When acne injections leave a dent and why the dose is kept small

"Doctor, I heard the spot dents after an acne injection?" This question always comes back when an injection is suggested for a red, swollen pimple. Many people arrive having read reviews saying their skin sank after an injection.

So many people try squeezing a throbbing spot themselves or simply wait for it to go down.

A red, hard, swollen pimple hurts even when you just touch it, and there is a large lump under it. The injection puts a very small amount of anti-inflammatory medicine into that spot. Afterwards people notice these changes.

• The throbbing of a spot that hurt to the touch eases
• A large swollen lump flattens
• There is less worry about dents and marks from squeezing by hand
• The needle mark barely shows, so you can go about your day

The 2024 American Academy of Dermatology acne guideline also includes adding an injection for large, swollen lesions as a recommendation. It is listed as a good practice statement based on clinical experience, not a graded recommendation built from trials (J Am Acad Dermatol 2024 · PMID 38300170).

"Can't you just squeeze it?" Some people ask this back. Not every pimple is treated with an injection. Whiteheads and comedones have sebum sitting near the opening, so extraction is the right way to clear them.

A red, hard spot usually has inflammation going on deeper in the skin. Pressing hard on it can push the inflammation deeper or leave a red mark and a dented scar. So what can be extracted is extracted, and deep swollen inflammation is calmed with an injection first.

The dent is what people worry about most. If too much of the steroid in the injection goes in, the skin at that spot can dip slightly.

A 2020 survey in the United States asked 100 dermatology clinicians how they use these injections. Close to 9 in 10 (88.8%) said fewer than 1 in 100 of their patients came back with a side effect. Put simply, dents are uncommon when the dose is respected. In the same survey, almost half (48.4%) said a dent, once it appears, lasts more than six months. It asked clinicians about their experience rather than following patients, so it cannot be read as an exact rate (J Clin Aesthet Dermatol 2020 · PMID 33488919).

Because a dent can last for months, Somsei Clinic keeps the dose small from the start. Spots to extract and spots that need an injection are separated first, and only the spots that need it are injected. On thin skin such as the nose, where a dip shows easily, the dose is reduced further and given little by little.

"An injection sounds scarier." People say this often too. A very fine needle puts a small amount into one spot, so it is a quick sting as the needle goes in.

The injection site barely shows, so most people go about their day straight away. Gentle cleansing and make-up are usually fine the same day or the next day. Because the site barely shows, it also fits into a short stay in Korea.

"If it comes back, I'll just get another one, right?" Some people ask this. An acne injection calms the spot that is there now. Injecting the same place repeatedly at short intervals can make the skin sink, so frequent repeats are not recommended.

Sebum keeps coming and dead skin builds up again at the pore opening. Repeating injections alone cannot stop new breakouts. The spots that are up need calming and new ones need reducing, or the same problem keeps coming back.

Even when extraction and injections settle what is there now, the sebum and dead skin remain. So Somsei Clinic does not stop at extraction and injections but runs three sessions built to reduce the next breakouts as well.

• Extraction and injectionsclear whiteheads and calm red inflammation
• Soothing care twicecalms sensitised skin with little pain or downtime
• Blue toning onceworks on marks left after acne
• Prescriptionmatched to the amount of sebum and inflammation

At each session the first check is whether a spot is a comedone or inflammation working deeper in. The prescription depends on whether whiteheads dominate, how much red inflammation there is and how much sebum the skin makes. At the next visit new spots are checked together, along with whether large inflammation has eased and whether the skin has become too sensitive.

Many people come in worn out by red spots that keep appearing in the same place. The program suits people like these.

• Red, painful spots keep coming back in the same place
• Spots return a few days after extraction
• You have squeezed or put up with spots for fear of dents
• You worry that large inflammation will leave marks and scars

If new breakouts are rare and dented scars bother you more, the acne scar program is suggested first.

Acne injections are easy to put off for fear of dents, but used at the right dose and only where needed they reduce the chance of deep inflammation turning into a scar. I struggled with acne myself for a long time, so I know how tiring it is when breakouts keep coming back. Whether a spot should be extracted or calmed can be decided together at the consultation.