Acne
Active acne is a medical condition, and the honest answer starts with an aesthetics practice not always being the right place for it. What we can do is help with congestion, mild inflammatory breakouts, and the skin-barrier problems that keep them coming back. What we cannot do is manage moderate to severe acne, cystic acne, or hormonal acne that needs prescription treatment — that is a dermatologist, and we will tell you so and mean it.
Why this happens
A breakout begins in the follicle. Cells lining it shed faster than they clear, sebum production rises under hormonal signalling, and the two combine into a plug. That plug is the comedone — the whitehead or blackhead — and at that stage there is no inflammation and nothing is red.
Inflammation is the second act. Cutibacterium acnes, a bacterium that lives on everybody's skin without causing trouble, thrives in the low-oxygen environment behind the plug. The immune response to it is what turns a comedone into a papule, a pustule, or — when the follicle wall ruptures deeper down — a nodule or a cyst.
Where in that sequence your skin is stuck determines who should be treating it. Congestion and surface inflammation respond well to exfoliation, extraction and a corrected routine, which is aesthetic work. Deep, painful lesions that scar are a follicular rupture problem, they are driven by hormones and sebum production, and the treatments that change either of those are prescriptions.
Barrier damage is the complication that keeps people cycling. Aggressive scrubs, high-strength actives layered without a plan, and stripping cleansers all provoke the skin into producing more oil and more inflammation, which reads as worsening acne and gets treated with more aggression. Breaking that loop is often the single most useful thing anyone does for a mild case.
What actually helps
Each of these does something specific about the mechanism above. The sentence under each one is what it does for this, which is not the same as what its own page says it does in general.
- Chemical peels
A light salicylic-based peel gets into the follicle and clears the plug at the point where it forms, which is why it helps congestion more than it helps inflammation.
- Medical facials
Extraction plus a corrected routine, which is where most mild cases actually change — and it lets us see how your skin reacts before anything stronger is considered.
What won’t work
- Anything we offer, for cystic or nodular acne. Painful lesions under the surface that last for weeks and leave marks need prescription treatment, and treating them with peels or facials delays the thing that would have worked while the scarring accumulates.
- Scrubs, brushes and abrasive exfoliants. Physical scrubbing ruptures inflamed lesions, spreads the contents into surrounding tissue, and makes the inflammation worse. It has felt productive to a lot of people for a long time and it is still the wrong move.
- Extraction of an inflamed lesion at home. What comes out is a fraction of what gets pushed deeper, and the deeper it goes the more likely it is to leave a mark that outlasts the spot by six months.
- Treating adult hormonal acne along the jaw as though it were teenage acne on the forehead. Different driver, different distribution, different treatment — and the jawline pattern in particular usually needs a prescription rather than a facial.
Where we’d start, and why
- 1We ask what your routine actually is, in order, including anything you have added in the last three months. A surprising number of cases resolve substantially once two products come out of it.
- 2A medical facial with extraction is usually the first appointment, because it treats the congestion that is there now and tells us how reactive your skin is before we commit to anything with downtime.
- 3If the picture is congestion-dominant rather than inflammation-dominant, a course of light peels spaced two to four weeks apart is the next step. If it is inflammation-dominant, that is the point at which we say so rather than starting a course that will not touch it.
- 4We do not treat active acne and pigment at the same time. Settling the inflammation first is what stops each new lesion leaving a mark, and treating the marks while new ones are forming is a loop nobody wins.
What would make us decline
These are the answers we actually give in the room, and they are the reason the practice is called what it is called.
- You have painful lesions under the skin, or acne that is already leaving scars. We will decline treatment and give you the name of what to search for in a dermatology practice, because starting a package here would cost you money and cost you months.
- You are on, or have recently finished, a course of oral isotretinoin. Skin on and after that treatment does not tolerate resurfacing or aggressive exfoliation, and the standard interval before any of it is measured in months. We will ask, and if the answer is recent, we will wait.
- You want a course of six treatments booked today for skin we have not seen behave yet. One appointment, then a decision, is the only sequence that is honest here.
- Your acne is clearly hormonally driven and you are asking us to treat it topically instead of seeing a physician about the driver. We will say that plainly, more than once if necessary.
What this is not
What we treat is mild, surface-level acne in an aesthetic setting. Moderate to severe acne, cystic acne, acne that scars, acne with sudden onset in adulthood, and acne accompanied by other symptoms are dermatology and sometimes endocrinology. That referral is not us passing you along — it is the treatment.
Questions about acne
How do I tell whether my acne is mild enough for an aesthetics practice?
Roughly: if what you have is blackheads, whiteheads and the occasional red spot that resolves in a few days without leaving a mark, an aesthetics practice can help. If you have lesions that are painful, sit under the surface, last more than a week, or leave marks that persist, that is a dermatologist's case.
Will a facial make me break out?
Sometimes, briefly. Extraction can bring congestion to the surface that was already forming, and it can look like a flare for a few days before it settles. We tell people this before the appointment rather than after, because the alternative is somebody concluding the treatment caused the problem.
Can you help with the marks left behind rather than the acne itself?
Yes, and it is a separate conversation — flat brown or red marks are pigment, dented ones are scarring, and they need different treatment. We would still want the active breakouts settled first, because treating marks while new ones keep appearing is not a plan.
When is this something I should see a dermatologist about instead?
If it hurts, if it scars, if it started suddenly in adulthood, if it is worsening despite a sensible routine, or if it is affecting how you live. Those are all reasons to see a physician, and none of them is a reason to book a facial and hope.