Acne is a sequence, and treatment follows the stage
Oil and clogged pores, active inflammation, and the scarring left behind are three different problems that happen to occur in order. Treating the stage you are actually in — and preventing the next one — is the whole discipline.
Acne develops in a sequence: excess sebum, then blocked pores from retained keratin, then bacterial proliferation, then inflammation. Treatment is chosen by which stage dominates. Non-inflamed comedones are managed by reducing oil and clearing pores; active inflammatory acne requires anti-inflammatory approaches; and scarring — the stage worth preventing — is treated separately once inflammation is controlled.
Why acne happens, in four steps
The sequence is consistent even when the trigger is not: excess sebum production, then retained keratin blocking the pore, then bacterial proliferation in the blocked environment, then inflammation as the immune system responds. Every acne treatment intervenes at one or more of these four points, which is why treatments that seem unrelated can both be legitimate.
It also explains why acne that is 'treated' at the surface returns. Clearing what is visible without addressing sebum production or pore blockage removes the current crop and leaves the mechanism intact. This is why acne is described as managed over a period rather than resolved in a session — and why the plan usually combines medication with procedures rather than choosing between them.
By stage
| Stage | What it looks like | Approach at DIESTA |
|---|---|---|
| Oil and blocked pores | Comedones, small bumps, congested texture | Agnes, Neobeam (1450nm), Aquapeel, Sonolab, plus routine correction |
| Active inflammation | Papules, pustules, painful lesions | PDT (photodynamic therapy), intralesional TA injection, extraction, Gold PTT, Agnes |
| Scarring and marks | Indentation, red marks, textural change | Multicell CO2, Gold PTT — and see the pores & scars page |
Stages frequently overlap on the same face, so the combination and the order are decided at consultation. No treatment listed here is described as a cure, and suitability and session counts are determined after examination.
Devices at each location
| Device | What it does | Location |
|---|---|---|
| Agnes | Selectively treats sebaceous glands, in a defined area or across the face | Gwanggyo |
| Gold PTT | Gold particle-based, staged across oil, active acne, redness and scarring | Gwanggyo |
| Neobeam | 1450nm, reduces sebaceous gland size | Gwanggyo |
| PDT · TA injection · extraction | Photodynamic therapy, intralesional injection for inflamed lesions, and controlled extraction | Gwanggyo |
| Aquapeel · Sonolab | Removes debris, sebum and surface keratin from pores | Cheonho |
| Multicell CO2 | Acne scarring and defined lesions | Cheonho |
The part that matters most: preventing scars
The single most consequential decision in acne treatment is how quickly inflammation is brought under control, because scarring is a function of how long and how deeply inflammation persists. An indented scar is far harder to treat than the lesion that produced it, and no scar treatment restores skin to its original state — it improves the appearance of damage that is already done.
This is why treating active inflammation aggressively is not cosmetic impatience but scar prevention, and why extraction performed at home is discouraged so consistently. Squeezing an inflamed lesion drives inflammatory contents deeper into the dermis, which is the mechanism that produces a permanent indentation instead of a temporary spot.
If you already have scarring, it is treated separately and after inflammation is controlled — resurfacing skin that is still actively breaking out is treating a moving target. The pores & scars page covers that stage in detail.
Frequently asked questions
Adult acne is common and typically has a different balance of causes than adolescent acne — hormonal fluctuation, stress, barrier damage from over-cleansing or over-treating, and comedogenic products all contribute, alongside the same underlying four-step mechanism. It also tends to sit lower on the face, along the jaw and chin. What matters clinically is that adult acne is frequently made worse by aggressive home routines undertaken out of frustration, which damage the barrier and prolong inflammation.
No — and this is the strongest recommendation on this page. Squeezing an inflamed lesion drives inflammatory contents deeper into the dermis rather than out of it, and that deeper inflammation is precisely the mechanism that produces a permanent indented scar instead of a temporary mark. Clinical extraction is a controlled procedure on lesions selected as appropriate, performed in sterile conditions. It is not the same act done more confidently.
Red and brown marks left after a lesion resolves — post-inflammatory erythema and hyperpigmentation — usually do fade over months, and are helped considerably by sun protection and patience. Indented scars do not: they represent lost tissue and require treatment to improve. Distinguishing the two matters, because patients frequently treat marks that would have faded anyway and delay treating scars that will not.
Often yes, and combining them is standard — but the specific medication changes what is safe. Isotretinoin in particular affects how skin heals and rules out certain procedures during and for a period after treatment. Bring the actual names and doses of anything you are taking, including anything prescribed abroad. This is one of the medication categories where an incomplete history creates real risk.
Agnes is a device that targets sebaceous glands selectively, used either on individual persistent lesions or across an area. It sits in the oil-control stage of treatment rather than the scarring stage. Whether it is appropriate for you depends on which stage dominates your acne — it is not a general acne treatment, and it is not a substitute for controlling active inflammation first.
Acne is managed over a period rather than resolved in a visit, because the underlying mechanism — sebum production and pore blockage — continues after visible lesions clear. Expect a plan measured in months, combining procedures with medication and routine correction, and expect it to be reassessed as your skin responds. Any plan that promises clearance in a fixed short number of sessions is describing the current crop of lesions, not the condition.