Sixty million people in the United States have acne, and it's not just for teens: One in five American adults has it, too [source: ARC]. The most common form of acne is comedonal, otherwise known as blackheads and whiteheads. These comedones are the result of a hair follicle getting clogged with oil, or sebum. Blackheads are open to the air, and whiteheads are pretty much closed.

These types of blemishes can cause trouble from the time puberty strikes. Lots of people seek some sort of help, most of them turning to over-the-counter medications sold at drugstores and supermarkets. But some go the often-more-expensive dermatologist or esthetician route. Those who choose to see an esthetician -- a skin-care expert with some level of professional training --are typically looking for an acne-oriented, or clinical, facial. One question comes up over and over: to extract or not to extract?

Since extractions are invasive, it's a serious question. When doing extractions, an esthetician manipulates the pores, either with fingertips or a metal tool, to remove the sebum that's causing the acne. Some extractions can even involve a tiny incision or a prick with a pointed tool called a lancet.

There's no doubt that extractions can be a major ally in the quest for smooth, clear skin. Getting that sebum out of the pore can flatten the bump, reduce the irritation and make pores appear smaller.

So, why the controversy? Shouldn't we all be extracting our little hearts out, ending up with perfect complexions? On the next page, we'll get to the sebum-filled heart of the matter and find out why it's important to think carefully before undergoing extractions.