05 December 2019
If popping pimples and seeing all that pus ooze out gives you a sense of satisfaction, you are not alone. Judging from the meteoric rise of Dr Sandra Lee (also better known as Dr Pimple Popper) and the popularity of her videos – she counts Selena Gomez as a fan and she has a range of merchandise creatively called #Popoholics- some of you might think that it is safe and easy to pop or squeeze your pimples. Afterall, if beauty therapists do it, what can possibly wrong?
Very wrong, in fact. A good proportion of my patients in Singapore deal with acne- teenage acne, adult onset acne…etc you name it. Acne and acne scars are very distressing, so I can understand the urge to pop those pimples for a quick fix. However, if you must- there is one area on your face you must be aware about because blindness and death can occur as a consequence if things go wrong, as seen in this unfortunate patient from China who attempted to treat himself. Not trolling you here.
Not to be confused with the geographical danger triangle (Bermuda Triangle), the danger triangle is a true, anatomical region on our faces where squeezing a pimple can cause a blood clot or infection to spread to the brain, to cause pressure on the brain or even brain infection and death.
The triangle of death in the face is bounded by the corners of the mouth at the bottom and the bridge of the nose at the apex of the triangle. The nose and part of the cheek bones (maxilla) lie within this triangle of death.
All of us have veins in our faces that drain blood back to the heart eventually. In the face, one of the most important veins that eventually drains back to the heart is called the facial vein.
Almost all the veins in our bodies contain valves, to prevent the backflow of blood in the wrong direction so that blood can flow in the correct direction back to the heart.
The facial veins are peculiar because they do not contain valves. Being valveless, blood can flow in the opposite direction to the brain via the cavernous sinus. The cavernous sinus is an important venous plexus in the brain. This means that blood clots and infections from the nose and sinuses can travel to the brain to cause life threatening infections and brain clots.
Cavernous sinus thrombosis is a life and sight threatening condition when a blood clot develops in the cavernous sinus of veins. The clot adds pressure to the surrounding nerves that control the movement of our eyeballs and the increase in pressure can cause stroke and even death. Likewise, an infection that spreads to the cavernous sinus can also spread to the brain.
However, the risk of a blood clot of infection developing from acne or bursting a pimple on the nose and spreading to the brain is very low. Plus, if your acne or infection were that severe, you would probably already be prescribed antibiotics by your doctor.
To discuss the treatment of acne and pimples would require a post in itself and I’ll save that for another time. Briefly speaking, acne can be treated and depending on the severity, a combination of skincare, medications or Q-switched laser and chemical peels may be required.
Acne that is left untreated does not affect a person’s confidence alone- it can also leave behind depressed acne scars and dark marks called post inflammatory hyperpigmentation.
Most doctors will advise you against popping your own pimples for good reasons. Besides the theoretical (albeit low) risk of death from popping pimples in the danger triangle of the face, extracting or popping pimples, especially in non-sterile setting (e.g. your home) can cause:
● Depressed acne scars
● Worsening of inflammation and acne
● Skin infection
Keeping your pores clean and free from blackheads and whiteheads are important in preventing and controlling acne. To some extent, doctors also perform extractions too, but not by manually squeezing or poking your face that your facial therapist does. The problems I find occurring with these manual squeezing or poking methods performed at beauty spas is infection and scarring on top of the pain experienced. I have a number of patients who are currently on treatment with me to lighten the marks and to treat the depressed scars left behind by these non-sterile extraction methods performed at beauty salons.
One of the treatments that doctors do to quickly reduce the inflammation in pimples is steroid (corticosteroid) injections. This is the urgent/emergency injection that some celebrities and influencers get before their big events. Steroid injections can reduce the inflammation and size of pimples within 24 to 72 hours. This is a very quick treatment in the clinic but it is not commonly performed in Singapore because there are some risks and caveats to steroid injections of pimples.
Steroid injections of acne or pimples are reserved for pimples that are very painful, cystic nodules that are not improving. This is because such cystic nodules have a risk of scarring and this balances the risk of steroid injections, which is the risk of leaving a depressed scar. Steroid injections are also not meant as a regular treatment for acne- it’s best that you discuss with your doctor about a treatment plan that’s personalised for you- but briefly speaking, it may consist of appropriate skincare, medications and clinic treatments.
Another safe and effective way of treating acne and getting rid of blackheads and whiteheads is exfoliation with chemical peels. Essentially, the top layer of the skin which contains blackheads, whiteheads, bacteria, dead skin…etc are removed to allow newer skin to be regenerated. I do mine every 4 weekly to get rid of my blackheads, whiteheads and pigmentation. I’ve written a blog post on chemical peels, so if you want to see how it is performed in my clinic and know more about it, read this post: The Truth About Chemical Peels.
The truth is, we are all humans and I know that despite reading this post on how pimples can be treated and the alternatives to extractions, some of you will return to your pimple popping ways.
So, if you do, you might be causing more harm than good to yourself. One point I would like to highlight is that not all pimples should be popped. A good example is cystic acne, where a cyst forms deep under the skin. The cyst contains bacteria, dead skin and oil. Because the cyst is deep under the skin, popping or extraction will not make the pimple better. Instead, you might end up pushing the infection deeper and worsening the inflammation. The best line of defense for cystic acne would be medications with treatments like the Q-switched laser.
And that’s it for my sharing on acne and extractions today! I hope you found this interesting and useful 🙂