Why acne treatment is split into three visits instead of done in one

People coming in for acne for the first time often ask how many sessions they will need. They usually add that a few days after extraction, new spots appear again.

Even skin that looks like one acne problem has several conditions mixed on one face: small bumps on the forehead, red painful inflammation on the jaw, marks where spots have settled, and pitted scars where they are old.

At the first visit, the skin often shows acne that has built up over time flaring all at once. In that state it is hard to tell which spots come back especially fast.

After one round of clearing, the skin's pattern shows. Some people have comedones that refill quickly on the forehead and cheeks; others have deep inflammation that keeps returning only on the jaw. The skin may look like the same acne, but these two people need different areas worked on at the next visit.

At the second visit, the first things checked are whether the spots extracted last time have filled again and where new red inflammation has appeared. Three visits does not mean the same procedure three times; the extraction range, the lesions that need an anti-inflammatory injection and the prescription are adjusted every visit.

Comedones, pores clogged with sebum and dead skin, are better extracted. Left alone, they turn into inflammation. Red, firm bumps usually have inflammation going on underneath, so they are not squeezed; an anti-inflammatory injection is placed there to calm them first. Pressing hard can push the contents inward instead of out, causing more swelling or leaving a pitted scar.

One clean day after extraction does not last. Sebum keeps coming and dead skin builds up in the pores again. So a prescription is part of the three visits, and procedures and medication go together. Irritated skin is calmed with a soothing treatment, and the red and brown marks left where acne has passed are treated with a toning laser.

If you are in Korea for only a short stay, keep in mind that the first visit mainly clears what has built up; the pattern that shapes the next visits only shows after that.

"My acne has calmed down but the marks and pitted scars bother me more." That is something often heard too. The clinic's acne care is split into a three-visit clearing course for acne that is still coming up and a three-visit scar course for the scars left behind.

People whose small bumps and red acne keep returning start with the clearing course. People whose new acne has calmed but who are bothered by pits and an uneven texture go to the scar course. Even if the scars bother you most, if red painful acne keeps coming up, it is better to do the clearing course first. Only once the inflammation settles can marks and pits be told apart accurately.

Red marks are a blood vessel response and brown marks are pigment, so they fade with time or with toning. A pitted scar is dermis that has actually sunk, so repeated toning alone will not fill it. That is why the scar course includes treatments like Potenza that give the dermis a stimulus to regenerate.

Some people come in because of scars, yet their skin still shows red inflammation coming up. Then the advice is, "Let's hold off on scar treatment for a little while." Even if the scars are worked on, new acne coming up on top turns those spots into marks and pits again.

If the skin has not settled yet, the first step is to reduce how often new inflammation appears. After that, red marks, pigment and pits are looked at separately, one by one.

Many people ask whether acne will stop once all three visits are done. The course is called "clearing," but that does not mean not a single spot for life. Over three visits, new breakouts become fewer and less frequent, and deep inflammation is kept from turning into scars.

Some people improve dramatically after treatment and then come back three or four months later with acne returning. As long as sebum keeps flowing and dead skin builds up in the pores again, acne can come back, so the improved state does not simply stay fixed.

One study looked at how quickly acne returns after treatment stops. Researchers at several North American centres took 243 patients with severe acne who had improved by at least half after 12 weeks of treatment and split them in two for 24 weeks: one group kept applying adapalene–benzoyl peroxide gel and the other applied a gel with no active ingredient (Br J Dermatol 2011 · PMID 21457209).

In the no-active-ingredient group, one in four had worsened again by day 56; in the group that kept using the medication, that point came at day 175. At week 24, 78.9% of those who kept using the medication held on to their initial improvement, compared with 45.8% of the others.

This study is about patients with severe acne continuing a topical medication, not about the clinic's three-visit course. Take from it only that, after improving, quite a few people see acne return within months once they stop.