Does your heartbeat increase when you see extraction videos online? Yeah, us too! In this episode, we discuss all things extraction, from comedones to “mirror-squirters” and everything in-between (including our favorite ways to extract).
ASCP Esty Talk with hosts Ella Cressman and Maggie Staszcuk
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0:00:37.5 EC: You are listening to ASCP Esty Talk, where we share insider tips, industry resources and education for estheticians at every stage of the journey. Let's talk because ASCP knows, it's all about you.
0:00:52.9 EC: Hello and welcome to ASCP Esty Talk. I am Ella Cressman, licensed esthetician, certified organic skincare formulator and content contributor for Associated Skin Care Professionals.
0:01:03.6 Maggie Staszcuk: And I am Maggie Staszcuk, licensed esthetician, ASCP Advanced Modality Specialist and Education Specialist.
0:01:10.4 EC: Maggie, I have a confession. I am addicted to extraction videos.
0:01:16.5 MS: I love extraction videos, Ella. [chuckle]
0:01:20.4 EC: What is it? What is it about them? I can't scroll past, and the other day, I spent two and a half hours looking at them, and I know you're not on social media, but I still sent you some TikTok videos, [chuckle] like my favorites, and I could have sent you more but I had to contain myself. These are so amazing of all kinds, won't you say?
0:01:39.9 MS: It's sexy and you can't look away and it's so satisfying.
0:01:43.7 EC: And I find myself holding my breath as they're doing it. They're like, they're pushing it out and oh, it's coming, oh, there it goes, there it goes, there it goes. Oh, they did it. It's so amazing. [laughter] And it reminds me, I remember my first blackhead. I remember I think it hereditary, not the blackheads but the love of them because I remember when my older brother was a teenager, my younger brother, myself and my mom were all in the bathroom watching my mom extract blackheads on my brother like, "Oh, you got one." And even to this day, my brother, my younger brother still likes to watch extractions too, so maybe it's genetic.
0:02:22.8 MS: It runs in the family.
0:02:23.7 EC: I think so. And then, you've heard my story about how blackhead changed my life but it is a blackhead that led to me being an esthetician. So one time, it was... I don't even know the year, but I had reached a professional ceiling in the niche market that I was in, that was industrial construction, and I had gone to California to set up an office, and I'm like, "I am not going any further. I have done all I can do in this thing." And I was 27, 28... 26, 27 years old. That sucks.
0:02:58.4 EC: And so, I had flew back home. I spent the weekend in LA with my cousin, and I saw his lifestyle, and it was very like laissez-faire. It was like, "Oh, we're gonna go have a meeting and we're gonna work." I'm like, "What? This is awesome." And then, I came back to... I came, flew back home, my dad picked me up from the airport and I said, "I don't know Dad. There's just something else out there and I'm not sure what it is. This isn't it though. I don't know." And then I looked over at him, I said, "What do you think?" And I did not hear the words that came out of his mouth because the only thing I could focus on was a small black dot on his cheek. And I'm like, "Is that a blackhead or is that a whisker?" And all I wanted to do... He sounded like Charlie Brown's parents. I don't know what kind of parental advice he was giving me. All I wanted to do was set that sebum plug free. And I said, "Oh my gosh, Dad, I think I've got it. I think I wanna be an esthetician." And that is all she wrote. [chuckle]
0:03:54.4 MS: I love that story. It's like the universe was sending you a message.
0:03:57.9 EC: Yeah, and it continues today. So what do you think? You wanna talk blackheads, whiteheads, pimples, papules, pustules and how to extract them?
0:04:05.8 MS: You know I do, Ella.
0:04:07.7 EC: Alright, well, let's do this. Why don't we play a little game. Why don't we go through each of them? We'll talk about the clinical definition and common terms, because there's two. As professionals, we have our clinical definition, but then we also have words we use to describe them to our clientele. And then, let's play a game called extractor walk away. You want to?
0:04:27.4 MS: Yeah.
0:04:27.9 EC: Okay. Well, let's start with open and closed comedones. Maggie, what's the definition?
0:04:32.7 MS: So an open and closed comedone clinical definition. Comedones are small flesh-colored, white or dark bumps that gives skin a rough texture, and the bumps are caused by acne. They're often found at the opening of skin pores. A solid core can often be seen in the middle of the small bump. And open comedones are often referred to as blackheads, as many of you probably know, and closed comedones are whiteheads.
0:05:02.1 MS: So the common terms that I use to describe open and closed comedones to my clients is grains of rice and bowling pins, because I think no matter what area of these obstructions, shall we call them, I think those obstructions are a good indication of what's going on in the skin. So when I'm looking for those, when I'm doing the extractions, there's another classification here, we have the hard ones, the grain of rice or the bowling pins, and then we also have the... [chuckle] Those are like a little bit softer at any rate, what's going on with the skin at that point, in my opinion, is a moisture hydration imbalance that's causing that sebum to slow down. The production is not stopping, but somehow it's getting slowed in the canal, if you will. And so, it's stopping and it's becoming sludgy and then boom, you got a plug. So let's talk extractor walk away. Ready? We'll count to three and then at the same time, let's both say whether we would extract or walk away from open and close comedones. Ready?
0:06:02.3 EC: Mm-hmm.
0:06:02.8 MS: One, two, three. Extract.
0:06:07.2 EC: Extract.
0:06:07.9 MS: Whew, yes, we're on the same page. So how are we gonna extract this? What's your favorite way?
0:06:12.6 EC: A bobby pin?
0:06:13.8 MS: A bobby pin? What? [chuckle]
0:06:17.3 EC: Just kidding, just kidding. Do not use a bobby pin. That is probably not within your scope of practice.
0:06:23.0 MS: That's it. Do what I say and not what I do.
0:06:24.9 EC: Yes, it is. Yes it is. I think probably, my favorite way to extract is just with my fingers.
0:06:30.8 MS: Same.
0:06:31.9 EC: Awesome.
0:06:32.5 MS: I think so too. I think when you have that, you have the flexibility, the fingertips. I usually use gloved fingertips not because just sanitary reasons, but also it gives me a lot more traction on the skin, and you can do that shimmy shake, like to shimmy...
0:06:46.3 EC: Yup.
0:06:47.6 MS: Rotating your fingers back and forth. Other ways, you know my least favorite way? Q-tips.
0:06:53.2 EC: I was just gonna say, Q-tips, you have no control with Q-tips, you can't get good pressure.
0:06:58.7 MS: And it skips.
0:07:00.7 EC: Yeah.
0:07:00.8 MS: It skips, and I think something to consider when you're doing any extractions is extract or damage, what is going to be, where or is it, am I gonna get it all out or am I gonna cause damage? And in those Q-tips, you skip.
0:07:13.3 EC: Do you use lancets?
0:07:15.1 MS: Ooh, sometimes. I love lancets.
0:07:18.6 EC: Do you?
0:07:19.3 MS: Yeah.
0:07:19.6 EC: When do you use a lancet for black... And I know some people love it for blackheads.
0:07:22.5 MS: I don't find I need them for an open comedone or a blackhead, but for the closed comedones, sometimes yeah.
0:07:30.9 EC: Oh, like milia?
0:07:32.2 MS: Yes, for milia.
0:07:33.4 EC: For milia, I agree, and that's because you're doing less damage?
0:07:37.9 MS: Yeah, I guess so, and also it just creates that opening in the skin, so I feel like I'm not having to extract as hard and all that gunk just comes out so nicely.
0:07:47.9 EC: Yeah, I would agree. What about comedone extractors?
0:07:51.7 MS: I do use those as well. I mean, that's kind of like using the bobby pin, you know?
0:07:56.0 EC: Yeah, [chuckle] that's why I was like, "Wait, what?" Yeah, and I use all the different comedone extractors, the loop, the crooked loopy thingy, I have very technical language like the pressy thingy [chuckle] and all the...
0:08:09.3 MS: I love the pressy thing.
0:08:10.4 EC: Pressy thingy for different ones.
0:08:12.5 MS: Yeah.
0:08:13.1 EC: Just what kind of pressure are you wanting? What direction? Like the forehead blackheads, like on the side of the forehead, by the brow bone, those seem to a diagonal, so we're at in the pore direction, so...
0:08:22.9 MS: Yeah, I think for anybody who does not use a comedone extractor who's listening in right now, it does take a little bit of practice, but it's very quick to adapt to, but also knowing how much pressure you're applying with that comedone extractor is important, and if you have too much slip on the skin, you don't want that, the skin needs to be dry because it's easy to bruise or tear the skin with a comedone extractor.
0:08:47.8 EC: Yes. So, evaluating like, am I doing more damage than what's good? What do you say to the argument that to leave them in there?
0:08:57.5 MS: No, get those suckers out.
0:09:00.4 EC: Yeah, bye. [chuckle] I say, you are cute. That's cute, but no.
0:09:02.9 MS: Yeah, and I have heard people say, "Oh no, you don't extract" and that's out of my scope. I don't know why anybody would argue that. Clients coming in for a facial, clean those pores man.
0:09:12.8 EC: Yeah, set a time limit if that's your concern.
0:09:15.3 MS: Right.
0:09:15.6 EC: Get in and out. Sometimes I'm like, "Oh gosh, they don't really need a massage, I can just keep going." That's cutting into my... It was cutting into my extraction time. You know another favorite device that I have is the ultrasonic spatula, that is my favorite here, where we live, it's very dry. And so that means some of those extractions are very stubborn, and so using that spatula softens them up, and it also, there's nothing better than watching one pop up up onto the blade, do you know what I'm talking about?
0:09:46.3 MS: Oh, I do, yeah.
0:09:47.4 EC: Ugh! I don't know how to describe it technically, other than pimple jumping, [chuckle] as soon as it hops on the blade and I'm like, "Oh my gosh, that... Oh, and the now I'll even go look to the client, "Look!" And they're like, "Oh my gosh," usually, unless they're just humoring me, they wanna see it too.
0:10:02.6 MS: They do, that's like a good way to solve the treatment also, [chuckle] that's like satisfaction for them also, their pores are getting cleaned out.
0:10:10.1 EC: Amen. What about steaming?
0:10:14.4 MS: Steaming, I think is so important, especially here in Colorado, it's so dry, but I think just a little. I know there's people that steam like the whole duration of the treatment that's too much, because ultimately the skin then closes down in my view.
0:10:28.3 EC: Yeah, I'm an opposite. I don't like steam 'cause I think it might be... For me, what I find is it makes it stickier and not sticky like a piece of gum on your shoe, but if I was a blackhead, for example, this is the sound I'd make after steam. Errrr! The first few are good, but when you're getting towards the end of those five or 10 minutes, the last ones are harder to get out, and so at that point, am I doing more harm than good? So I love instead of steam, the ultrasonic spatula, maybe an enzyme.
0:10:57.8 EC: Hey guys, stop! Let's take a quick break.
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0:11:51.4 EC: Let's get back to the conversation. Let's talk papules. You want to?
0:11:55.8 MS: Let's do it. So clinical definition of a papule, it's a raised area of skin tissue that's less than one centimeter round. A papule can have distinct or indistinct borders. It can appear in a variety of shapes, colors and sizes. It's not a diagnosis or a disease, and papules are often called skin lesions, which are essentially changes in your skin's color or texture.
0:12:18.3 EC: So the common term that I use when I'm talking to my clients about this one is a temper tantrum, and that's because there is mostly inflammation. And what's going on in the skin at this point is you have some kind of foreign body, the body set. Your the body thinks, oh, there's an intruder in here, and we're going to protect that area. A lot of times, it can be one of those sebum plugs, those comedones, and so that's why when you're extracting, it's so important to get... When you're removing an open or a closed comedone to get everything out, because if you leave it, the clients will be like, "Oh, it broke out afterwards," but usually that's because you didn't get everything out, which happens, and so the body is going, "I got you, I'm gonna get it out," kind of like a splinter. So it's creating all this inflammation around it.
0:13:05.4 EC: But the problem is, it's so deep down that there's not... There's not a head. So it's the temper tantrum because it's like flaring up. So let's talk about whether we would extract or walk away. You ready?
0:13:20.3 MS: I'm ready.
0:13:20.9 EC: Okay. One, two, three, walk away.
0:13:24.0 MS: Walk away.
0:13:25.1 EC: Oh, I didn't know [chuckle] if we're gonna match up on this, so why walk away?
0:13:32.1 MS: Well, like you said, it's all inflammation. There's nothing to extract. It hasn't come to a head yet. If you are extracting this, you're potentially leading to scarring if it does come to a head and burst or two, you're just creating more inflammation.
0:13:46.2 EC: So what should people do then?
0:13:47.5 MS: They need to let it alone. And the body is going to ultimately heal that inflammation.
0:13:53.9 EC: I think so too. Another thing that you could think about doing, I like to just barely press on it. 'Cause sometimes, I've had what I thought was a papule, ended up extracting quite lovely. I don't recommend it. I could say like, I've just lightly pressed to see where it could be and then I apply anti-inflammatories in the clinic. And then I also advise that they ice it because that icing, the literal icing of the skin calms the inflammation and then either the body is gonna go, "Oh, that's just a little bit of oil" or it's going to create pus and purge it out right.
0:14:26.5 MS: Yeah.
0:14:26.8 EC: But I've seen people who take a lancet and just blindly poke. Like there's... You know you stick a little toothpick in a cake to see if it's done in the middle.
0:14:34.9 MS: Yeah.
0:14:35.3 EC: That's what they're doing. They're like trying to extract it and that I think is creating more inflammation, like you said.
0:14:42.1 MS: It is. It's almost like having a bug bite that you're just randomly squeezing or randomly poking with a lancet, there's nothing there.
0:14:50.5 EC: Yeah, [laughter] yes, can you imagine?
0:14:52.1 MS: That sounds... That sounds horrible.
0:14:53.9 EC: Yeah, poking a mosquito bite. Oh, no. No, no, no. Don't do it. Walk away.
0:15:00.0 MS: Walk away.
0:15:00.7 EC: Pustules on the other hand.
0:15:01.4 MS: Yeah, pustules. So pustules are a small circumscribed elevation of the skin containing pus and having an inflamed base.
0:15:11.1 EC: So the common term that I use for these, if I'm talking to or speaking with a client, I'm gonna call them mirror squirt-ters because everyone knows what that means and everyone's experienced that. And those are my favorite. [laughter] Those are so satisfying. But if I'm speaking to another professional, I often call them The Matrix. You know in that movie where Keanu Reeves goes to dodge a bullet and he leans back and his body's like an L. I don't know how he has the ab support for that, but for the pustules...
0:15:40.0 MS: Well, it's Reeves.
0:15:42.8 EC: Sure. [chuckle] And I'm sure there's no editing. Well, that's how I feel when I encounter pustules in the treatment room. I have to lean back and it's almost slow motion where I'm like, "Whoa." [chuckle] You know so because I'm not gonna lie, I've been hit before.
0:16:00.4 MS: I've been hit before too and it's gross. That's why you have to use your Maglite.
0:16:03.5 EC: Yeah, the loop light decorator is the third name for this category. [chuckle] So what's going on in the skin for this one, or should we talk extract or walk away before you...
0:16:16.1 MS: Let's do extract or walk away.
0:16:18.5 EC: Okay. Are you ready Maggie? Extract or walk away. One, two, three, extract.
0:16:25.1 MS: Extract.
0:16:25.2 EC: Oh, we're on the same page again. So what's going on in the skin with a pustule is that there is that foreign body again, but the body has produced pus and is trying to push it out. So by helping it align, extracting it, you are assisting the body in what it's trying to do. Also by extracting, you're avoiding scarring.
0:16:43.7 MS: Yeah. And this is where you want to use those lancets, I think. Create that little hole so that the pus can escape instead of just squeezing and letting that skin burst.
0:16:51.9 EC: Ah, yeah, good. Good option. In high school, there was this boy in... This is not me being judgy. This is just me being... Remember genetically designed to extract. There was this boy who had pustules and comedones and I'm like, "Do you want to... " A very kind conversation, "Don't you wanna get that out of there?" He said, "No, my mom says not to extract it, to leave it," and I hear that sense like not... "Don't extract it, leave it alone," but really when it gets to this point, pustules, that kind of inflammation is actually causing structural damage.
0:17:25.6 EC: And so the longer you leave this pustule in, the more opportunity for pick... Pock scarring for acne scarring. So the faster... If it's pustule, the faster you can get it out, the better. The smaller the opportunity for that scarring. Something else to think about when you're extracting, once you have poked the hole as Maggie said, is the great idea, is to get up and underneath it. Not pushing too close to that hole but rather up and underneath it and squeezing from beneath it. And that is the best way to really empty.
0:17:55.6 EC: Another question that I like to ask after extracting, I'll gently press on it and I ask my client, "Do you feel a bruise or a sharp pain sensation?" Because from my personal experience, I kind of figured out that if I felt a bruise that meant I got it all, but if I still could feel a sharp pain, that meant there was something else in it. So sometimes you just... It just needs a minute and you can go back and try that, up and underneath it method and get the rest of it.
0:18:19.8 MS: Interesting. I always had the mindset that when you're extracting and you get to the point where it looks like there's clear blood, for lack of a better word, but you know what I mean? It's like oily with...
0:18:29.5 EC: White blood cells.
0:18:30.4 MS: A little bit of blood. Yeah. You're done. Everything that is in there has come out, that's gonna come out and you're done with the extraction.
0:18:38.8 EC: Try it. Try pressing on it again just to see because I've gotten to that point and then they still hurt or even with a failed attempt at extracting a papule, [chuckle] that white blood cell still comes out, you know. So that's my experience and it works really well. And sometimes I'll just walk away, come to a different area of the skin, come back and voila! Bigger seed.
0:19:00.6 EC: Yeah, they're hiding. They're in there and they're like, I'm happy it's warmer in here. There's lots of stuff going on. So try it. Try that, just to make sure. Not go to town and squeeze the heck out of it but just go back and make sure. If they're experiencing a sharp pain... If you've gone to that point where it's that white blood cells coming out, the coagulation... That yellowy liquid.
0:19:20.6 MS: Yeah.
0:19:20.9 EC: If you got to that point and they have... That sensation is bruised, you're good, but if the sensation is... Sharp pain, you might wanna give it a little bit more attention or also to come back in a couple of days. Another thing to think of, like you said, put a loop light in front of you or wear a swash card because I've literally had it in my eye, in my ear [chuckle] like in... On my scrub tops. It's not... It's not good. So let's talk about post-extraction. What do you do post-extraction, Maggie?
0:19:52.3 MS: Definitely using something that's anti-inflammatory, so some kind of toner or serum solution that's applied to the area that's been extracted. I think a lot of people post-extractions feel like they still have a breakout and there is nothing there, everything's been extracted, but it's inflamed from the extraction, so something that's reducing that inflammation.
0:20:15.7 EC: Yes. Oh, I love that. Great idea. How about hydration and moisture?
0:20:20.6 MS: Yeah. I think that's with any treatment, regardless of extractions, and that people who suffer from acne in general, maybe think they don't need moisturizer or they don't need serum. Regardless of your sebum output, you do.
0:20:36.5 EC: Yeah, I agree. I think that's one of the biggest disservices that this industry has impressed upon people, it's like, "Oh, my skin is oily I don't need a moisturizer," but it's about achieving balance because acne is an imbalance somewhere. And so what we can deal with is topical part of that, and so supporting... And it's not just an oil issue, that's another part that drives me nuts about acne... Acne marketing, it's not an oil issue, it's often like a compromised issue, like the microbiome is compromised, or the barrier function is compromised, or the immune function is compromised, or it has nothing to do with topical, it's something inside so...
0:21:16.2 MS: Yeah, and I'll say to, you know, we're talking about what we would do post-extraction, but so many times I would have clients come in suffering from acne, and we would always preach, don't pick, but your clients are gonna pick no matter what you're saying. And so I would always say, "Okay, if you're gonna pick fine, but for every lesion you're picking, wrap your fingers in a new piece of clean-X."
0:21:39.5 EC: Yeah, you talk them out to do it.
0:21:41.4 MS: I don't know if I would go that far, but [chuckle] just whatever you can do to eliminate that spread of bacteria from different areas of the face.
0:21:48.6 EC: Yeah, yeah, and that's a good point. Great point. Now you're the advanced modality specialist.
0:21:54.2 MS: So they say.
0:21:54.3 EC: So they say, I believe it. Have you... Is there any additional devices for extractions?
0:22:00.7 MS: Yeah, I don't know about for extracting per se, but for acne and post-treatment, there is of course high frequency you know where we're zapping all all those little acne lesions. You talked about that ultrasonic spatula, which is awesome for not just helping with extractions, but also infusing and breaking up all those impactions to help with the extraction.
0:22:21.1 EC: How about other methods?
0:22:23.7 MS: I don't know, we've kind of covered all of them. I mean, definitely the bobby pin, we don't wanna leave that one out.
0:22:28.5 EC: Yes, for sure. [chuckle]
0:22:31.7 MS: The extractor, the lancet, always using your fingers, I think that's number one go to. A lot of people still use Q-tips, which if that works for you, I think it's important that we stress sanitation, so wearing your gloves, wrapping your fingers, and then you're bringing bodily fluids to the surface, so making sure you're double bagging that, and your lancets go in the sharps, your blood soaked whatever bacterial infested tissue, don't just toss that wherever, don't just set that on the counter, that's gotta get wrapped in your gloves or double bagged or whatever your state's dictating and properly disposed of also.
0:23:09.5 EC: Yes, I agree. I do wanna share one other method that is what my... Everybody has their school buddy, and I shared that. Initially, my class was a class of two, and so me and my school buddy, we were really close, and her middle name was Autumn Fern, and I'll never forget when we were learning extractions, I also shared about my school experience and how a lot of self-taught was going on. So like, "What do you do in there?" And she's like, "This is the Autumn Fern method." That was her middle name.
0:23:35.0 EC: And basically, speaking of gloved fingers, she would put her pinky in the nostril and lift up [chuckle] the nostril, and use her pointer finger and her thumb to squeeze and that helped her get a lot more. So I do wanna pay homage to... I won't say your first name, but Autumn Fern and the Autumn Fern method, because I thought that was ingenious and I think about her every time that I do that still.
0:24:01.4 MS: I love it.
0:24:02.0 EC: Yeah.
0:24:02.6 MS: I love the Autumn Fern method.
0:24:04.3 EC: Yeah, it's cute.
0:24:05.6 MS: I'm gonna have to test that out.
0:24:07.1 EC: Alright, now listeners, we wanna hear from you. What is your favorite extraction story? Let us know, reach out, post on social media, Twitter, Instagram, Facebook, or by emailing. Get connected to ascpskincare.com. We wanna know all the details. In the meantime, thanks for listening to ASCP Esty Talk. For more information on this episode or for ways to connect with Maggie, myself, or to learn more about ASCP, check out the show notes, and stay tuned for the next episode of ASCP Esty Talk.
0:24:37.1 EC: Thanks for joining us today. If you like what you hear and you want more, subscribe. If you wanna belong to the only all inclusive association for estheticians that includes professional liability insurance, education, industry insights, and an opportunity to spotlight your six skills join at ascpskincare.com. Only $259 per year for all this goodness. ASCP knows it's all about you.