Stop Popping, and Think Twice About Facials
Updated: Sep 29
中文摘要在文末
Let me start with the fact that makes everything else in this article obvious.
Scarring happens mainly through two routes:
One — the lesion is large and nodulocystic. The deep, painful, swollen kind. These damage the skin's structure from the inside because of the sheer volume of inflammation involved.
Two — you popped it.
That's essentially it. And look at what that means: one of the two main causes of permanent facial scarring is a choice.
Not a genetic predisposition. Not bad luck. A thing people do, several times a week, in front of a bathroom mirror, in the belief that they're helping.
So: stop.
Why popping causes scars
When you squeeze a lesion, most of what you think you're removing outward is being driven downward and sidewaysinto the surrounding tissue. The contents rupture into deeper layers, where they trigger far more inflammation across a wider area than the original lesion would have produced.
That expanded inflammation is what damages the skin's architecture. And once the architecture is damaged, it's permanent — that's the difference between a scar and a mark. A mark is a colour change in intact skin and it fades. A scar is structural, and I can improve it but I can't eliminate it.
You're also introducing bacteria from your fingers into an open wound, and creating an injury that will leave a darker post-inflammatory mark than the spot would have.
So the immediate satisfaction costs you: a bigger lesion, a longer heal, a darker mark, and a real chance of a permanent scar.
I understand the impulse completely. There's a genuine compulsion to it, and telling someone to stop is easier said than done. But it's worth knowing that the thing you're doing to make it go away faster is the thing most likely to make it permanent.
Facials and extractions
Here I want to be careful, because I'm making a specific argument rather than a blanket one.
People care about facials because of cleanliness, and that instinct isn't wrong. Keeping skin clean is reasonable. If that were the whole picture, I'd have no objection.
What concerns me more is the inflammation and scarring risk.
Extraction — professional or otherwise — is mechanical trauma to inflamed skin. The risk from any single session is low, and I want to say that plainly rather than overstate it. Most people have a facial and nothing bad happens.
But the risk is cumulative.
Over years of regular extractions, that repeated trauma can build into significant inflammation — enough to activate acne and trigger a flare, or, at worse, to contribute to scarring. I've seen skin that's been worked on regularly for a long time and is in a worse state than it would have been left alone.
The other issue is what a facial is actually treating. Extraction addresses what's on your face today. It does nothing about the process producing new lesions tomorrow. So people go monthly, indefinitely, treating output rather than cause — spending money and accepting cumulative trauma without moving toward control.
The alternative, which is genuinely better
Here's the part that makes the argument practical rather than just restrictive.
The active ingredients we use will clear most of what extraction targets — comedones included — in a much safer way, and keep it clear.
That's the whole point of a properly-titrated combination of benzoyl peroxide, azelaic acid and a retinoid. Retinoids in particular work directly on comedone formation. They don't just remove what's there; they reduce what forms next.
So the comparison isn't "extraction versus nothing." It's:
Extraction — clears today's comedones, mechanical trauma, cumulative risk, does nothing about tomorrow, repeat monthly forever.
Actives — clear existing comedones more gradually, reduce new formation, no mechanical trauma, and the benefit compounds rather than the risk.
Gradually is the honest word. Extraction is faster in the short term, and I'm not going to pretend otherwise. But over six months the actives are ahead, and over three years there's no comparison.
What about the deep painful ones?
The large nodulocystic lesions are the other main route to scarring, and those genuinely shouldn't be left to run their course.
Don't squeeze them. This is the category where popping does the most damage, and the one where the impulse is strongest because they hurt.
Come in. For individual large lesions I can use intralesional steroid injection, which settles the lesion quickly and — importantly — reduces the inflammation that would otherwise cause scarring. That's the right way to deal with one, and it's a straightforward procedure.
If you're getting these regularly, that's a signal about the overall severity and the plan probably needs to change, which is a conversation worth having rather than managing one lesion at a time.
What to do instead when you want to pick
Practical, because "stop picking" alone doesn't work:
Notice when it happens. For most people it's a specific situation — the bathroom mirror at night, magnifying mirrors, idle moments. Remove the trigger where you can. Magnifying mirrors in particular are worth getting rid of.
Keep your hands occupied in the situations where you'd pick.
Treat the lesion instead. Having something specific to apply gives the impulse somewhere to go.
Cover it if you need to. A patch or dressing over a lesion serves as a physical barrier as much as anything.
And accept the timeline. A lesion left alone resolves in a few days and usually fades. A popped lesion takes longer, leaves a darker mark, and may leave a scar. Doing nothing is faster. That's counterintuitive and it's true.
If you already have scarring
Then the priority order matters, and it's the same one as everywhere in this programme.
Control the active acne first. Nothing you do to scars will hold while inflammation continues in the deeper layers — it'll look better for a while and then worsen back as the underlying process surfaces.
Then, for structural scarring, I refer out for procedures. That's not something I do here.
And the marks — the flat brown and red ones — those aren't scars, they respond well, and the Fade phase addresses them. There's a separate article on telling the two apart, because they get conflated constantly and it changes what's realistic.
The short version
Two main routes to scarring: big nodulocystic lesions, and popping.
Come in for the first. Stop doing the second.
And think about whether monthly extractions are treating your acne or just treating today's face — because the actives do the same job with less trauma, and they work on tomorrow as well.
Klinik Dr Tan (Skin & Acne), Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred.
Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.
I'm a GP with a strong interest in skin, not a dermatologist. For scar procedures, I refer.
Read more about our acne treatment programme : Acne Marks vs Scars, Acne Treatment in KK, /skinandacne
简要说明
我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan（皮肤与暗疮）。我是对皮肤有专长的普通科医生，不是皮肤专科医生。
先说一个让这整篇文章都变得显而易见的事实：
疤痕主要透过两条路径产生：
病灶又大又是结节囊肿型——那种深、痛、肿的。它们从内部破坏皮肤结构，因为发炎的量太大。
你把它挤了。
大致就是这两条。请注意这意味着什么：造成永久性脸部疤痕的两大主因之一，是一个「选择」。
不是遗传体质，不是运气不好。是人们每周做好几次、对着浴室镜子做、而且相信自己是在帮忙的一件事。
所以：停下来。
为什么挤压会造成疤痕
当你挤压一个病灶时，你以为被挤出来的东西，多数其实是被推往下方和侧面进入周围组织。内容物破入更深的层次，在更大的范围内引发比原本病灶多得多的发炎。
那个被放大的发炎，正是破坏皮肤构造的东西。而构造一旦被破坏就是永久的——这就是疤和印的差别。印是完整皮肤上的颜色改变，会淡掉；疤是结构性的，我可以改善但无法消除。
你同时也把手指上的细菌带进一个开放的伤口，并制造一个会留下比原本更深的色素印的创伤。
所以那一瞬间的满足感，代价是：更大的病灶、更长的愈合、更深的印，以及留下永久疤痕的实际机率。
我完全理解那个冲动。那确实带有强迫性，叫人停下来说得容易做得难。但值得知道的是：你为了让它快点消失而做的那件事，正是最可能让它变成永久的那件事。
关于脸部护理与粉刺清除（facial / extraction）
这里我要说得精准，因为我提的是一个具体的论点，不是全面否定。
大家在意 facial 是因为「清洁」，那个直觉并没有错。 保持皮肤干净是合理的。如果只有这一面，我不会有意见。
我更在意的是发炎和疤痕的风险。
粉刺清除——不论是不是专业操作——都是对发炎中的皮肤施加机械性创伤。单次的风险是低的，这一点我要老实说，不想夸大。多数人做完 facial 什么事也没有。
但风险会累积。
在多年规律的粉刺清除之后，那些反覆的创伤可能累积成显著的发炎——足以活化痘痘、引发爆发，更糟的情况下促成疤痕。我见过被长期规律「处理」的皮肤，状态比放着不管还糟。
另一个问题是 facial 到底在治什么。粉刺清除处理的是你「今天」脸上的东西，对「明天」会产生新病灶的那个过程毫无作用。 所以人们每个月去、无限期地去，治的是产出而不是原因——花着钱、承受累积的创伤，却没有往「控制」的方向前进。
更好的替代方案
我们使用的活性成分可以用安全得多的方式清掉粉刺清除所针对的大部分东西（包括粉刺），而且能维持住。
这正是过氧化苯甲酰、杜鹃花酸、A 酸这个逐步加量的组合的意义。A 酸尤其直接作用在粉刺的形成上——它不只清除已经在那里的，它减少接下来会形成的。
所以比较的不是「清粉刺 vs 什么都不做」，而是：
粉刺清除——清掉今天的粉刺、机械性创伤、风险累积、对明天没有作用、每月重复到永远。
活性成分——比较渐进地清掉现有粉刺、减少新的形成、无机械性创伤，而且累积的是效益不是风险。
「渐进」是诚实的用词。短期内粉刺清除比较快，我不会假装不是。但六个月后活性成分领先，三年后没有可比性。
那些又深又痛的怎么办？
大颗的结节囊肿型病灶是通往疤痕的另一条主要路径，这些确实不该放着自己好。
不要挤。 这一类是挤压伤害最大的，也是冲动最强的（因为会痛）。
请来诊所。 对个别的大颗病灶，我可以做病灶内类固醇注射，能让它快速消退，而且重要的是减少那些原本会造成疤痕的发炎。这是处理它的正确方式，而且是简单的操作。
如果你经常长这些，那是关于整体严重度的讯号，治疗计划大概需要改变——那值得好好谈一次，而不是一颗一颗处理。
想挤的时候可以做什么（因为光说「不要挤」没有用）：
留意它什么时候发生（多数人是特定情境——晚上的浴室镜子、放大镜、发呆的时候）。能移除的诱因就移除，放大镜尤其值得丢掉。 在会挤的情境里让手有事做。 改成「处理」它（有具体的东西可以擦，冲动才有去处）。需要的话遮起来（痘痘贴或敷料本身就是物理屏障）。
并且接受时间表：放着不管的病灶几天就消退，而且通常会淡掉。被挤过的病灶好得更慢、留下更深的印、还可能留疤。什么都不做反而更快。 这违反直觉，而且是真的。
如果你已经有疤痕：先控制活跃的痘痘。 只要发炎还在深层持续，你对疤做的任何处理都留不住——会好看一阵子，然后随着底下的过程浮上来又变回去。 然后，结构性的疤痕我会转介做疗程。而那些平的褐色和红色的痘印不是疤，它们反应良好，淡化期会处理。
简短版：通往疤痕的两条主要路径——大颗的结节囊肿型病灶，以及挤压。第一种请来诊所。第二种请停止。并且想一想，每月的粉刺清除是在治疗你的痘痘，还是只是在处理今天这张脸。
Klinik Dr Tan (Skin & Acne)，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。建议预约。疤痕疗程我会转介。
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