By Olivia Hart

"Extractions are the heart of most facials," says Samantha Susca, a New York–based licensed aesthetician and founder of Refinery4. "Without clearing the pores, products cannot effectively do their job, and the skin cannot maintain and balance itself." Two licensed aestheticians — Susca and Lexie Bennett, community lead at milk + honey spa, medspa and salon in San Diego — walked us through what extractions actually do, who should skip them, and the red flags that separate a professional from a person with gloves and optimism.

What Are Extractions, Exactly?

Extractions remove the buildup of oil, dead skin cells and debris trapped inside pores. They target blackheads, whiteheads and certain superficial pustules. That is the full scope. Cystic acne is somebody else's job.

"Extractions are particularly effective for blackheads, whiteheads and certain superficial pustules," says Bennett. "Deep cystic or nodular acne generally isn't appropriate for traditional facial extractions and is better addressed by a dermatologist."

Susca draws the line even finer. "Blackheads and non-inflamed whiteheads are usually the most suitable forms of congestion for extractions," she says. "Deeper bumps, known as closed comedones, are entirely different in nature, and only with extreme precision and experience, should be extracted with a disposable lancet only." The key skill, in her words, is discerning "between congestion that can be safely released and a lesion that should be left undisturbed and pretreated with topicals."

Who Should Get Them — and Who Shouldn't?

Bennett is candid about her client base: "I can always find something worth extracting on every face I work with, so I would say extractions are for everyone, but the clients who tend to see the greatest improvements are those dealing with blackheads, clogged pores, closed comedones and small pustules."

The payoff extends past a cleaner T-zone. Susca says a gentle clearing "will lead to a decrease in bacteria and balanced sebaceous activity, resulting in a calmer and clearer complexion with a stronger microbiome long-term." That is a fairly generous return on ten minutes of steam.

But skin condition on the day matters more than skin type. Both experts said so. "Not every blemish is ready to be extracted," Bennett says. "Knowing when to leave something alone is just as important as knowing how to remove it. I tend to be more conservative with inflamed, compromised, irritated or broken skin, and deep, painful cystic breakouts. In those cases, calming inflammation and supporting the skin barrier should take priority."

Susca is similarly selective with reactive skin. "I believe the most effective treatments begin with understanding what the skin can comfortably tolerate, not simply what we can remove from it," she says.

What Actually Happens During the Procedure?

Preparation does the heavy lifting. "Proper extractions begin well before any pressure is applied," says Bennett. "First, we prepare and soften the skin, often using steam, a specialized solution or a combination of both." Then comes controlled pressure with specialized tools to release what is obstructing the follicle.

The two differ on hardware. Susca uses diamond microdermabrasion first to remove surface keratinized buildup, then works "primarily using gloves and just my own fingertips, which allows me to feel and regulate the pressure." She rejects loop extractors outright: "I also never ever use a loop extractor tool, as I find those to be extremely damaging to the skin, ineffective for deep pore clearing, and difficult to keep sterile."

Bennett favors an ultrasonic skin spatula for surface congestion and blackheads, a Schamberg extractor for stubborn comedones, and sometimes just gloved fingers. Afterward she cleanses, treats for calming and recovery, then moves to the relaxing part of the facial. Structure, not improvisation.

What Separates a Good Extraction From a Bad One?

Restraint. That is the whole answer, according to both.

"A good extraction is precise and causes as little trauma as possible," says Bennett. "A bad extraction can leave behind torn skin, significant redness, bruising or more inflammation than was there to begin with. If something isn't releasing with the appropriate amount of skin prep and pressure, it may simply not be ready."

Susca frames the ideal as near-effortless. "When the skin has been properly prepared and the congestion is ready to release, the process should be relatively effortless," she says. "The moment excessive force becomes necessary, the treatment is no longer serving the skin." Repeated squeezing in one spot, she warns, can cause damage, prolong inflammation and leave marks "far more difficult to address than the original congestion."

Normal aftereffects include temporary redness, sensitivity and a few new whiteheads. "As the subcutaneous bacteria dies off, redness can linger and some whiteheads may appear," Susca says, noting this can last "between a few hours to a few days," longer on sensitive skin.

How to Tell If Your Provider Is Doing It Safely

Scarring, broken capillaries and post-inflammatory hyperpigmentation are the real risks. The checklist from both experts:

• Gloves, always. "My first rule is always gloves," says Bennett. "Proper sanitation and skin preparation are nonnegotiable."
• An explanation on request. Bennett urges clients to ask how the skin is being prepped and why a blemish is being extracted.
• A real consultation. Susca says recent use of exfoliating acids, retinoids or other sensitizing treatments should always be disclosed and discussed.
• Pain as a stop signal. "Sharp pain, aggressive squeezing or prolonged manipulation in one area should never be necessary," says Susca. Bennett agrees: "Repeated forceful pressure is a red flag."

How Often — and Why Not at Home?

"There's no universal schedule for professional extractions," says Susca. "Someone with persistent congestion may benefit from extractions every four to six weeks. Another person may need them only seasonally." Bennett suggests monthly facials to start, noting many clients eventually stretch appointments to every other month or seasonally with consistent home care.

Home extractions get a firm no from both. "At-home extractions are a huge no for me, and that includes my own skin!" says Bennett, who points out that standing inches from a mirror makes people fixate and do "far more damage than the original breakout ever would have caused." Susca adds that what looks like a clogged pore may be something else entirely, and pressing on it blindly can break small blood vessels or leave pigmentation behind.

The bottom line: extractions reward preparation and judgment, not pressure. Choose the aesthetician who knows what to leave alone.