Acne Extraction vs Injection: Which Suits Your Acne

Acne extraction and acne injection differ in both the type of acne involved and the principle behind them. Acne extraction physically removes the plug inside the pore with sterile instruments, so it is used for whitehead and blackhead comedones. An acne injection is when a doctor injects an anti-inflammatory medicine into a large acne nodule that is swollen and painful; information from the AAD states that most nodules tend to flatten within roughly 48-72 hours. Results vary by individual. Both methods help manage individual lesions, but neither addresses the underlying cause of acne.

What Is Acne Extraction?

Acne extraction (comedone extraction or acne extraction) is a procedure in which a trained provider uses sterile instruments to remove the plug inside the pore from the skin. The target is comedonal acne, not every type of inflamed acne.

What sits inside a comedone is oil (sebum) mixed with dead skin cells that has stayed in the pore until it forms a small bump. If the pore opening is closed, it appears as a whitehead (closed comedone). If the pore opening is open and the material inside is exposed to air until it changes colour, it appears as a blackhead (open comedone). These two types are the group that acne extraction is designed to manage.

The general steps start with cleansing the skin and assessing which lesions are “ready” to be removed and which should be left alone. In some cases there may be a step to soften the upper layer of skin or open the pore first. Instruments such as a comedone extractor or a sterile needle are then used to make a small opening in the pore, and the plug is removed with controlled pressure. It ends with cleansing the skin and possibly using a product to reduce irritation. Patient materials from the American Academy of Dermatology (AAD) state that when performed by a dermatologist, extraction is a low-risk way to remove whiteheads and blackheads, but it is usually not the first-line option, because it takes time and is generally considered when medication has not managed comedonal acne as well as expected. At Onnyx Clinic, acne extraction is done under a doctor’s assessment and supervision.

One point worth agreeing on is that acne extraction “clears what is stuck there now”. Information from Mayo Clinic explains that opening and removing comedones can help the skin look better for a period, but it does not stop the process that creates new comedones, and if the technique is not appropriate there is still a risk of scarring. Acne extraction is therefore usually positioned as an add-on to a skin-care plan that already includes ongoing treatment. At Onnyx Clinic, full-face acne extraction is THB 500 per session, which a doctor usually considers alongside other care approaches according to each person’s skin condition.

What Is an Acne Injection?

An acne injection (intralesional corticosteroid injection) is when a doctor injects a small amount of a corticosteroid medicine directly into an inflamed acne nodule, in order to reduce inflammation, swelling, and pain faster than waiting for it to settle on its own.

The principle is clearly different from extraction, because an acne injection does not remove anything from the skin. Instead it delivers an anti-inflammatory medicine to the inflamed spot, so the inflammatory reaction settles and the lump gradually flattens and softens. The AAD states that corticosteroid injection usually causes most acne nodules or cysts to flatten within roughly 48-72 hours, and helps reduce the risk of scarring from prolonged inflammation. In 2024, the AAD also updated its acne management guidelines, stating that corticosteroid injection is an option that can be considered for large acne nodules, to reduce inflammation and pain more quickly.

The concentration of the medicine is a detail that doctors take seriously. A survey of dermatologists’ practice published through the NIH’s PMC database indicates that the approach used for acne usually involves low-level concentrations, with the choice of concentration and amount of medicine being at the doctor’s discretion according to the characteristics of each lesion. This information is not intended for self-medication. The reason is that the higher the concentration or the larger the amount, the greater the chance of local side effects, such as the skin in that area becoming indented. This explains why the AAD emphasises that corticosteroid injection should be performed by a doctor, and that it suits spot-specific management of acne nodules that are very painful, rather than being a way to manage many lesions across the whole face at once.

At Onnyx Clinic, acne injection is charged per spot, starting at THB 100 per spot, and the number of spots that can be treated in one session depends on the doctor’s assessment rather than on a wish to inject every single lesion. The medicine used must be prescribed and injected by a doctor. You should not buy the medicine and inject it yourself, or receive an injection from someone who is not a doctor in a place that is not a medical facility.

How Do Acne Extraction and Injection Differ?

In short, extraction manages the “plug” in acne that is not yet inflamed, while injection manages the “inflammation” in large acne nodules. The two methods are therefore used for different types of acne and are not interchangeable options.

There are two differences that people often get the wrong way round. The first is the expectation about time. Extraction usually shows a change more quickly because the plug has already been removed, but how much you see depends on each person’s skin condition, whereas an injection has to wait for the medicine to take effect, so most people see clear flattening on days 1-3 after the procedure. The second is the scope of use. Extraction can be done on many lesions in one session because it clears an area of skin, whereas injection is spot-specific management according to medical indications, and the AAD clearly states that it is not a method used on many lesions at once.

Another point worth emphasising is that neither method keeps acne from coming back, because they do not address the oiliness, clogging, bacteria, or hormonal factors behind it. If you want acne to settle in the long term, treating the underlying cause remains the core, through an acne treatment program or an approach the doctor assesses as suited to your skin condition.

Which Suits Which Type of Acne?

The most direct way is to start with the “type of acne” first and then choose the procedure, rather than choosing a procedure first and trying to apply it to every kind of acne, because different types of acne respond clearly differently.

The group usually considered for acne extraction

• Whiteheads (closed comedones) — small raised bumps, white or skin-coloured, not red and not painful, usually scattered across the forehead, cheeks, or chin
• Blackheads (open comedones) — small dark dots at an open pore opening, not painful when pressed, most often found on the nose and nasolabial area
• Comedones that persist after using medication — cases where topical medication has reduced new acne, but a number of pre-existing comedones remain

The group usually considered for an acne injection

• Nodules — firm lumps under the skin, fairly large, painful when pressed, usually with no visible head
• Cysts — soft lumps with a lot of inflammation, clearly painful, and with a higher risk of scarring than other types of acne
• A large inflamed lesion in a spot that has a big impact — for example, a single lesion painful enough to disrupt daily life, where you want the inflammation to settle faster

The group usually not suited to either method includes small pustules scattered across the face, numerous red inflamed lesions that have not yet consolidated into nodules, or acne that is actively spreading over a wide area, because intervening lesion by lesion in this state is usually not worth the risk of marks. The approach that usually works better is to calm the inflammation across the whole face first. If you are still unsure which group your current acne falls into, having a doctor assess it is the more reliable route, and if the acne is linked to your menstrual cycle or recurs around the jawline and chin, that is a case where caring for the underlying cause matters more than managing one lesion at a time.

How to Care for Skin After Extraction and After Injection

Aftercare has the same goal in both cases: to let the skin recover from inflammation quickly and reduce the chance of marks. The details differ slightly, though, because the wound from extraction is a shallow open wound, while an injection leaves a small needle mark.

After acne extraction, the commonly recommended approach is as follows.

• Avoid touching and picking at the treated area on the first day, to reduce the chance of infection and reduce repeat inflammation
• Wash your face with a gentle product and clean water for roughly the first 1-2 days; you should not yet scrub the skin or use strong acids
• Pause topical retinoids or benzoyl peroxide on the extracted area for about 1-2 days, then return to using them as your doctor advises
• Use sunscreen consistently, because an area that has just been inflamed is more prone to dark marks than usual, especially in Asian skin tones
• Avoid applying makeup over areas with scabs until the skin has closed completely, which usually takes roughly 1-3 days

After an acne injection, the commonly recommended approach is as follows.

• Press gently with clean cotton if there is slight bleeding, and do not massage or rub the injected area
• Watch how the lump goes down over 1-3 days; if it is still swollen or becomes more painful after 5-7 days, go back to have the doctor assess it
• Do not ask for a repeat injection at the same spot too soon — generally it is spaced roughly 4-8 weeks apart, at the doctor’s discretion, to reduce the risk of indented skin
• Tell the doctor if you have previously had indented skin or loss of pigment from an earlier injection, because that affects the choice of concentration and amount of medicine

Both cases share one principle: do not rush into strong products to “heal faster”, because added irritation usually makes marks more noticeable instead. And if what actually concerns you is the marks left after acne subsides, or skin that has already become indented, those are a different set of care approaches that a doctor can assess.

How Often Can You Do It, and What Are the Risks?

Both acne extraction and acne injection have a sensible ceiling on frequency. Doing them too often does not make the skin improve faster; it increases the risk of marks and long-term changes in the skin.

For acne extraction, the frequency commonly used is about every 2-4 weeks, which is close to the cycle in which new comedones form and become visible. The main risk is not in what is done at the clinic, but in extracting or squeezing acne yourself between sessions. The AAD explains that squeezing acne yourself often pushes part of the plug deeper than before, which increases inflammation, makes the acne more noticeable and more painful, and risks infection from bacteria on the hands. The consequence people worry about most is dark marks and scars, which take many times longer to care for than the acne itself.

For acne injection, the risk to be aware of is local side effects from the corticosteroid. Information from Mayo Clinic states that side effects that can occur include thinning of the skin at the injection site and changes in skin colour, while dermatology information from DermNet states that local atrophy and hypopigmentation are side effects that can occur from injecting steroid into the skin layer. In some people this gradually improves over several months, but DermNet states that in some people the indentation may persist and does not fully return to normal in every person, so there is no guarantee of results. The more frequently injections are given, the more spots injected, or the higher the concentration used beyond what is necessary, the more the chance of these side effects increases. This is the reason doctors tend to space repeat injections at the same spot roughly 4-8 weeks apart, at the doctor’s discretion, and to inject occasionally according to indications.

An additional precaution concerns groups who should inform the doctor before the procedure, such as people with a history of raised scars or keloids, people taking blood thinners, people who are pregnant or breastfeeding, people with a history of allergy to anaesthetics or injectable medicines, and people with a skin infection in that area. This information affects the choice of method and the appropriate timing.

When Extraction or Injection Is Not the Answer

The clearest sign is when new acne keeps appearing to the point that you have to come back and manage it lesion by lesion every week. That indicates the problem lies in the underlying cause, not in the individual lesion, and repeating procedures usually does not change the situation.

The approaches to treating the underlying cause that doctors commonly consider are ongoing use of medication, such as topical retinoids to reduce clogging of the pores, benzoyl peroxide to reduce bacteria and inflammation, or antibiotics and other medicines according to severity and the doctor’s assessment. Information from Mayo Clinic states that most acne medications usually take roughly 4-8 weeks before a change is seen, and truly getting acne to settle usually takes several months, while the AAD advises that if you have used general acne-care products and see no change in roughly 4-6 weeks, you should consult a dermatologist, because treating acne early helps reduce the long-term risk of marks and depressed scars.

Clinically, there are also program and procedure options that a doctor may consider alongside, to care for acne as a whole rather than managing it lesion by lesion. At Onnyx Clinic, the available options include Program Acne Clear at THB 999 per session, Treatment 4 formulas at THB 799 per session, the Reju Acne program at THB 1,500 for the 2cc size and THB 2,999 for the 5cc size, and the Pico laser Acne program at THB 2,000 per session. None of these are items that suit everyone. The choice depends on the type of acne, its severity, the skin condition, and previous treatment history, all of which a doctor must assess first, and results vary by individual.

What to remember is that acne extraction and acne injection are good tools in their own context: they help clear plugs that are stuck there, and help painful acne nodules settle faster. But neither is a treatment that keeps acne from coming back, and acne is not cured by procedures alone without caring for the underlying cause.

Summary and Consulting a Doctor

Acne extraction suits whitehead and blackhead comedones, and works by removing the plug with sterile instruments. An acne injection suits nodules or cysts that are swollen and painful, and works by injecting an anti-inflammatory medicine into the lesion, which usually brings the lump down in roughly 1-3 days. Both methods have a ceiling on frequency and risks that have to be weighed, and neither replaces treating the underlying cause of acne. Results vary by individual. If you are not sure whether your current acne should be extracted, injected, or approached by treating the underlying cause first, you are welcome to come in for an assessment and an individual plan from the experienced doctors at Onnyx Clinic. Ask questions and book an appointment via LINE @onnyxclinic

References

• American Academy of Dermatology — Pimple popping: Why only a dermatologist should do it: aad.org
• American Academy of Dermatology — Updated guidelines for the management of acne (2024): aad.org
• Mayo Clinic — Acne: Diagnosis and treatment (drainage and extraction, steroid injection): mayoclinic.org
• DermNet — Intralesional steroid injection: dermnetnz.org
• NIH / PubMed Central — Dermatologist Use of Intralesional Triamcinolone in the Treatment of Acne: pmc.ncbi.nlm.nih.gov

This content is for general information only and is not a diagnosis or individual medical advice. Results vary by individual. Please consult a doctor for an assessment suited to you.