5.5 Extraction Procedures: Comedone Extractors, Lancets & Safe Technique

Why Extractions Are Tested

RCW 18.16.020 includes pore extraction in the practice of esthetics, so it is part of master esthetics too. The NIC Advanced Practice outline asks you to "determine method of extraction" and show "competent use of implements used for extractions (e.g., comedone extractor, lancet)." The Combined Practice outline repeats the same items. Good extraction clears follicles; bad extraction leaves broken capillaries, scars, and post-inflammatory hyperpigmentation (PIH).

Choosing Which Lesions to Extract

Preparing the Skin

1. Cleanse and analyze under a magnifying lamp.
2. Soften the impactions: use steam or warm, moist towels, an enzyme mask, or galvanic desincrustation. In desincrustation, the active electrode is the negative pole (cathode), which produces an alkaline reaction (sodium hydroxide) that saponifies hardened sebum (section 7.2).
3. Put on gloves and keep supplies clean and within reach.
4. Protect the eyes from bright light and keep the client draped.

Techniques

Manual (fingertip) extraction

• Wrap the fingertips in cotton or gauze. Never use fingernails.
• Press gently down and around the lesion with a rolling motion that lifts the plug from the bottom, moving around it from several sides.
• If the plug does not release after a few gentle attempts, stop. Repeated squeezing bruises tissue and can rupture the follicle wall into the dermis.

Comedone extractor

• A metal tool with a loop or a small flat plate with a hole.
• Center the loop over the comedo and apply light, even pressure, sliding or rocking it so the plug lifts out.
• Use extra care on thin skin, the nose sides, and areas with visible capillaries.

Lancet

• A sterile, single-use blade used to open the surface of a milium or closed comedo.
• Hold it nearly parallel (horizontal) to the skin and pierce only the top layer over the lesion, never straight down into the dermis.
• Express the contents gently with gauze-wrapped fingertips or an extractor.
• Discard the lancet immediately in a sharps container.

After Extraction

• Wipe with an antiseptic toner or astringent.
• Many protocols follow with high frequency for its germicidal effect, a calming mask, or blue LED (section 6.2).
• Do not apply heavy makeup over freshly extracted skin.
• Document which areas were extracted and how the skin responded.

Contraindications and Cautions

• Active herpes simplex, impetigo, or other contagious conditions (WAC 308-20-110(1)(e)).
• Inflamed cystic or nodular acne (refer).
• Rosacea and telangiectasia: pressure can worsen redness and visible vessels.
• Sunburned, peeled, or recently resurfaced skin.
• Clients using oral isotretinoin or blood thinners, whose skin may tear or bruise easily.
• Darker skin types: aggressive extraction increases PIH risk, so use the lightest pressure that works.

Washington Infection-Control Rules That Apply

WAC 308-20-110 contains several rules that apply directly to extraction:

• Sharps: disposable sharp objects that touch blood or body fluids must go into a sealable, rigid (puncture-proof), labeled container strong enough to protect against cuts. Such containers must be available whenever services are performed (WAC 308-20-110(5)(d)-(e)).
• Nonelectrical tools such as extractors: remove debris, clean with soap or detergent and water, rinse, then disinfect with an EPA-registered disinfectant with bactericidal, fungicidal, and virucidal activity, or use an FDA-registered steam or dry heat sterilizer (WAC 308-20-110(7)(a)).
• Single-use items: anything that touches the client's skin and cannot be cleaned and disinfected must be discarded after that client (WAC 308-20-110(6)(e)).
• Gloves: disposable gloves are discarded after each client (WAC 308-20-110(6)(f)).
• Storage: cleaned and disinfected tools go into a closed, non-airtight container or UV sterilizer cabinet. The rule permits UV cabinets only for storing tools that are already clean and disinfected (WAC 308-20-110(6)(c)).

The OSHA Bloodborne Pathogens Standard in section 2.1 also applies when an employee may be exposed to blood during extractions.