Why clearing acne is like getting a six pack or growing a seed

If you have ever spoken to me, you probably know by now that I am really into analogies and there are two things I always compare the acne clearing process to: growing a seed in a garden and getting a six pack.  Since there are so many misconceptions and misunderstandings about acne, I have found that these comparisons make the acne clearing process easy to understand for people.

CLEARING ACNE IS LIKE TRYING TO GET A SIX PACK

I use the six pack analogy because it takes just as much time and work to get clear skin as it does to get a six pack and both processes require a multitargeted approach.  Both our skin and our bodies are affected by internal and external factors so they require a comprehensive approach that targets all of those different factors at once. For example, you can’t just get a six pack by doing cardio.  You have to do cardio AND strength training AND watch your diet AND pay attention to your lifestyle.  Well, you also cannot get clear skin by just using the right skin care products because acne is a multifactorial disease that is caused by Retention Hyperkeratosis and exacerbated by many other triggers.  So you also have to manage other factors like your diet, lifestyle, hormones, household products, and a bunch of other things that we go over in detail in my 8 Steps To Clear Skin e-course. 

THE ACNE PROCESS IS LIKE GROWING A SEED

In addition to being affected by multiple factors, acne also takes place in multiple stages which is why I use the other analogy of growing a seed.  Much like a flower, acne doesn’t just start and end as we see it.  It takes time for a flower to bloom and it has to first make its way through many stages: first, it starts as a seed then eventually sprouts into a bud then finally blooms into a flower that we see above ground.  Well, acne also takes a lot of time to make its way to the surface of our skin and develop into the pimples that we actually see and notice and it also starts as a little seed deep beneath the surface that we don’t see until later.

WHAT IS AN ACNE SEED?

The technical term for an acne seed is a microcomedone.  A microcomedone is a cluster of mostly dead skin cells that might be mixed with oil and comedogenic ingredients from pore-clogging products.  It’s called a micro-comedone because when it first forms, it is microscopic so it’s invisible to the naked eye.  And I call it a seed because it literally looks and feels like a sesame seed because it’s firm and white.  It’s also the seed from which all the different types of acne grow from.  This is basically the baby version of a pimple that gets planted beneath the surface of the skin.  As it matures, it also passes through different stages of growth: first as an open or closed comedone (blackhead or whitehead) then eventually a papule, pustule, cyst, and nodule which we go over in detail in our post about The Seven Different Types of Acne.  What is unique about our acne program is that we not only target the multi factors that contribute to acne but we target each of the multiple phases of acne.  We have acne programs available at our San Francisco acne clinic and worldwide through our virtual program.

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Direct vs indirect acne triggers: what you don't do is as important as what you do

When people are trying to figure out what is breaking them out, they tend to think about things they are eating, touching, or doing that might directly impact their skin.  For example, one of the most common things people blame their breakouts on are foods like chocolate or greasy food (which, by the way, are both actually not triggers at all).  What they don’t realize is that what you don’t do is just as likely to break you out as what you do. I often compare the clearing process to trying to get in shape so let’s use the analogy of trying to get a six pack as an example.  So if you were trying to get a six pack, there would be direct triggers that might directly impact your fitness like eating donuts three times a day or drinking lots of alcohol. But not working out can also indirectly affect your progress because you are missing the benefits of dropping calories and strengthening your muscles that working out would provide.  Just like the process of trying to get in shape, the clearing process is also affected by both indirect and direct triggers.

WHAT IS A DIRECT ACNE TRIGGER?

A direct acne trigger is a trigger that directly impacts the clearing process.  There are way more direct triggers than indirect triggers and we explain each of them in detail in our 8 Steps To Clear Skin e-course:

Pore clogging products
Products like shampoo, conditioner, and laundry detergent that contain comedogenic ingredients.

Lifestyle triggers 
Things like sun exposure and acne mechanica.

Ingestible triggers
Including diet and medications.

WHAT IS AN INDIRECT ACNE TRIGGER?

An indirect acne trigger is something that can break you out because you are not doing it.  Indirect triggers tend to take longer to cause a breakout than direct triggers but not always:

Not using your acne clearing products
If you are using products that facilitate the clearing process and you skip a few sessions, acne seeds have a chance to form deep beneath the skin that can take months or years to show up on the surface for reasons I will explain below.  There are many reasons why people might not be using their acne clearing products but the most common reasons I see with my clients are that they travel and forget their products, they run out of their products, or they decide they want to start playing around with new products.  

Not keeping up with acne treatments
If you stop or delay receiving treatments like ours that help clear out your follicles and accelerate the clearing process, this can also cause a slow backup of acne seeds that form inside of the skin.  This is also a trigger that may take months or years to build up so we have clients who don’t keep up with their maintenance treatments and then they come back a year later freaking out and wondering why they are broken out.  They usually start obsessing over potential direct triggers like diet too without realizing that they are breaking out from something they failed to do months or years ago.

DELAYED REACTION TIMES FOR DIRECT VS. INDIRECT TRIGGERS

As we also teach in our course, different trigger categories (ingestibles, lifestyle, products, etc) have different delayed reaction times.  So if you eat cheese, that typically takes longer to show up as a visible pimple on your face than stress would.  As I mentioned, indirect triggers tend to take longer to show up then direct triggers do.  So if your Doctor tells you to avoid your acne clearing skincare products while your skin heals after a laser procedure, it will take longer to break out from not those products than it would to break out if you use a pore-clogging liquid makeup.  Since indirect triggers have such a long delayed reaction time and people tend to attribute only direct triggers to breakouts, most of my clients won’t even connect the dots.  I had a client run out of one of her active products while she was traveling out of the country so she didn’t use her serum for 3 weeks.  She didn’t notice an increase in breakouts during those three weeks or immediately after so skipping her serum had actually planted seeds deep inside of her follicles.  When those seeds finally moved up towards the surface of the skin, she didn’t even think to attribute it to the serum she skipped months before and instead started obsessing about what she was eating instead. So the next you have a breakout, don’t just ask yourself what you have been doing.  Ask yourself what you haven’t been doing that might have triggered you and think months back, not days back.

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All about rosacea and acne rosacea

Rosacea is a chronic skin condition that most notably causes flushing and redness on the face. Just like acne, it’s a highly misunderstood condition and it’s often misdiagnosed. True rosacea is actually very rare and in the decade or so that I have been practicing, I have probably had over a hundred people who thought they had rosacea because they were diagnosed or they self-diagnosed and only 3 of those people actually had rosacea. Symptoms of rosacea might flare up then calm down in cycles but rosacea flare ups tend to last weeks or months whereas acne flare ups tend to last years.  

ROSACEA IS OFTEN MISDIAGNOSED FOR THESE CONDITIONS

• Acne rosacea is often confused for a type of acne called inflamed acne

• Irritation from using skincare products that are too strong, irritating, or not appropriate for your skin type

• Irritation from using skincare products that are not nourishing or moisturizing enough 

• Redness from chronic picking or post-inflammatory hyperpigmentation (PIH) which are dark marks leftover from inflamed acne or picking

• Redness from having a genetic tendency to flush easily that is common in people with fair skin

SYMPTOMS

There are four subtypes of rosacea that I list below but there are some common symptoms that can occur with all of the subtypes:

• Redness and flushing on the face or body that looks like a sunburn

• Broken blood vessels on your face or eyes that look like spider veins

• Rough, raised, dry patches called plaques

• Sensitivity, burning, stinging

• Oils skin or enlarged pores

• Bumpy skin texture

ROSACEA TYPES

You might have one or a combination of these subtypes and your type of rosacea might also shift throughout your life:

• Subtype One: Erythematotelangiectatic Rosacea

  This is the most well known form of rosacea characterized by persistent redness, flushing, and enlarged blood vessels.

• Subtype Two: Papulopustular Rosacea
  This is rosacea that occurs with acne-like breakouts.  It can also show up as hardened patches called plaques and excessive oiliness.

• Subtype Three: Phymatous/Rhinophyma Rosacea
  This is a rare type of rosacea that causes thickening skin on the cheeks, chin, forehead, ears, or nose (Rhinophyma).

• Subtype Four: Ocular Rosacea
  This type of rosacea affects the eyes and can cause symptoms like pain, swelling, redness, and vision issues.

CAUSES

The cause of rosacea is unknown but, much like acne, it’s likely a multifactorial disease that is caused by the perfect storm of genes, internal factors, and external factors.  There are theories that it might be caused by a bacteria called Helicobacter Pylori, an overgrowth of demodex mites, or a protein called cathelicidin that might cause redness and swelling.  Similar to acne, there are many potential internal and external triggers that can initiate a flare up or exacerbate an existing flare up.  Everyone has different triggers so you might be triggered by one or a combination of any of these:

• Spicy foods

• Hot drinks

• Exercise

• Cosmetics and skincare products

• Certain drugs + medications

• Extreme weather (cold or hot)

• Sun exposure

• Wind exposure

• Stress

• Heat, humidity

• Alcohol

• Smoking

• Improper skincare routine (products that are too strong or not nourishing enough)

RISK FACTORS

Rosacea can affect anyone but these factors make it more likely:

• Fair skinned people with blond hair, blue eyes, and European descent

• Women are more like to develop rosacea than men

• Rosacea usually affects people between the ages of 30-50

• Family history of rosacea

• Smoking can increase the risk

DIAGNOSIS

There are no tests to diagnose rosacea but your Doctor will examine your skin and ask you questions to determine whether or not you have rosacea.  They might also test you to rule out lupus or allergies which both have similar symptoms. As I mentioned, many of our clients who have red, sensitive skin or a type of acne called inflamed acne come to us mistakenly thinking they have rosacea or acne rosacea because they have been wrongly diagnosed by a doctor or they have self diagnosed.  This isn’t a surprise since Doctors and Dermatologists tend to spend very little time actually touching and getting to know our skin, lifestyle, habits, and skincare routines. Most of the time, we find that they don’t actually have rosacea and their skin is just raw and red from not having a proper skincare routine or they have one of the four types of inflamed acne which are also characterized by redness, swelling, and soreness.

TREATMENT

Just like acne, there is no cure for rosacea and it’s a condition that needs to be managed long term using a multi-targeted approach.  Also, just like with acne, Dermatologists can be less than helpful and will likely spend 2 minutes barely looking at your skin before writing you one prescription after another.  In my experience, Dermatologists and Doctors rarely take the time to really understand our particular manifestation of a condition and to put the time into developing a comprehensive treatment plan that is customized based on our unique skin type, rosacea type, and lifestyle factors.  They will likely prescribe you a bunch of different topical and/or oral medications and they will just keep on prescribing until you land on one where the improvements you see outweigh the potential side effects. Some common treatments might include:

• Antibiotics like doxycycline, tetracycline, or minocycline may reduce swelling, inflammation, and the acne like bumps that occur with Papulopustular Rosacea.

• Isotretinoin is a very strong drug that may be prescribed under one of it’s brand names like Accutane, Absorica, Myorisan, Sotret, Zenatane, Amnesteem, or Claravis.  Potential side effects include vision and hearing problems, birth defects, liver or pancreas problems, increased pressure inside the skull, and joint pain.

• Topical treatments like Brimonidine 

THE AES SOLUTION

Many of our clients with acne rosacea (subtype 2: Papulopustular Rosacea) have seen significant improvements with our prescription-free program using a combination of personalized product plans made up of balancing and nourishing skincare products and lifestyle coaching.  Since most people who come to our clinic thinking they have rosacea actually just have irritated skin, inflamed acne,or PIH, we take a 3-step approach to determining whether or not they actually have rosacea:

1. The first step whether we are working with a client who has rosacea or acne is to rehabilitate any sensitivity and dryness using our skincare products made up of balancing, nourishing ingredients.  This helps rule out sensitivity and irritation. If a client is local and able to come to our clinic, we will customize a product plan for them during the Initial Consultation but we also teach our long distance clients how to customize their own product plan based on where there skin is at on any given day through our Virtual Program and our e-course The 8 Steps To Clear Skin. 

2. Once someone is on an appropriate product plan, the second step is to clear their acne with our prescription-free program which helps rule out regular acne vs. rosacea acne. 

3. Once the acne is cleared, we target the PIH using specialized chemical peels and products which rules out the possibility that the “rosacea” is actually pigmentation.

If there is still remaining redness or other rosacea symptoms after all of these steps, then it can be deduced that rosacea is actually present.   If you are curious to learn more, you can get in touch with any questions through our website or Instagram @aes_acneclinic.

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Heat and steam are actually terrible for acne so skip the sauna and the steam

Your Esthetician steams your face before extractions because she says it opens up your pores. You go into the sauna thinking that it’s expelling toxins and letting your pores breathe.  Sorry to burst your bubble but none of that is actually happening and you are likely causing more harm than good to your acne-prone skin. We never steam our clients before an acne facial or body treatment and we’ve had some clients get upset that they are because they think we are cheating them out of some essential part of the process.  But we don’t use steam because heat and steam are more likely to swell your pores shut than open them up! Also, we never perform extractions during the initial appointment precisely because we want clients to begin using the product kits which help break up congestion in the follicles so they are loose and easy to extract so even if steam did open up the pores, it wouldn’t be necessary anyways.

This is explained by basic physics people
Heat expands, cold contracts. Just think about wearing a ring on your finger-have you noticed that it might feel tight and swollen in the summer when the weather is warmer and a little looser in the winter when it’s colder?  This is exactly what happens to your pores. When you are exposed to heat or steam, your pores swell up and the congestion that is already struggling to be contained inside of our follicles can get squeezed so tight that the follicle wall might rupture and become more inflamed.  So if you are already struggling with an inflamed acne type, especially cystic acne, you should be avoiding saunas and steam because they can worsen inflammation. If you have a primarily non-inflamed acne type, you might be able to get away with heat and steam as long as you don’t notice an increase in inflammation symptoms such as redness, swelling, pus, and soreness.

Only oil can stretch the pores open or closed
Pore size is mostly genetic and there isn’t anything you can do to significantly change it.  Pores don’t actually get smaller or bigger on their own: How big or small your pores are depends on the amount of oil your sebaceous glands produce because oil is what flows through the follicle and stretches the pores open, making it appear larger or smaller.  And oil production is determined by testosterone levels because testosterone is the chemical messenger that triggers the oil gland to get pumping among many other things. Testosterone levels are primarily biological. For example, we are born with biological clocks that signal our testosterone levels to surge during puberty, pregnancy, and the menstrual cycle.  There are certain dietary and lifestyle factors that are within our control like dairy, soy, and stress that can impact testosterone levels so if we can reduce the levels of testosterone in the body, we can reduce oil production, and maybe cause the pores to appear smaller because there is less oil stretching the pore open. This is a big maybe though and it’s unrealistic to expect poreless skin because all of humans have oil glands that are constantly producing oil throughout our lives.  I know this is not good news if you are a pore-hater but remember that oil and pores serve really amazing life saving functions so if you really had the choice, you wouldn’t want to close them up!

Topical products might help 
Some active ingredients in acne products like benzoyl peroxide can help absorb oil on the skin which might make pores appear smaller.  Other ingredients like alpha hydroxy acids can exfoliate and break up congestion in the follicles so pores might appear smaller as congestion gets purged out of the follicles.  Our Clearing Treatment contains benzoyl peroxide and our serums and peels contain alpha hydroxy acids and other exfoliating ingredients that help cut oil and clear the follicles from the inside out.  The holistic aspects of our program include dietary and lifestyle recommendations that aim to target and reduce oil production. We don’t promise that our program or products will deliver smaller looking pores because, as I mentioned, it’s largely biological and the changes we might be able to achieve will be minimal.  There really is no program or product out there that will give you flawless poreless skin but if you have a chance at minimizing your pore size at all, our program is probably your best shot.

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The differences between teenage acne and adult acne and why they are mostly similar

Any time I see another clinic or skincare product that claims to target “teenage acne” or “adult acne”, I know right away that they probably don’t know what they are talking about.  Or maybe they do know what they are talking about and they are just using those terms as a way to make money marketing to different demographics. But if they actually believe that teenage acne and adult acne are so different that they require different interventions, they don’t understand the basic physiology of acne.  There are a few differences between acne as a teenager and acne as an adult but they are fundamentally similar and require the same approach.

Difference #1: Teenagers have increased hormones which causes more oil production
The most notable difference between adult and teenage acne is that teenagers usually have increased hormone fluctuations which leads to excess oil production.  Some adults can also have significantly increased hormone fluctuations when they are pregnant, stressed, using certain medications, menopausal etc. Hormones don’t cause acne though and they don’t even directly trigger acne: hormones exacerbate acne indirectly by triggering the oil glands into overdrive which then triggers a genetic condition called RH that is at the root of all acne regardless of what age, what type, or how severe it is.  If someone has increased oil production whether they are a teen or an adult AND they have RH, their acne can be more stubborn and it can take longer to get them clear because it can be difficult to purge their follicles at a faster rate than they are being filled up by oil and other debris. The increase in oil production can also lead to more inflammation so teenagers might have acne that is more big, red, sore, and pus filled than adults. 

Difference #2: Teenagers have unhealthy lifestyles (not that it matters anyway)
Some professionals say that teenagers have more acne because they lead an unhealthy lifestyle that includes lots of junk food, fried foods, and lack of sleep.  I know adults who live terribly unhealthy lifestyles and teens that live healthy lifestyles but, to be honest, it doesn’t really matter because living or eating “unhealthy” does not cause acne and living or eating “healthy” does not cause clear skin.  I know a lot of teens who eat like crap and never get a pimple and I know a lot of adults who meditate, get good sleep, eat clean and still have acne. In my experience working with teens, their biggest barrier to getting clear is not usually their hormones or their lifestyles: it’s their lack of discipline.  Teenagers usually have a harder time sticking to the guidelines that living an acne-friendly lifestyle requires. They also tend to be less motivated because they are not usually the ones paying for our program and they have a harder time conceptualizing that there is a delayed reaction between trigger exposure and breakout.  So while they are away at summer camp, they might think it’s okay to eat potentially triggering foods like cheese because they won’t actually experience a breakout for 1-3 months. On the other hand, adults tend to be more disciplined and they are usually so fed up with acne by the time they are in their twenties and thirties that they are willing to do whatever it takes to get clear.  Of course, there are exceptions to every rule and I have had some teenage clients who are more disciplined than some of my adult clients but adults are more likely to be able to get away with a lack of discipline because they don’t have the excess oil production to account for. It’s important to note that there are certain foods that need to be avoided such as dairy, soy, and peanuts but the reason they need to be avoided is not due to the fact that they are unhealthy but rather because they can lead to an increase in hormones.

Difference #3: Teenagers tend to breakout in different areas than adults
Teenagers tend to breakout primarily in their t-zone and adults usually breakout on the lower half of their face and the perimeters (forehead, temples, cheeks).  This is another generalization with lots of exceptions and the location of someone’s acne can have a lot to do with which products they are using. For example, an adult might break out on their forehead because they are using a pore-clogging shampoo and a teen might break out on their cheeks from using a pore-clogging blush even if that is not their typical breakout area.  There are lots of misconceptions about what causes acne to show up on different areas of the face and I mostly blame the face maps that are found all over the internet nowadays. When my clients tell me, “I think my acne is hormonal because it’s along my jawline and the lower half of my face,” I cringe. If acne along the jawline was due to hormones then why do most teens get acne on their t-zones?  It’s bullcrap. Forget those stupid face maps. The areas that we tend to breakout shift throughout our lives in a wave that starts on our t-zones during puberty and migrates towards the edges and bottom half of our face as we move into our twenties and thirties because our oil glands tend to get more activated in those areas.

Hormones, oil, and lifestyle only matter if you are born with RH
Why do you think some teenagers get acne and others don't despite the fact that they all tend to have hormonal fluctuations and an “unhealthy” lifestyle?  It's because only some teens are born with Retention Hyperkeratosis (RH) which is a genetic disease that causes a dysfunction in the hair follicles that leads to an overproduction of skin cells and an inability to wash them out of the follicle effectively. So an increase in oil production doesn’t create acne for a teen who isn’t born with RH because they have a natural cleaning system built into their follicles that is able to wash the excess oil out.  Teenagers who are born with RH essentially have a backed up plumbing system so even just a little increase in oil can cause their follicles to completely overflow.  

Why teenage acne and adult acne are still more similar than different
Despite a potential difference in hormones, behavior, and breakout location, the underlying cause of acne and the majority of its triggers are the same for teens and adults.  Acne is a multifactorial disease and hormones and oil are just two of dozens (if not hundreds) of potential puzzle pieces. A good acne program will account for oil and hormones anyways regardless of your age by having you eliminate certain foods, supplements, lifestyle factors and products that may be contributing to hormonal fluctuations and/or oil production. A good acne product plan will also include ingredients and instructions to fight inflammation whether you have severely inflamed acne, mildly inflamed acne, or no inflammation at all.   And, most importantly, a good acne program will target the potential triggers AND the underlying cause of acne and once those factors are managed the location of your breakouts is obsolete.

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The root cause of acne is a genetic disease called Retention Hyperkeratosis-not hormones or diet or a poor lifestyle

When clients first come to see me, it takes a while to clear their heads of all of the lies and misconceptions they have been brainwashed into believing about acne.  Whether a client is starting our program with an in-person Consultation or our E-Course, we always start with a lesson on the cause of acne because I have never met a single person who actually knows what the cause of acne is.  Most people blame their acne on puberty, hormones, stress, diet, lack of exercise, weather, pollution, gut imbalances, and the list goes on and on. Although all of those things can be contributing factors, the true root cause of acne is a genetic disease called Retention Hyperkeratosis (we just call it RH because it’s so much easier).  The entire first lesson of our e-course breaks down the details of RH but here are a few tidbits: 

We are born with RH in our DNA
We are either born or not born with a predisposition towards retention hyperkeratosis. Just like any gene, it doesn’t have to be passed down directly from our parents and we might have inherited it from a grandparent or great great grandparent. The gene also has dormant and active periods and usually requires a trigger to become activated. This is similar to how you might have a genetic predisposition towards an allergy that might not get triggered until you are in your 20s and you might have periods where your symptoms are not as active as other periods. The gene also tends to manifest in different ways in different family members so your Mom might have had mild non-inflamed acne that was primarily diet triggered only for a few years as a teenager but you can have severely inflamed acne that is hormonally triggered from the ages of 13 to 45. 

RH is similar to diabetes
Our method is largely based on the research of Dr James Fulton and in his book, Acne RX, he compares acne to diabetes. Diabetics are born with a genetic predisposition that makes them unable to effectively process insulin and those of us with acne are born with a gene that makes it difficult for us to process skin cells effectively.  Acne and diabetes are also both conditions we are born with that don’t usually show symptoms until later and they are both multifactorial diseases in that they are triggered and exacerbated by a multitude of internal and external factors including diet and lifestyle.

RH manifests in many different ways throughout our lives
Even though RH is the root cause of acne, there are many other internal factors (e.g. hormones, stress) and external factors (e.g. skincare products, household products) that play a role in determining how the condition manifests itself.  So what type of acne we have at any given moment, what triggers our acne and in what amount, the location of the acne on our face or body, and the severity of our acne shifts throughout most of our lives. This is one of the many reasons why acne treatments still have such a low rate of success.

RH is a chronic disease but most of us reach a burnout stage at some point
For most of us, acne is a chronic condition that we will have to deal with for many years.  Most of us reach a burnout stage at some point in our lives where the condition just goes dormant but nobody knows when or why that happens.  For the lucky few, their acne gets triggered when they start puberty and it burns out when puberty ends which is why there is a misconception that acne is a teenage phase but many of us suffer with it well into our twenties, thirties, and forties although it might go through phases of being active and dormant throughout.  I have had many clients who were initially triggered by puberty in their teens whose acne slowed down in their twenties, completely cleared in their forties, and then got retriggered in their fifties because of menopause.

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Acne Scars and Dark Marks are Two Different Things

Acne scar

Post-Inflammatory Hyperpigmentation (PIH)

It’s amazing how many people mistakenly confuse the dark marks leftover from acne (post-inflammatory hyperpigmentation) with acne scars. I have clients walk through my doors that have done HUNDREDS of hours of research on acne and yet it seems the more information they have consumed, the less informed they are. Acne scars and dark marks are important to understand and be able to distinguish because if you suffer from acne, chances are you will experience one or both of these at some point on your acne journey. Understanding them can also help you take the necessary actions to prevent them in the first place.

How to tell the difference
Acne scars are textural changes in the skin that can be either indented or raised. Post-Inflammatory Hyperpigmentation looks like discoloration that may be red, brown, purple, or white but these marks are flat rather than textured. Scars and pigmentation may also appear together in the same area especially in cases of picking.

The causes
Acne scars and dark marks both occur in response to inflamed acne and picking but they are caused by two different mechanisms. Dark marks occur when inflammation triggers an increase in melanin which are pigment producing cells. Scars on the other hand occur when inflammation essentially eats away at the skin’s tissues causing the tissue to atrophy or overgrow.

Are they treatable?
Dark marks leftover from acne are usually treatable but , unfortunately, it’s nearly impossible to completely eliminate acne scars. There are treatments that can improve their appearance but it’s incredibly difficult to restore skin back to its natural state once the tissue has been damaged. Check out our post on dark marks for more information on how to treat them.

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You actually can't make your pores smaller

Before we talk about pore size, let’s start with a little lesson on what a pore actually is because I’ve found that most people think they know but they actually don’t know what and where this basic skin structure is.  It’s not our fault we are so misinformed: we hear skincare companies say their products “clean deep down inside the pores” and see visuals in TV commercials that show products going into the “pore” and washing out debris.  But a pore is not the tube-like structure that extends beneath the surface of the skin where acne and debris form. That tube-like structure is called a follicle and the pore is just the opening to the follicle on the surface of the skin.  So you can’t actually “clean deep down inside the pores” because there is nothing deep about the pores-they are just a surface structure that acts like a gateway to all of the truly deep stuff like the sweat glands, oil glands, fat, nerves, and the follicles where acne forms.  In my post about how heat and steam are actually terrible for acne, I discuss how pore size is determined by what is inside of the follicle so the next two sections are taken directly from that post:

Only oil can stretch the pores open or closed
Pore size is mostly genetic and there isn’t anything you can do to significantly change it.  Pores don’t actually get smaller or bigger on their own: How big or small your pores are depends on the amount of oil your sebaceous glands produce because oil is what flows through the follicle and stretches the pores open, making it appear larger or smaller.  And oil production is determined by testosterone levels because testosterone is the chemical messenger that triggers the oil gland to get pumping among many other things. Testosterone levels are primarily biological. For example, we are born with biological clocks that signal our testosterone levels to surge during puberty, pregnancy, and the menstrual cycle.  There are certain dietary and lifestyle factors that are within our control like dairy, soy, and stress that can impact testosterone levels so if we can reduce the levels of testosterone in the body, we can reduce oil production, and maybe cause the pores to appear smaller because there is less oil stretching the pore open. This is a big maybe though and it’s unrealistic to expect poreless skin because all of humans have oil glands that are constantly producing oil throughout our lives.  I know this is not good news if you are a pore-hater but remember that oil and pores serve really amazing life saving functions so if you really had the choice, you wouldn’t want to close them up!

Topical products might help 
Some active ingredients in acne products like benzoyl peroxide can help absorb oil on the skin which might make pores appear smaller.  Other ingredients like alpha hydroxy acids can exfoliate and break up congestion in the follicles so pores might appear smaller as congestion gets purged out of the follicles.  Our Clearing Treatment contains benzoyl peroxide and our serums and peels contain alpha hydroxy acids and other exfoliating ingredients that help cut oil and clear the follicles from the inside out.  The holistic aspects of our program include dietary and lifestyle recommendations that aim to target and reduce oil production. We don’t promise that our program or products will deliver smaller looking pores because, as I mentioned, it’s largely biological and the changes we might be able to achieve will be minimal.  There really is no program or product out there that will give you flawless poreless skin but if you have a chance at minimizing your pore size at all, our program is probably your best shot.

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6 ways to prevent forehead acne

Most of our clients blame their bangs or their oily hair for the breakouts along their hairline.  Others have seen too many face maps on Pinterest and suspect their forehead acne is a manifestation of their poor digestive systems.  But if you are breaking out on your forehead or anywhere else on your hairline, it’s likely triggered by comedogenic ingredients in your hair products, towels, and pillowcases.  Here are some tips on how to eliminate forehead breakout triggers but keep in mind that preventing new acne from forming is just the first step. Once you eliminate a trigger, you still have old acne sitting in your skin that needs to be pulled or “purged” out which is why getting clear requires a comprehensive and multi-targeted process like our program:

1. Do not use shampoo, conditioner, or styling products that contain potentially pore-clogging ingredients. Check every hair product against our comedogenic ingredients list and if you purchase a product online, check the ingredient list on the actual packaging when it arrives to make sure it is actually acne-friendly because products are often reformulated and not updated on websites.

2. Bring your own acne-friendly hair products with you whether you are getting your hair colored, cut, styled, or blow dried and explicitly tell your stylist to only use those approved products on your hair.  If possible, wash your hair right before your appointment so they don’t use salon towels on your hair which may have residue from cloggy detergent or fabric softener on it.  

3. If you are getting your hair colored or doing some type of keratin treatment or brazilian blowout, unfortunately, you are likely going to be exposed to some comedogenic ingredients.  There isn't much that can be done in this case so at least try to minimize the impact by washing your hair out that night. If you get some type of treatment that needs to be left in your hair for a few nights, use a new pillowcase every night so the residual from the nights before are not making contact with your face.

4. Never use the towels provided at a gym or workout studio because they are likely washed with comedogenic and highly fragranced detergent.  Always bring your own.

5. Don’t travel without your own shampoo, conditioner, styling products, pillowcase, and towel.  Hotels also use highly fragranced and/or comedogenic detergent, fabric softener, and dryer sheets that leave a waxy residue that spreads to your hair and face.

6. Follow these guidelines regardless of how often you go to the hair stylist or travel.  A lot of people think that just because they don’t travel or get their hair done often that they don’t need to use caution but it only takes one ingredient in one product to touch your face one time for one second to trigger a breakout.  This means that just going to the hair stylist or traveling once can plant acne seeds in your skin that take months to get out.

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Post-Inflammatory Pigmentation: Acne Marks and Discoloration Caused By Pimples

What Is Post-Inflammatory Pigmentation?
Post-Inflammatory Pigmentation is the fancy term for skin discoloration caused by inflammation. Unlike acne scars, pigmentation usually resolves on its own and is highly treatable. If you read my post on the seven different types of acne, you know that there are four types of inflamed acne and any one of these can lead to discolored marks that last for weeks, months, and even years after the acne itself is long gone. You can even cause a non-inflamed acne lesion like a blackhead or whitehead to become inflamed by picking at it which is why leaving your hands off your face is so important. The most common type of discoloration causes the skin to turn darker or HYPER-pigment although, in rare cases, your skin might HYPO-pigment or turn lighter. There are three types of post-inflammatory pigmentation or discolored marks that can occur from inflamed acne or picking: Postinflammatory erythema which are pink or red marks, postinflammatory hyperpigmentation which are brown marks, and postinflammatory hypopigmentation which are white marks.

Postinflammatory erythema

Postinflammatory hyperpigmentation

Postinflammatory hypopigmentation

How To Prevent Pigmentation
The most effective and sustainable way to prevent pigmentation is to clear the acne itself. If your acne is still active though, there are two keys to preventing pigmentation:

1. Reducing Inflammation: this is key because it is the inflammation rather than the acne itself that causes the pigmentation in the first place. The two main tools we use to reduce inflammation with our program are icing and using an effective and non-comedogenic benzoyl peroxide product like our Clearing Treatment.

2. Avoiding abrasion and pressure: pressure and abrasion inflicted on the skin can send signals to our bodies that we are injured which can then set off the inflammatory response that leads to pigmentation. The best way to avoid this is to avoid picking or even resting against your hands or anything else that might put pressure on areas of your face or body that are broken out. Also, avoid any form of mechanical exfoliation (scrubs, exfoliating brushes, loofahs, microdermabrasion) which can tear and damage the skin.

How To Treat Pigmentation
Treating pigmentation should only be done once your skin is completely clear. If your skin is still broken out, you will likely be wasting your time and money treating the existing pigmentation because you will likely just have more pigmentation come up from future breakouts. The methods used to treat pigmentation also typically speed up the cell turnover process which can accelerate the rate of acne movement and trigger an inflammatory response that actually induces more pigmentation. Once your skin is completely clear, the most effective way to get rid of pigmentation is a combination of mild chemical peels and a daily product plan that helps purge the pigmented cells out of the skin. Our serums contain mandelic acid and lactic acid which are two of the most gentle and effective exfoliants for clearing acne and our acne facials include peels that contain a cocktail of ingredients meant to target acne and speed up the lifting and lightening of all three types of pigmentation.

How Long Does Pigmentation Treatment Take and What To Expect
Pigmentation usually takes longer than acne itself to clear out of the skin. With our program, most people see acne clear within 6-8 treatments over 3-4 months but it can take 3-4 times as long for the pigmentation to lift depending on how aggressive your product plan is and what type of peels your skin can tolerate.

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