If you’re dealing with persistent acne and even prescription treatments aren’t getting you the results you want, you may be wondering if there are additional treatments to help speed you along the road to clearer skin. The short answer: yes! But not all in-office treatments may be right for you and your skin. Here, we’ll dive into everything you need to know about “acne surgery” and the most common in-office acne procedures.
Surgery to remove acne sounds intimidating, but it isn't as extreme as it sounds; there are usually no incisions involved, and recovery time may be as brief as a day or two.
In addition to extractions and excisions, surgical procedures that may improve the appearance of acne include non-invasive chemical peels, lasers, light therapies, and occasionally injections or cryotherapy. The treatment that's best for you depends on the type of acne you have.
An extraction is the surgical equivalent of "popping" a pimple. It is performed by a licensed skin care provider in an office using sterile tools specifically designed to remove large or stubborn whiteheads and blackheads. This technique can provide a "quick fix" when your acne medication isn't working as quickly as you'd like or you want to look your best for a special event. Because it's performed by a professional, there is less risk of scarring or worsening the pimple.
Similar to extractions, excisions address blemishes on a pimple-by-pimple basis. This procedure is performed in a licensed medical provider's office using a tiny scalpel and small sterile instruments to remove the contents of stubborn comedones (whiteheads or blackheads). This treatment is best for especially large whiteheads, or in some cases, for acne cysts or nodules very close to the skin's surface. Extractions and excision procedures are most suited to stand-out pimples that aren't responding quickly enough to your first line of acne treatments. If excision is part of cystic acne surgery, the cyst will be drained and extracted as well.
A chemical peel is a resurfacing procedure that entails applying a solution to the skin's surface. Post-peel, healed skin typically looks smoother and healthier than the old skin. Chemical peels can be effective for mild to severe acne. Superficial "lunchtime" peels that remove only the outermost layer of the epidermis may be performed in an aesthetic spa. In contrast, deeper peels that target several layers are performed in a medical office and can have a longer recovery time.
There are several different types of light and laser therapies used for acne, including blue and/or red light therapy, YAG lasers, and photodynamic therapy. These have different degrees of effectiveness depending on the type of acne. Although there are some FDA-approved light devices designed for home use, the most effective treatments are performed in a medical office.
Corticosteroids are used for several inflammatory conditions, including the deep nodules associated with cystic acne. During this procedure, a cortisone medication (Kenalog) is carefully injected directly into the nodule by a medical professional.
Cryotherapy, or "cold therapy," is another option. The extreme cold is thought to work by restoring the skin’s normal microflora, reducing inflammation, and removing dead skin cells from the skin's surface. Because working with extremely cold substances that freeze skin on contact can be dangerous, this procedure should be performed only in a doctor's office. Cryotherapy can be used for different types of acne, including cystic acne.¹
The short answer is yes, many of these procedures can help your acne, but individual outcomes depend on the type of acne you have, your skin tone, tolerance for the procedure, and of course, the expertise of your provider.
A small study found that extractions or excisions work better than oral antibiotics.² These approaches might work well if you have a special event or photo shoot coming up and are looking for quicker results.
Chemical peels may provide good results depending on the severity of your acne. These are generally good options for mild to moderate acne.³ A chemical peel has been shown to enhance improvements when combined with a low-dose oral medication.⁴
Light and laser therapies have been found to work best as adjunct treatments. Red and blue light work especially well when combined with collagen or low-dose oral acne medications.⁵ ⁶ The Nd:YAG laser uses light of a very specific wavelength to treat moderate to severe acne.⁷ ⁸
Using corticosteroid injections to treat cystic acne is commonplace, and it's easy to find many dermatologists who recommend this technique. It's important to know that while there's little published research regarding their effectiveness, the studies that do exist around corticosteroid injections and acne are promising.⁹
Cryotherapy is often painful. The good news is that newer cryotherapy devices that can better control the target and temperature precisely are making cryotherapy a good option if you would like to try an adjunct therapy for cystic acne.¹⁰ You can talk with your dermatology provider to see if this may be right for you.
The bottom line is that several procedures may help manage the appearance of acne, and their effectiveness depends on variables, including the type of acne you have, your skin tone, and your tolerance for the specific procedure. It's important to note that each procedure has potential side effects and involves varying degrees of discomfort.
Ultimately, these procedures are all adjunct treatments to your daily skincare routine. A great long-term strategy for treating acne is a personalized skin treatment regimen—and with Curology, it’s easy to follow one that’s designed to be effective for your unique skin concerns.
Our licensed dermatology providers will work with you to examine your skin, assess your skincare goals, and provide custom treatment options tailored to your specific concerns. To get started with a trial,* all you need to do is answer a few questions about your skin, snap some selfies, and wait to be put in touch with one of our dermatology providers. The path to a better skincare routine is really that simple!
There are various types of “acne surgery.” Depending on the procedure, your skin may be exposed to red or blue light, a laser, cold therapy, a specially formulated chemical cocktail that can peel the top layers of your skin, an injection, or merely tiny sterile tools that remove whiteheads and blackheads.
It depends on the procedure, but typically not much. But your skin may be red and tender for several days, depending on the type of procedure you have. Talk to your dermatology provider to learn how a specific procedure might feel and how your skin may react.
There is a broad continuum for the cost of procedures, and it is essential to have appropriate expectations. Your skincare provider can give you specific information tailored to your desired outcome.
Rho, N.K. Revisiting the Role of Local Cryotherapy for Acne Treatment: A Review and Update. J Clin Med. (2022, December 20).
Sitohang, I., et al. Acne Lesion Extraction versus Oral Doxycycline for Moderate Acne Vulgaris: A Randomized Clinical Trial. The Journal of Clinical and Aesthetic Dermatology. (June 2021).
Zheng, Y., et al. Efficacy and safety of 2% supramolecular salicylic acid compared with 5% benzoil peroxide/0.1% adapalene in acne treatment; a randomized, split face, open-label, single-center study. Cutaneous and Ocular Toxicology. (March 2019).
Ye, D., et al. A prospective, randomized, split-face study of concomitant administration of low-dose oral isotretinoin with 30% salicylic acid chemical peeling for the treatment of acne vulgaris in Asian population. International Journal of Dermatology. (June 2022).
Zhao, C., et al. Therapeutic effect of alternating red and blue light irradiation combined with collagen in patients with acne vulgaris and the risk factors of short-term recurrence. American Journal of Translational Research. (2022, November 15).
Li, Y., et al. Efficacy and safety of low-level light therapy by delicate pulsed light combined with low-dose oral isotretinoin for the treatment of acne vulgaris: a randomized split-face study. Lasers in Medical Science. (2022, July 13).
Kesty, K. and Goldberg, D. J. 650 usec 1064nm Nd:YAG laser treatment of acne: A double-blind randomized control study. Journal of Cosmetic Dermatology. (September 2020).
El-Din Monib, K.M. and Hussein, M.S. Nd:YAG laser vs. IPL in inflammatory and noninflammatory acne lesion treatment. Journal of Cosmetic Dermatology. (September 2020).
Gallagher, T., et al. Dermatologist Use of Intralesional Triamcinolone in the Treatment of Acne. The Journal of Clinical and Aesthetic Dermatology. (December 2020).
Rho, N.K. Revisiting the Role of Local Cryotherapy for Acne Treatment: A Review and Update. J Clin Med. Ibid.
Meredith Hartle is a board-certified Family Medicine physician at Curology. She earned her medical degree at Kirksville College of Osteopathic Medicine in Kirksville, MO.
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Meredith Hartle, DO