Primarily, sebaceous glands become over-active under influence of hormones such as testosterone. They then pump out more in the way of oily sebum, which then tends to collect on the surface of the skin, which then tends to keep dead surface skin cells stuck onto the surface of the skin rather than allowing then to be naturally shed into the environment. These excessive skin cells then tend to aggregate in areas that are depressed, such as the “pores”. This in turn creates an obstruction to the further outflow of sebum, which therefore builds up in the sebaceous gland, applying pressure in the neck of the gland which then dilates. Sebum continues to find its way out around the obstruction (if it didn’t, you’d get a cyst), leading to more sticking of surface cells which are now even more likely to congregate into the now dilated “pore” opening. Of course, the “pore” opening then stretches even further…….

When we look closely at untreated “pores”, we can see that there are actually little yellow (sometimes blackened; due to oxidation) plugs in the pores, and this is where treatment must start.

Firstly, the plugs must be removed. Then, sebaceous activity and sebum production must be reduced, and thirdly we must try to narrow the now-empty “pore”.

1) “Pores” cannot close if they are being held open by plugs of dried sebum, so plug removal comes first, and this is done by first loosening the plugs with hydroxy acids, especially salicylic acid, and then suctioning the plugs with microdermabrasion. Loosening the plugs first makes the microdermabrasion more efficient. Some larger plugs are resistent to microdermabrasion and need direct removal one by one. Microdermabrasion brings the additional benefit of removal surface dead cells that would otherwise contribute to the formation of future plugs. Once the plugs are gone and the pores are empty, an unintended but inevitable visual effect arises. The yellowness of the unoxidised plug, from any distance, tends to camouflage the presence of the pore because the plug is roughly the same colour as the surrounding skin and its presence creates a fairly flat surface with the surrounding skin. However, once the plug is removed, there remains an emply pore. This is in effect a tiny hole, which of course creates a shadow within it, and the blackness of the shadow, from any distance, is going to be more noticeable than the plug had been previously! Patients will sometimes describe that initial treatments have made their pores look worse, but on further thought and explanation realise that it is this shadowing effect that they are now noticing. Nonetheless, the emptying of the pores is a necessary precondition to further pore improvement.

2) Sebaceous gland activity is commonly reduced by using Vitamin Ain your skin care regime, either natural Retinol or a prescription version, but retinol is better tolerated. Potent doses of Vitamin A are required, and retinyl palmitate will not be strong enough. Sebaceous gland activity can be very rapidly brought under control with photodynamic therapy (PDT). This will kill off a large proportion of sebaceous gland cells, and well reduce gland activity, but comes with temporary side effects and would cause a temporary outbreak of whiteheads along with moderately severe redness, like a sunburn. However, patients who are frustrated with slow progress with other treatments,and who accept a week or so of redness, appreciate the long-term benefits that come with photodynamic therapy.

 

 

3) Once the “pores” are empty of plugs, and the gland activity controlled, it remains to try to reduce the size of the empty, deactivated pores. This is achieved through whatever process we use to stimulate collagen formation around the pore, and a number of types of treatment will have this effect. Collagen is laid down after peels, microdermabrasion, laser treatments, Omnilux, IPL and practically any treatment process that involves significant mechanical, chemical, light or thermal stimulation to the depper skin layers. Choosing one treatment modality over another depends on whatever other skin problems are being addressed at the same time. For example, someone hoping to treat both pores and sun-damage pigmentation would choose IPL, whereas someone with no pigment problem but with persisting acne would choose microdermabrasion. Treatments are always tailored to the individual.

 

Finally, remember that it took a long time for the “pores” to develop and its going to take a long time to shrink them down. Changes in collagen structure do not occur overnight, and the treatment regime has to be maintained to get the results we are looking for. Compare pore treatments with muscle development at the gym; one visit will not help you, one aggrssive visit will hurt you, but sustained and disciplined activity will always bring results.