Approaching a Facial When You Have Acne

Facials are touted as a great way to keep your face clear of blemishes and looking youthful. When done right, some of the benefits may include unplugging pores, smoothing skin, increasing skin hydration, improving facial glow, and reducing skin oils based on your needs. Many people with acne get facials, and some studies estimate that over 20% of people with acne have tried facials before seeking help from a physician.^[1,2] While facials may seem promising, there are a few things to keep in mind when getting a facial. 

The First Step if You Are Getting a Facial for Acne

Make sure you have acne. There are several other conditions that cause pimples and can look like acne. Two conditions that can look like acne are rosacea and perioral dermatitis.

Rosacea can cause redness and red pimples, but often the skin in rosacea can also be extra sensitive and dry, making treatment a bit more complicated. Perioral dermatitis has pimples that appear around the mouth, nose, and eyes. The affected skin may have an impaired skin barrier and more skin sensitivity.^[3] This can also be more complicated to treat than traditional acne.

If a facial intended for acne is performed on someone with rosacea or perioral dermatitis, this can lead to irritated, red, and inflamed skin. If you have rosacea or perioral dermatitis, some of the steps of a normal facial may be skipped and customized so that the nourishing parts of the facial can still be performed without the parts that can be harsher to the skin (such as exfoliation or facial steaming).

The best way to approach this is to check with your local physician or dermatologist to identify what parts of a facial would be appropriate for you.

What Should You Expect from a Facial?

Facials are generally meant to relax you along with getting treatment to the face. Here are some of the steps involved with a facial and how your acne may respond. Depending on your esthetician or practitioner, some of these steps may be performed in different orders. But here are some common steps that may be included in a facial if you have acne:

Cleansing

Cleansing with a gentle face wash helps prepare your face for the rest of the facial and typically does not makes acne worse. 

Exfoliation

Exfoliation is where skin cells are removed from the surface of the skin and can help to unclog pores. A number of different creams or gels can help with exfoliation. Sometimes the exfoliation is done mechanically or sometimes by a chemical peel. Estheticians and practitioners, such as physician assistants and nurse practitioners, perform superficial exfoliation. Dermatologists perform deeper exfoliations, such as deeper chemical peels. Spa based facial exfoliations typically work on the superficial layers of the skin to assist in unclogging pores or removing the top-most layers of dead skin, which may be helpful in those with acne.^[4] 

Facial Steaming or Heating

Steaming has several purposes in a facial. Firstly, the increase in temperature and the moisture may soften the skin. Secondly, it may soften the material that is within the clogged pores, known as sebum, so that it can be more easily removed. The key is that both the heat and the moisture may allow for softer skin and sebum that can make extractions easier.

This step may be helpful if people with acne have a lot of blackheads, but caution should be used if other kinds of acne lesions exist as well. For example, inflammatory acne-like red bumps, deeper nodules, or pus-filled bumps, may become more inflamed and swollen with heating and steaming. If the steam or the facial wraps feel too hot, you should ask to have the steaming stopped or the wraps removed.

This step can be skipped if there are not many blackheads. 

Extractions and Clearing of Pores

This step needs to be performed with care. Extractions can lead to scarring if they are done too vigorously or if the lesions being extracted are inflammatory red bumps or nodules. Extractions are typically performed for blackheads. Other types of lesions may be more painful or bleed if they are extracted. Sometimes blackheads may be right next to more painful inflammatory lesions that can hurt during an extraction. Generally, extractions should be limited to blackheads.

In those with darker skin types, extractions that are too harsh can lead to dark spots that may develop as the extraction site heals (known as post-inflammatory hyperpigmentation). 

Facial Masks 

Facial masks can be tailored to each person’s skin. The ingredients in the masks can be directed to soothe the skin and reduce oil production for those with acne. Some of the materials used in these masks have been studied for their properties, but few have been studied for how they will specifically affect acne. Masks can be made from many different materials and some examples include clays, oils, botanicals, peptides, and cellulose. Materials like clay may have astringent (drying) properties^[5] that can be helpful in oily skin. The research into botanicals and natural products is growing to understand how they affect acne^[6,7] and facial blemishes.^[8] Two examples include epigallocatechin-3-gallate (a plant compound in green tea)^[7] and tea tree oil extracts.^[9] Ingredients should be discussed with an esthetician, dermatologist, or a qualified health professional before being used for a facial.

Moisturizers 

A facial typically ends with the application of a skin cream, moisturizer, or a gel. Typically, thinner moisturizers such as gels and serums may have a lower risk of clogging facial pores. Regardless, it is important to let the person doing your facial know if you tend to react or breakout with skin creams or other topical products.

Overall, facials can be fun, relaxing, and helpful whether you have acne or not. Acne generally cannot be cured with the use of facials alone, but they can be helpful when performed carefully along with medical therapies. Facials should be discussed with a dermatologist or qualified health provider to assess if facials are a right choice if you have acne.

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