Common Acne Procedures That Can Help When Topicals Aren’t Enough

When you’ve tried every cleanser, serum, and prescription cream under the sun, and your breakouts still won’t budge, your dermatologist may suggest something more direct an in-office procedure often referred to as "acne surgery." But don’t let the term intimidate you. These treatments are typically quick, minimally invasive, and performed right in a dermatologist’s office or medical spa.

While not a first step in acne management, these procedures can make a significant difference when other options fall short. Here’s a breakdown of the most common ones and what you need to know before booking an appointment.

Blemish Excision: Targeting the Deep, Stubborn Pimples

When inflamed cysts or nodules refuse to shrink with medication, blemish excision might be recommended. This procedure involves making a tiny incision in the skin to remove pus, keratin, or other debris trapped inside a pimple.

• Performed under local numbing agents

• Ideal for deep or painful cystic acne

• May result in slight scarring

• Healing begins once the blockage is cleared

According to the American Academy of Dermatology, approximately 20% of teens with acne develop severe cystic forms that may require procedural intervention like this.

Blemish Extractions: Clearing Blackheads and Whiteheads Safely

Unlike excisions, extractions focus on non-inflamed blemishes like blackheads and whiteheads. These can be done by a dermatologist or licensed esthetician, typically following exfoliation.

• Uses a comedone extractor or gentle pressure

• No anesthesia needed

• Can be part of a facial treatment at a spa

• Should never be done at home to avoid infection and scarring

While tempting, at-home squeezing can do more harm than good especially when it comes to deeper lesions.

Laser Treatments: Addressing Both Acne and Scars

Laser therapy is one of the more advanced options in acne management. These treatments use focused light energy to kill acne-causing bacteria, reduce inflammation, and promote skin regeneration.

• Different types suit various skin tones and acne types

• Some require only one session, others need a series

• Also effective on acne scars

• May cost hundreds per session and are often not covered by insurance

In one clinical study, patients saw up to a 50% reduction in active acne lesions after a full course of laser therapy.

Chemical Peels: A Fresh Start for Troubled Skin

Chemical peels offer controlled exfoliation to remove dead skin cells, unclog pores, and stimulate new cell growth. They range from gentle, no-downtime options to deeper peels that require healing time.

• Common agents include glycolic, salicylic, and trichloroacetic acid

• Superficial peels treat mild acne and improve skin texture

• Medium and deep peels can address scarring and hyperpigmentation

• Post-treatment redness or flaking is normal

Peels can be an effective addition to a broader acne management plan, especially for women dealing with adult acne or post-inflammatory pigmentation.

Cortisone Injections: The Quick Fix for Big Breakouts

Also known as intralesional corticosteroid injections, these are tiny doses of anti-inflammatory medication injected directly into an angry, swollen pimple.

• Flatten blemishes within 24–48 hours

• Useful before big events or for painful cysts

• Not a long-term acne solution

• Minimal discomfort with a fine needle

Dermatologists often reserve cortisone injections for those emergency situations when a breakout needs to calm down fast.

Keep in Mind: Procedures Complement, They Don’t Replace Treatment

While these acne treatments can deliver real results, they’re not stand-alone solutions. They work best in combination with a dermatologist-approved skincare regimen, which may include topical retinoids, antibiotics, or oral medications.

And remember, attempting any of these procedures at home especially excisions or extractions can lead to infection, worsening inflammation, or permanent scarring.

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