Why Your Esthetician Didn't Extract Everything
open to learn about hyperkeratinization!
Happy Tuesday!
I’m going to be on a panel in a few hours about adult acne! If you’re around in NYC, come say hi! It’s free to register and I’d love to meet you.
Inspired by tonight, let’s answer three acne-related questions.
I have a lot of congestion and was pretty surprised at a facial recently where the facialist didn’t do many extractions and said that my skin was too dehydrated. Is that normal?
This is a really good question that comes up a lot. The satisfying extraction videos that you see online, where gunk appears to effortlessly spew out of pores, is actually the result of a lot of preparation. You don’t see the preparation part because it’s not particularly entertaining to watch and sometimes can actually take more than just one facial. Another reason is that despite how it may look, not everything should be extracted and doing so can actually make the problem worse.
Prepping the skin for extractions is one of the many reasons you want to leave extractions to professionals. We need to soften the skin and make it more pliable, with steam or hot towels and plenty of hydration. We need to loosen dead skin with things like enzymes, acids or other solutions that will help make it possible to remove everything from the pore. We do all of this to make it less likely that you’ll scar or damage the surrounding tissue by exerting too much pressure. Sometimes this can be achieved during a single facial, but there’s only so much progress you can make in a short amount of time, so you’ll be given home care instructions to ready your skin for the next time. (Plus, really think about the timing. In a 60 minute facial you may have 20 minutes to prep and extract, so there’s only so much you can do at once.) On the flip side, just as important as the prep is the immediate after care. There’s an open wound on the skin! We’ll use different products and tools to disinfect, kill bacteria, reduce inflammation and encourage healing. This also takes time. You don’t want anyone rushing through the steps or forcing anything before it’s ready.
A lot of congestion, especially non-inflammatory blackheads and whiteheads, has been there for a long time and/or is just realllly stuck in there. Even if you see the top of a juicy blackhead that seems ready to burst, or a collection of bumpy whiteheads that look poppable, you can’t see what’s brewing underneath. If the skin is dehydrated, that pore is going to be tight around the impaction and make it very difficult to extract. Closed comedones are some of the trickiest things to loosen!
Inflamed acne presents a different set of considerations, primarily because extracting these lesions comes with heightened risk and is often unadvisable. Pressure can aggravate and worsen acne, resulting in scarring (both texture and pigmentation), broken capillaries and enlarged pores. Not to mention the risk of damaging the pore wall, causing bacteria–and the breakout–to spread. Instead of extracting, the best course of action is often to use products/tools to calm the inflammation, kill bacteria and enable healing.
So to answer your question, yes it is more normal than you think! I’d follow your provider's instructions for home care and make sure your next appointment is long enough for ample extractions.
Why do you and so many others always recommend mandelic acid over retinoids for acne? Is mandelic acid new? I feel like I’m seeing it everywhere now!
Oh, mandelic acid! LOML! A perfect molecule! I could (and should?) write a whole post about its antimicrobial, anti-inflammatory, gently exfoliating wondrousness. Mandelic acid was actually discovered in 1831 and has a fascinating history of use in various medicinal purposes! But you’re right that its widespread popularity in skincare is fairly new.
Up until the past few years, the magic of mandelic acid was only really appreciated by those who had long struggled with acne and were working with acne specialists/following strict acne protocols. Compared to other AHAs, like lactic and glycolic acid, mandelic wasn’t as researched or known to be as effective in skincare, plus there just weren’t (and comparatively still aren’t) tons of products that featured it as a hero ingredient. But there’s a reason why all of the acne-focused brands, like Sofie Pavitt’s Mandelic Clearing Serum and Cool As A Cucumber (the hosts of tonight’s panel) feature it as their main acne-fighting ingredient. The reasons I listed above (antimicrobial, anti-inflammatory and gently exfoliating) make it ideal for acne-prone skin, but the gentle exfoliation part is what makes it stand out from retinoids. You see, folks who are acne-prone are predisposed to hyperkeratinization, or the overproduction of dead skin cells, which then get clogged in the pore. Exfoliating helps to remove this dead cell build up, but too much and you overstrip the skin. Mandelic acid, with its large molecule size, is so gentle that it can be used regularly (daily, for many people), to keep pores clear and prevent dead skin buildup. On the other hand, retinoids (which can be very beneficial for acne and part of its management, there is lots of nuance, don’t get mad at me) work by increasing cell turnover aka creating more dead skin cells! So my belief, along with many other experts, is that mandelic acid should be the first line of defense when clearing acne. Adding retinoids too early can exacerbate the congestion and inhibit progress. (Again, there is so much nuance here and everyone is different, but if your primary tool against acne is retinoids and you haven’t had success, I’d strongly urge you to try mandelic instead.)
Acne spot treatment recommendations please!!!
Last year I wrote a very thorough post about spot treatments that covers pretty much every question you might have, such as the different types, when to use, when not to use, troubleshooting & best practices, how to incorporate them in your routine (with scenarios!), how to use under makeup…
In addition to the below, the post also has spot treatment recs for things other than acne, but here ya go for acne/breakouts:
LION Pair Acne Cream: I discovered on my honeymoon in Japan, this is hands down the best spot treatment I’ve ever used, it’s just a pain to get.
Activist Manuka Honey Mask: can use for acne or irritated, dry skin.
Sofie Pavitt Benzoyl Peroxide Mask: this one is spicy. You can use 2-3x weekly in breakout areas, reserve for the week before your period or as a powerhouse spot treatment for nasty surprise pimples.
Clearstem Sulfur Spot & Mask or iNNBEAUTY PROJECT Pimple Paste: both stronger than Naturium’s and I like better than any other sulfur-based option. They’re both purple-ish and have unique ingredient blends beyond the sulfur to address inflammation and pigmentation.
La Roche-Posay Effaclar Duo: has salicylic acid & benzoyl peroxide. Best drugstore option.
Rael Miracle Patch: the GOAT of pimple patches. Invisible, undetectable, superior adhesion, better than whichever ones you’ll ask about I promise.
Take A Rec/Leave A Rec
Have a rec or need a rec for an aesthetic provider? Tell us in the chat!
This is an ongoing resource for subscribers and I’ll figure out a handy place for the link to live eventually, but bookmark it for now. [This is a crowdsourced list and should not be considered a recommendation or endorsement from me, but obviously I will share recs if I have them.]
Office Hours Reminder
Join us for Office Hours on Sunday! This exclusive weekly opportunity is available to paying subscribers.
Every Sunday at 5pm EST, I’ll begin a new thread for the week in Substack Chat, where you can ask me anything. Every Monday from 8-9pm EST, I’ll be in that chat live, answering questions for the hour. That way, if you can’t make it, you can submit any time after 5pm Sunday and still get an answer. If you can make it live, join in! You can ask questions in real time and (hopefully) interact with others in class ;)
Discount Codes
Dermstore: JOLIE for 15% off (La Roche-Posay)
Sofie Pavitt Face: JOLIE10 for 10% off
Stylevana: SHOPJOLIE for 10% off (LION Pair Acne Cream)
you can find all of my discount codes here
Have a great week!
xx,
Jolie