Acne is a medical condition rather than a cosmetic one, which is why it responds to medical treatment and why treating it well requires a physician rather than a facial. It is also the condition where getting treatment right early matters most, because every month of active inflammation is a month in which scarring can form.
Sam Assassa, MD is board certified in Internal Medicine and an associate member of the American College of Physicians, having trained and practiced in internal medicine before moving into aesthetics. That background matters for a condition driven by hormones and treated in part with systemic medication. He founded Beverly Hills Aesthetics in 1995 and has performed more than 25,000 aesthetic procedures.
“Treat the acne first and treat it properly. Every month somebody spends on the wrong regimen is a month they are still making scars, and the scars cost far more to fix than the acne did.” — Sam Assassa, MD
What Causes Acne
The skin contains pores connected to oil glands by follicles. Those glands produce sebum, and they are stimulated by androgens, which are produced by the adrenal glands in both men and women. When sebum production increases and dead skin cells accumulate, follicles become blocked, bacteria proliferate in the trapped environment, and inflammation follows.
Acne commonly begins at puberty when the oil glands activate, and it can occur at any age. Adult acne, particularly in women along the jawline and chin, is common and frequently hormonal.
Contributing factors include genetics, the menstrual cycle, stress, hot and humid conditions, oil based cosmetics, certain medications, and squeezing lesions, which drives inflammation deeper and raises the risk of scarring.
Medical Treatments for Active Acne
Treatment is matched to severity and to what has already been tried.
- Topical Retinoids: Adapalene, tazarotene, and tretinoin are vitamin A derivatives that clear blocked follicles and prevent new comedones from forming. They are the foundation of most acne regimens.
- Topical Antibacterials: Reducing bacterial populations and inflammation in the follicle.
- Oral Antibiotics: For moderate to severe inflammatory acne, typically started at a higher dose and reduced as the acne clears, and used for a defined period rather than indefinitely.
- Hormonal Treatment: Oral contraceptives can control acne in women by moderating the hormonal drive to the oil glands, and are frequently effective where topical treatment has not been.
- Corticosteroid Injection: A dilute corticosteroid injected into an inflamed cyst or nodule reduces inflammation, speeds resolution over a few days, and lowers the likelihood of that lesion leaving a scar.
Procedural Treatments for Acne and Oily Skin
- Chemical Peels: Clearing surface congestion, reducing comedones, and improving post-acne discoloration.
- Microneedling: For texture and scarring, used once active acne is controlled rather than during a flare.
- Laser Resurfacing: For established scarring and significant texture change.
- Intradermal Neuromodulator: Small superficial doses can reduce sebum production and the appearance of enlarged pores in patients with oily skin.
Please note: intradermal neuromodulator treatment for oil control and pore appearance is an off label application. These products carry FDA approval for indications that do not include sebum reduction. Off label use of an approved medication is legal and common in medicine, and it is discussed at consultation so you understand what is being recommended and why.
Treating Acne Before Treating Scars
Sequencing is the single most consequential decision in acne care and it is the one most often reversed.
Treating scars while acne remains active means working on a face that is still producing new lesions, so new scarring forms while old scarring is being addressed. Some scar treatments can also aggravate active acne by spreading bacteria across the skin. Getting the acne under control first is what makes subsequent scar treatment worth paying for.
That said, controlling acne quickly is itself the best scar prevention available. Prolonged inflammation is what damages the dermis, so effective early treatment reduces how much scarring there is to treat later.
Acne Treatment Risks and Safety
Every treatment described here carries considerations, and they differ substantially between them.
Topical retinoids commonly cause dryness, irritation, peeling, and increased sun sensitivity, particularly in the first weeks, and they are not used in pregnancy. Oral antibiotics can cause gastrointestinal effects and photosensitivity, and are used for defined periods rather than indefinitely to limit resistance. Oral contraceptives carry their own medical profile and are prescribed only after a full history. Corticosteroid injection can cause a small depression or lightening at the injection site, which is why it is used selectively rather than routinely.
Procedural treatments carry the risks described on their individual pages, with post-inflammatory hyperpigmentation the most relevant concern for acne patients, who are frequently prone to it.
Individual results vary and no outcome can be guaranteed.
Frequently Asked Questions About Acne Treatment
How long does acne treatment take to work?
Longer than most people expect, which is why regimens get abandoned prematurely. Topical retinoids typically take eight to twelve weeks to show meaningful improvement and often cause an initial worsening in the first few weeks as existing congestion surfaces. Oral treatment generally shows change sooner but still measures in weeks rather than days. Judging a regimen at two weeks and switching is the most common reason acne treatment fails.
Can I treat acne and acne scars at the same time?
Generally no, and the order matters more than the speed. Treating scars while acne is still active means new lesions keep forming and creating new scarring while old scarring is being worked on, and some scar treatments can worsen active acne. Bringing the acne under control first is not a delay, it is what makes the scar treatment effective and worth the cost.
Why do I have acne as an adult?
Adult acne is common and is frequently hormonal, particularly in women, where it often presents along the jawline and chin and fluctuates with the menstrual cycle. Stress, certain medications, and skincare or cosmetic products that block follicles also contribute. Because the drivers differ from adolescent acne, the treatment often does too, and hormonal approaches are frequently more effective than the topical regimens that worked in someone’s teens.
Should I be squeezing my pimples?
No, and it is the habit most directly responsible for scarring. Squeezing forces inflammatory contents deeper into the dermis rather than removing them, which extends healing, worsens the lesion, and substantially raises the chance it leaves a permanent mark. An inflamed cyst that you would otherwise be tempted to squeeze can often be treated with a corticosteroid injection instead, which resolves it in days.
Will Neurotox® really help my oily skin and large pores?
Small superficial doses can reduce sebum production and improve the appearance of enlarged pores in patients whose skin is genuinely oily, and results are temporary in the same way other neuromodulator treatments are. It is an off label use, meaning the product is FDA approved for other indications, and that is discussed at consultation. It is a refinement rather than an acne treatment, and it is not a substitute for treating active acne medically.
How much does acne treatment cost in Beverly Hills?
Cost varies with the plan, and medical management with topical or oral treatment differs considerably from a procedural course. Pricing is confirmed at consultation once a plan exists. Current figures are published on the fees page, and several payment options are available.
Why Patients Choose Beverly Hills Aesthetics for Acne
- Physician Led Treatment: Acne treated as the medical condition it is, by a board certified physician.
- Internal Medicine Background: Training in systemic and hormonal medicine informing treatment of a hormonally driven condition.
- Medical And Procedural Together: Prescription treatment and in-office procedures available under one roof.
- Correct Sequencing: Active acne controlled before scar treatment begins.
- Scar Prevention Focus: Early control prioritized because it reduces how much scarring forms.
Schedule an Acne Consultation in Beverly Hills
If your acne has not responded to what you have been using, or you are watching it leave marks you know will be harder to fix than the acne itself, a proper medical assessment is the place to start. Dr. Assassa will evaluate what is driving your acne and build a plan around it. Beverly Hills Aesthetics serves patients from Beverly Hills, Los Angeles, West Hollywood, and Century City. Request a consultation or schedule your appointment online.