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Comedone Extraction vs Photodynamic Therapy

Comedone Extraction: A provider clears blackheads and whiteheads with a small tool. The result is immediate and temporary — pores refill within weeks unless a daily treatment changes them.

Photodynamic Therapy: A light-activated drug applied in the office, then switched on with a lamp or laser. It is the strongest non-drug option for inflammatory acne, and the downtime is a real week.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Last updated: 10/22/2026
Editorial illustration for Comedone Extraction, based on the entry’s treatment or equipment reference.Editorial illustration for Photodynamic Therapy, based on the entry’s treatment or equipment reference.
Choose ifKey differencesWhat is it?What it treatsTreatment areasSkin tonesHow it worksBefore your treatmentDay of treatmentAfter your treatmentRisksCostQuestionsRelated

Choose Comedone Extraction if…

Choose for an instant clear-out of blackheads, whiteheads or milia — temporary unless a daily treatment keeps pores clear.

  • Stubborn blackheads or milia
  • An event coming up
  • You're also using a retinoid at home

Choose Photodynamic Therapy if…

Choose to treat a whole area of sun damage at once — or as a strong non-drug option for stubborn acne — with a real week of downtime.

  • Many precancerous patches on the face or scalp
  • You can stay out of light for 48 hours
  • You can take a week of redness
Fine together

Can you have both?

Extractions can be done before photodynamic therapy for acne. Follow the clinic's sun-avoidance advice afterwards.

Key differences

● Comedone Extraction
● Photodynamic Therapy
DowntimeNone → 2+ weeks
1–2 days
3–7 days
PainMinimal → Needs anesthesia or sedation
Mild
Moderate
Results showImmediately → 3+ months
Immediately
1–4 weeks
How long it lastsWeeks → Years or permanent
Weeks
1–2 years
Visits neededOne → Every few months
Every few months
A short series (2–3)
Cost per visit$ → $$$$$
$
$$
ReversibleYes, can be undone → No, permanent
No, wears off
No, permanent

What is it?

Comedone Extraction

Photodynamic Therapy

What is it?

It clears clogged pores.

Blackheads and whiteheads are removed by a clinician.

It helps selected plugs.

It does not address every cause of acne.

It is not for inflamed spots.

Nodules and cysts need a different plan.

Pressure can scar.

Excessive force can cause scarring or pigment change.

It pairs medicine with light.

A photosensitizing medicine is activated by a set light exposure.

It treats precancers.

It is used for actinic keratoses and some superficial lesions.

It differs from LED therapy.

It is not ordinary LED or UV treatment.

Light avoidance is needed after.

Sunscreen alone may not prevent activation.

What it treats

Evidence level
Comedone Extraction
Photodynamic Therapy
Strong evidenceMost established uses
—
Existing educational image of Actinic Keratosis

Actinic Keratosis

Clears 75–90% of spots.

Moderate evidenceSome supportive research
dark keratin plugs in dilated pores on the nose and adjacent left cheek, with the face turned to the person’s right on light skin.

Blackheads

Clears them the same day.

AI-generated educational illustration of Milia: 1. Milia Header — Light Skin; Lighter skin. Not a clinical photograph.

Milia

Removes stubborn milia.

Existing educational image of Basal Cell Carcinoma

Basal Cell Carcinoma

Treats superficial types.

Limited evidenceEarly or small studies
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Helps clogged pores alongside treatment.

Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Used for stubborn acne.

Not effective
Shoulders and upper back on fair skin, covered in a sheet of many small pink-red bumps, all of them the same size and packed close together.

Fungal Acne

These bumps aren't clogged pores.

AI-generated educational illustration of Melanoma: 1. Melanoma Header — Light Skin; Lighter skin. Not a clinical photograph.

Melanoma

Needs excision.

Can make it worse
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Squeezing worsens redness.

Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Light can darken patches.

Treatment areas

Treatment areas

Face; the selected area depends on the concern and treatment plan.

Face; the selected area depends on the concern and treatment plan.

Skin tones

Skin tone
● Comedone Extraction
● Photodynamic Therapy
Lighter skin
Low risk
Brief redness.
Low risk
Redness and peeling.
Medium skin
Low risk
Gentle technique matters.
Some risk
Temporary darkening possible.
Deeper skin
Some risk
Squeezing can leave dark marks; choose an experienced provider.
Some risk
Dark marks are more likely; strict light avoidance helps.

How it works

Comedone Extraction

Photodynamic Therapy

How it works
Comedone Extraction mechanism diagram. An accessible plug is selected: A clinician identifies a suitable comedone. The plug is carefully removed: Controlled extraction lifts out trapped keratin and sebum. The pore opening is cleared: Ongoing acne care helps reduce new blockages.
Photodynamic Therapy mechanism diagram. A photosensitizer is applied: The selected medicine accumulates in the prepared treatment area. Light activates the medicine: A matched light regimen produces reactive molecules. Selected cells are damaged: Inflammation and healing follow; treatment response varies.
Diagram explanation

An accessible plug is selected: A clinician identifies a suitable comedone. The plug is carefully removed: Controlled extraction lifts out trapped keratin and sebum. The pore opening is cleared: Ongoing acne care helps reduce new blockages.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

A photosensitizer is applied: The selected medicine accumulates in the prepared treatment area. Light activates the medicine: A matched light regimen produces reactive molecules. Selected cells are damaged: Inflammation and healing follow; treatment response varies.

Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.

Before your treatment

Comedone Extraction
Photodynamic Therapy
2–4 weeks before

Prep products: Some providers ask for a retinoid or salicylic acid first, which loosens plugs and makes extraction easier.

2 weeks before: Sun and tanning: Avoid sun and tanning for 2 weeks.

Before you book: Time off: Clear several days, especially the 48 hours after, when you must stay out of sunlight and bright indoor light.

The week before

A few days before: Do not pick: No picking or squeezing at home.

5 to 7 days before: Actives: Stop retinoids and exfoliating acids.

Day of treatment

Comedone Extraction
Photodynamic Therapy
Before you arrive

Clean face: Come without makeup if you can.

Not specified
Arrival & prep

Skin is cleaned and the provider decides which spots can be extracted.

Photos, consent covering the off-label use and the downtime, and a medication review.

Treatment

The provider presses around the pore with a metal loop or two swabs, opening whiteheads first with a tiny sterile needle.

You feel firm pinching at each spot. A full face takes 10 to 30 minutes. Blackheads are pressure more than pain; whiteheads and deeper plugs sting when opened, and a long run is tiring rather than sharp. A painful spot is not forced.

Skin is cleaned and degreased, sometimes with microdermabrasion or an acetone wipe, so the drug soaks in evenly.

The solution goes on and you wait 20 minutes to 3 hours in a dim room. Then eye shields go on and you sit under a blue or red light for 8 to 20 minutes, or a laser or IPL is passed over. Stinging builds and peaks at the end; cold air helps.

Before you leave

Red, blotchy skin with pink rings where spots were, sometimes pinpoint scabs.

The least comfortable procedure on this list.

After your treatment

Comedone Extraction
Photodynamic Therapy
First 24 hours

Hours 2 to 6: Redness and small raised rings, sometimes into the next day, with occasional pinpoint scabs where a whitehead was opened.

Days 1 to 2: Redness mostly gone.

First 48 hours: Stay strictly out of sunlight and bright indoor light; daylight through a window can trigger a severe reaction.

Days 2–7

Days 3 to 7: Skin looks normal.

Days 4 to 10: Peeling and flaking, sometimes in sheets.

Weeks 2–4
Not specified

Weeks 1 to 2: An acne flare is common in the first week or two, before improvement starts.

Time to results

Immediately

2–4 weeks

How long results last

Weeks; pores refill without daily treatment

Treated spots clear; new ones may form

Risks

Risks
  • A brown mark that persists
  • Inflamed spots after every session
  • Dark patches
  • Prolonged redness
  • A cold sore outbreak

Cost

Per session

With a dermatologist it is often bundled into an acne visit at no extra charge.

In the US, PDT for acne generally costs about $400 to $1,500 per session, so a course commonly lands between $800 and $4,000.

Insurance

Insurance sometimes covers it when billed as acne surgery at a medical dermatology visit.

Insurance does not cover PDT for acne, because the approved indication is precancerous sun damage.

Questions

Comedone Extraction

Photodynamic Therapy

Individual Questions
Does extraction get rid of blackheads for good?

No. It empties the pore that day. It refills over 4 to 8 weeks unless a daily retinoid changes how the pore behaves.

Is it better than doing it myself?

Mostly yes — technique and restraint. A provider uses sterile tools, opens closed spots properly, and stops when a spot resists. Home squeezing causes most brown marks and small scars.

Can they extract a cyst?

No. Deep, red, painful lumps have no opening to press through, and forcing one makes it worse. A cortisone injection is the answer.

Does it make pores smaller?

Only in appearance, and briefly. An empty pore looks smaller; pore size does not change.

Does it hurt?

Blackheads feel like firm pinching. Whiteheads sting for a second when opened. Uncomfortable rather than painful.

Is photodynamic therapy approved for acne?

Not in the US. It is FDA-approved for precancerous sun spots; using it for acne is off-label. That is legal and common, but it means no standard protocol and results that vary between clinics.

How bad is the downtime really?

Plan for 5 to 7 days of a visibly red, then swollen, then peeling face, with the worst in the first 48 hours. It is closer to a medium-depth peel than a laser facial.

Why do I have to stay out of the sun for 48 hours?

The drug is still in your skin, and sunlight — including through a car or office window — activates it and can cause a severe burn. This is the most important instruction of the treatment.

Does it cure acne?

No. Improvement typically lasts 6 to 12 months and repeat courses are often needed. It does not treat scars or existing brown marks.

Is it safe on deeper skin tones?

It can be done, but the risk of lasting dark patches is meaningfully higher, because the treatment works by causing strong inflammation. A shorter incubation, a lower light dose and an experienced provider make a large difference.

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