scope of practice, and medical authority. A dermatologist is a medical doctor who has completed extensive training focused on diagnosing and treating all skin diseases. Consequently, their extractions are considered a medical procedure within a comprehensive treatment plan.
Estheticians are licensed skincare specialists focused on cosmetic treatments and superficial skin issues. Their extractions are limited to non-inflamed, superficial comedones as part of a facial. Estheticians are legally restricted from treating deeper, inflamed, or cystic acne, which requires a medical diagnosis and prescription treatments. Only a dermatologist can use tools that pierce the skin for lesions like milia, administer prescription-strength anesthetics, or perform incision and drainage on cystic lesions.