For most people, acne is an inherited condition of the pores. When someone is prone to acne, their pores clog with dead skin cells much faster than normal. Healthy pores shed about one layer of dead skin cells per day inside the pore, but acne-prone pores shed up to five layers of dead skin cells per day. The body just can’t keep up with keeping the pore clear. Technically, this is called “retention hyperkeratosis” — dead skin cells shedding more quickly than the pore can expel them.

This first picture is of a normal healthy pore.

As the dead skin cells begin to accumulate inside the pore, the cells become sticky and get stuck inside the pore and form a plug. Medically, this is called a “microcomedone” – essentially the precursor to all acne. As you can see in this picture, there are more dead skin cells shedding inside the pore. Hormonal fluctuations trigger more oil production inside the pore. Normally, this isn’t a problem because the dead skin cells don’t get trapped. But with acne prone-skin, when the dead skin cells shed more quickly and form a blockage, the perfect environment for the P. Acnes bacteria is created. The oil is a nutrient for the bacteria, so the bacteria proliferates. So you see, bacteria is not the “cause” of acne, it is the effect of too many dead skin cells. This is an important distinction to remember.

But, some people don’t get inflamed lesions — inflammation is also an inherited tendency. If the dead skin cells and the oil that form the plug don’t become inflamed, the plug becomes a whitehead; that is, a non-inflamed lesion under the skin, also called a “closed comedone”.

Or the plug can become a blackhead, which is a noninflamed acne lesion where the pore remains open, also known as an “open comedone”. In the case of a blackhead, the tip of the plug darkens as it is exposed to oxygen in the environment. As the oil in the pore builds up, inflammation can develop in the cells surrounding the pore. Blackheads can be infected or not depending on whether the P. acnes bacteria have affected the cells around the pore.

As the oil and the dead skin cells build up, they put pressure on the cells surrounding the pore. With enough pressure, the sides of the pore rupture and the contents of the pore leak into the surrounding skin. Because this sebaceous material contains a lot of P. acnes bacteria, the surrounding skin now becomes infected, creating a red bump that we know as a pimple. The medical term for this red bump is an inflammatory papule.

This next drawing shows an inflammatory pustule, which is different from a pimple only in that it contains white blood cells. When the immune system fights off the P. acnes infection, white blood cells, which are soldiers of the immune system — pile up, creating pus in the pore.

Now another, deeper inflamed lesion can form called a nodule or cyst. It is a solid dome-shaped lesion that extends below the surface, deep into the layers of the skin. Scarring is common with nodules and can sometimes leave an impaction behind, which can flare again and again. When a group of pustules cluster together under the skin, they form a cyst. An acne cyst can appear similar to a nodule, but is pus-filled, and can have a diameter of 5mm or more across. They are usually very painful and scarring is common with cysts.

So you see, acne is primarily an inherited dead skin cell problem. Most acne, no matter what form it takes, starts with microcomedones. This means the solution lies in products that penetrate the pore and prevent dead skin cells from building up. That’s why your home care routine and lifestyle changes are so crucial — it’s all about preventing the microcomedones (the beginning of acne) from forming at all.  This is the best way to get rid of acne.

To effectively manage acne, my approach is from a holistic standpoint, meaning we look at more than just your skin – we view you as a whole person with your body’s own unique biology and skin’s challenges. There is no such thing as a one-size-fits all system, so I tailor a program just for you. Combining the power of clinical-grade acne care products from Face Reality that are customized for your type of acne with a series of bi-monthly to monthly in-office treatments will speed the clearing of your skin. Because everyone is just a bit different, we monitor you closely to make sure you’re on track to get clear and stay clear. This is a guided program, where we take a comprehensive approach to treating your skin, with it’s unique skin type, acne type and tolerance to products

• This is a guided program, where we take a comprehensive approach to treating your skin, with it’s unique skin type, acne type and tolerance to products
• We teach you about the real causes of acne and aggravating factors that make you break out – such as foods, medications, cosmetics, stress and more. When you're armed with this knowledge, you can more easily keep your skin under control!
• This NOT a quick-fix. Acne cannot be cleared up with a couple of visits and random products. You can expect to need a minimum of 6 to 10 office visits depending on the type of acne you have and other factors that can slow clearing such as lifestyle, dietary habits, and proper use of your home care products
• The program requires a financial investment of in-office treatments every 2-3 weeks plus the purchase of customized home care products. The first set of acne products is about $180 and home care products are not included in the cost of the treatment visits. Home care products will need to be replenished when you run out or we make changes to your regimen.
• We will make treatment visit appointments around your work/school schedule and you will need to make time to attend them
• You will be asked to discontinue using skin care products from other sources during the program
• You will be provided a list of pore-clogging ingredients and you’ll need to remove certain types of makeup and other products that clog pores from your daily routine
• You will need to be dedicated to using your home care products twice per day, as instructed (parents, this can be challenging for some teens!)
• The average time to clear up most skin is 4 to 6 months. Everyone is different and some people clear faster than others!
• Acne is triggered by internal factors, too! We will review and ask that you make changes to your lifestyle such as cleaning up your diet, adding supplements, avoiding factors that trigger acne
• Once clear, clients go on a Maintenance regimen, where they continue to use their home care products to keep their skin clear. Some clients also opt to have a Treatment visit every few months for deep cleaning and extractions
• Parents of teens, as heartbreaking as it is to watch your own child struggle with acne, the truth is that some teens aren’t ready or willing to commit to the program and you will need to be realistic about the amount of clearing we can achieve when they skip their home care regimen, have diets heavy in processed foods that they keep eating, or won’t attend their treatment visits
• The program works if you follow it! Clients who are clear of their acne after years of struggling will tell you it was worth it for the self-esteem, confidence and peace of mind they now have with clear skin!

If you come in for a consultation only, the cost is $75. If you come in for a treatment and consultation on the same visit, which is what most people do, the cost is $95. Each treatment appointment following that is $65. It typically takes about six to eight treatments over a 3 to 4 month period of time to see results (if you are compliant and follow the program). The typical cost is $180 for the set of home care products you initially take home. Most of the products such as the cleansers and moisturizers will last you quite a long time. The active products such as the serums and Acne Med are purposefully put in smaller containers as these will be strengthened at different points in your treatment plan. All products are reasonably priced for the budget conscious.

As we are not a medical facility, we are unable to bill medical insurance for products or treatments. Some clients are, however, able to use their FSA plan savings towards the home care product purchases (check with your insurance plan!).

We do not have any physicians or nurses on staff. We are Licensed Estheticians licensed by the State of Washington. How we different from medical settings:

• We have more time to spend with clients.
• We listen carefully to their concerns.
• We touch and feel the skin each time they come in.
• We keep updated with the latest and greatest information in the world of acne.
• We have the best and most effective acne products with no need for prescription drugs or products.
• We have compassion and empathy for the client.
• We give the client honest and straightforward answers.
• We have a system that will work to get their skin clear!
• We coach the client through every step of the process of getting their skin clear. They are not left to figure it out on their own.
• We create a close communicative relationship with the acne client.
• The client does not have to put up with irritated, dry skin while getting clear.

At your consultation, we take these steps:

• Review your intake form and discuss your previous and current treatments, medications and lifestyle factors
• Determine your skin type, acne type and skin tolerance
• Go over aggravating factors that make you break out – foods, medications, cosmetics and skin care products, stress, etc.
• Provide you with a packet of information that has everything that we discuss in the consultation
• Provide you with a treatment plan for the products and in-office treatments you will need to start clearing up your skin
• (and, if you are getting a treatment the same visit) perform the acne treatment, which includes deep cleansing, exfoliation and extractions and repair
• Schedule your next treatment appointments

The first consultation and treatment appointment is scheduled for about 90 minutes and subsequent appointments for 45 minutes. When your skin starts to clear up and there are less extractions to do, the treatments will take less time.

After analyzing your skin's current condition and progress, we either perform a very mild chemical peel on your skin or we do a gentle enzyme with steam for exfoliation and to start deep cleaning sluggish pores. Generally speaking, neither of these are uncomfortable or will make your skin visibly peel (in some cases there might be very mild peeling or flaking). We then perform extractions of the existing acne impactions. For most people, extractions very tolerable and are only slightly uncomfortable. We keep your comfort level in mind and chat with you during the treatment.

Extractions are important to clear the current lesions and impactions out from the pores and then your home care products help prevent new ones from forming. It takes up to 90 days for acne to form and come to the surface, so in the three to four months that we are working with you, you will have some breakouts (also known as purging). These are just old lesions coming to the surface that we extract every two weeks. Once we break the cycle of old acne coming to the surface and preventing new acne from forming, skin begins to clear and we can work on things like leftover dark spots (hyperpigmentation) and any scarring.

Most people are a bit red for a few hours following extractions – there’s no way around it. We just recommend you don't have a special event scheduled within 24 hours of getting a treatment.

If you live close enough to the studio, it is in your best interest to have acne facial treatments with us. That is the fastest way to get clear; and also helps us to monitor your home care to get you clear in the fastest possible way. We do have some clients on our Virtual Acne Program, typically those who have moved away or gone off to college and would like to continue the program to maintain results. In those cases, we schedule a phone call or Zoom meeting and ask for follow-up pictures and regular updates, then skin care products are shipped directly to you.

Yes. It is all part of the program as a whole. There are too many brands in the marketplace that have pore-clogging ingredients in them, and they change formulas all the time. Acne is challenging enough to get under control. In order to eliminate the variables, we require that you use only our products. We don’t want to have to wonder if an outside product is causing a problem or delaying your progress.

You will need to use products to control your acne until you outgrow or stop producing acne; and no one knows when that is. Many people do, (usually from changes in hormone levels, stress and lifestyle choices) but we are unable to predict when, so you may have to use them for a while to manage the condition.