Acne Treatment

Subsurface acne

Sub-surface acne consists of sebum plugs trapped deep within hair follicles without forming whiteheads or blackheads, resulting in a rough, textured skin surface across the forehead, cheeks, and chin without redness or swelling. It is caused by an accumulation of excess oil and dead skin cells clogging the follicles. Proper management requires prescribed pore-clearing active ingredients, medical-grade extractions, and a structured chemical peel regimen — without picking or squeezing.

Medically reviewed by BS.Ths.CKI Kim Kha — BonBoz Clinic

What are closed comedones and how do they differ from whiteheads?

Both are clogged follicles caused by trapped sebum and dead skin cells. However, closed comedones (hidden acne) sit deeper beneath the skin with closed follicular openings, preventing them from coming to a visible head. Whiteheads are more superficial, presenting as small, visible white bumps. If left untreated, closed comedones can turn into inflammatory acne as bacteria proliferate within the clogged pores. Under angled light or when stretching the skin, you will see clusters of tiny, textured bumps—a hallmark sign of this condition.

Why do closed comedones keep recurring?

Three common culprits include: improper cleansing (leaving sunscreen or foundation residue overnight), skincare products that are overly rich or contain comedogenic ingredients, and increased sebum production triggered by hormonal fluctuations or stress. Additionally, aggressive scrubbing or overusing physical exfoliants can compromise the skin barrier, making pores even more prone to clogging.

What to avoid

Do not pick or squeeze closed comedones: because the plugs lie deep within the skin, squeezing will not extract them. Instead, it can rupture the follicle internally, leading to inflammation and post-inflammatory hyperpigmentation (PIH). The same risks apply to using peel-off masks or at-home lancing needles. Furthermore, using high-strength retinoids without professional guidance often causes excessive peeling and severe irritation, leading to premature discontinuation.

Evidence-based management

Unclog pores with prescribed active ingredients (retinoids, BHA, azelaic acid) to facilitate the natural purging of trapped sebum over 6–12 weeks; undergo medical-grade comedone extractions once the plugs have matured to accelerate clearance; and apply structured chemical peels to remove the dead cell buildup obstructing the follicles. Concurrently, audit your entire daily skincare routine to eliminate any comedogenic formulations.

How BonBoz approaches treatment

Our dermatologists conduct in-depth skin analyses to differentiate closed comedones from inflamed lesions, folliculitis papules, or cosmetic contact dermatitis (which appear similar but require distinct treatment protocols). We then review your current product regimen, prescribe a personalized pore-clearing plan, and schedule medical extractions and chemical peels accordingly. You will receive transparent guidance from the start: clearing closed comedones is a progressive process taking several weeks, not an instant single-session fix.

Severity levels

1

Mild — scattered on the forehead and chin

A few dozen small, non-inflammatory papules. Reviewing your skincare routine and applying prescribed topicals is usually sufficient.

2

Moderate — dense across the cheeks

Visible uneven texture under angled light, with some comedones turning inflammatory. Requires medical-grade comedone extractions combined with a structured chemical peel regimen.

3

Severe — accompanied by inflammatory acne and post-acne marks

Widespread closed comedones progressing into inflammatory lesions, leaving dark spots. The treatment protocol prioritizes controlling inflammation while unclogging pores, with close clinical monitoring.

When should you see a doctor?

  • Closed comedones are spreading or becoming red, swollen, and painful—progressing into inflammatory acne.
  • Over-the-counter products have shown no improvement after 2–3 months, or are causing irritation, peeling, and a burning sensation.
  • Rough texture accompanied by itching and localized redness—potentially folliculitis or an allergic reaction, not closed comedones.
  • You are planning to get acne extractions at a spa that does not provide a prior consultation with a doctor.

How BonBoz treats it

Prescription Pore-Clearing Protocol

Topical retinoids, BHA, or azelaic acid tailored by physicians to specific skin types — the foundation for natural clearing of sebum plugs.

Learn about this method →

Medical-Grade Acne Extraction

Extracting mature comedones using sterile instruments without forcing immature lesions — shortening healing time and minimizing post-inflammatory hyperpigmentation.

Learn about this method →

Chemical Peels

Controlled exfoliation to clear pore-clogging dead skin cells according to a structured treatment plan.

Learn about this method →

Skincare Product Audit

Eliminating comedogenic ingredients and reorganizing the cleansing routine — an often overlooked step that ultimately determines acne recurrence.

Learn about this method →

Cost guidance

Comedonal acne is primarily treated with prescription topical medications; acne extractions and chemical peels are charged per session. The doctor will estimate the expected number of sessions following a skin analysis; an estimated range is available in our cost calculator.

The final price follows the doctor’s recommendation after an in-person exam. A confirmed quote has no hidden extras.

Chân dung BS.Ths.CKI Kim Kha

BS.Ths.CKI Kim Kha

Aesthetic Dermatology

  • Graduated as a General Practitioner — Tay Nguyen University (2018)
  • Specialist Level I in Dermatology — Pham Ngoc Thach University of Medicine, degree awarded in 2025
  • Medical Practicing Certificate No. 009784/ĐL-CCHN — Issued by the Department of Health of Dak Lak Province on 15/10/2021
  • Over 8 years of experience in aesthetic dermatology practice (since 2018), including over 4 years of practice with an official Medical Practicing Certificate
  • Primary Specialization in Plastic and Reconstructive Surgery; Certificates in Dermatological Procedures & Minor Surgery, Microsurgery, and Lasers & Light Therapies in Dermatology
  • Certificates in Dermal Fillers, Botox, and Thread Lifts; Certificates in Emergency Resuscitation and Infection Control
  • Formerly practiced at the Aesthetic Dermatology Unit — Post and Telecommunications General Hospital (2019–2021) and Venus Sunrise Clinic (2022–2024) before joining BonBoz Clinic (2025)
  • Former lecturer in Aesthetic Dermatology Theory at Ana Aesthetic Training School (2018–2019)
  • Over 5,000 clinical dermatology cases treated
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Frequently asked questions

Can closed comedones go away on their own?

Some clogs may clear naturally if you stop using pore-clogging products and cleanse properly; however, this is usually slow and they can easily become inflamed. Prescription comedolytic active ingredients significantly shorten this process.

Does extracting closed comedones cause scarring?

When performed properly on ready-to-extract comedones using sterile tools, the risk of scarring is minimal. Scarring typically results from forcing unready lesions or picking at them at home.

How long does it take to clear closed comedones?

It usually takes 6–12 weeks with the right protocol and strict compliance; denser comedones may require more time. Skin texture improves gradually and will not clear in a single session.

Is daily exfoliation necessary?

No. Mild chemical exfoliation 2–3 times a week is sufficient; daily physical exfoliation compromises the skin barrier and worsens closed comedones.

Can sunscreen cause closed comedones?

It can, especially if the formula is heavy and comedogenic for your skin type, or if it is not thoroughly removed. Choose non-comedogenic formulas and double cleanse thoroughly in the evening.

What causes closed comedones on the forehead?

They are commonly caused by bangs, hair styling products, sweat trapped under hats, or incomplete makeup removal along the hairline.

Do clay masks help?

They temporarily absorb excess oil but cannot extract deep comedones. Using them once a week as a supportive step is fine, but they cannot replace proper treatment.

What is the difference between closed comedones and folliculitis?

Folliculitis presents as itchy, red papules, often with small pustules at the top, caused by bacteria or fungi; its management is entirely different from closed comedones. A dermatologist's skin examination is required for an accurate differential diagnosis.

Do topical retinoids cause skin peeling?

They can during the first 2–4 weeks, especially if started at a high concentration. Your doctor will guide you on gradual acclimation and proper moisturizing to help the skin build tolerance.

Can they recur after clearing up?

They can recur if you return to old habits (using pore-clogging products, improper cleansing). Maintaining a simple, skin-type-appropriate skincare routine is the best way to prevent recurrence.

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