Sebaceous Hyperplasia Treatment in Toronto

By Basil Russo, Founder, Bar Beauty Medical, 46 Fort York Blvd, CityPlace Toronto. Clinically reviewed by Jasmine Saggu, RN, Lead Injector.

Sebaceous hyperplasia is the small, soft, yellowish bump with a dip in the middle that appears on foreheads and cheeks, usually from the late thirties onward, and usually in numbers. People bring them to us calling them whiteheads that will not pop, or milia that nothing shifts, or simply “these things that keep appearing”.

They are enlarged oil glands. They are benign. And there is one genuinely important thing to establish before anyone treats them, which is the first section of this page rather than a footnote at the bottom.

The part that actually matters: it can look like a skin cancer

Sebaceous hyperplasia is commonly confused with basal cell carcinoma, the most common form of skin cancer. They share several features. Both can be pearly or translucent, both can have visible fine blood vessels running across the surface, both favour sun exposed areas of the face, and both become more common with age.

This is not a theoretical concern. It is a well recognised diagnostic overlap, and it is the single reason we insist on the same thing every time: a lesion should be confirmed as benign by a physician before we treat it.

Some pointers, offered so you understand our position rather than so you can self diagnose:

• Sebaceous hyperplasia is typically soft, yellowish or skin toned, with a distinct central dimple, and it usually appears as several lesions rather than one. It sits still. It has often been there for years unchanged.
• A lesion that should be seen urgently is one that is growing, changing, bleeding, crusting, ulcerating, failing to heal, or appearing alone and behaving differently from everything else on your face.

If you have a single new bump that is changing, do not book a laser. Book a doctor. We will tell you exactly this at consultation and we will not treat you until it has been assessed. Losing that booking is a trade we are happy to make.

The central dimple, and what is underneath it

The dip in the middle of the bump is not incidental. It is the follicular opening, and it is the giveaway sign.

A sebaceous gland normally sits alongside a hair follicle and empties oil into it. In sebaceous hyperplasia the gland enlarges and its individual lobules multiply, crowding around that central opening. What you see on the surface is the ring of enlarged lobules pushing up, with the follicular opening still sitting in the middle as a small crater. That is the anatomy of the dimple.

It also explains two things people find frustrating. It explains why they cannot be squeezed. There is no plug of debris to extract, only enlarged glandular tissue, and squeezing produces nothing except bruising and inflammation. And it explains why they recur, which we will come back to.

Why they appear, and why it is mostly not about your skincare

Several factors drive this and almost none of them are things you did to yourself.

• Age. Sebaceous gland turnover slows with age, cells accumulate within the gland, and the gland enlarges. This is the main driver and it is why these appear from the late thirties onward.
• Cumulative sun exposure. Lesions cluster on the forehead, temples and cheeks, the areas with the most lifetime ultraviolet exposure.
• Genetics. A familial pattern is common, and some people develop many lesions at a relatively young age.
• Ciclosporin. This is worth knowing. Long term ciclosporin, most often in transplant recipients, is strongly associated with widespread sebaceous hyperplasia. If you are on it, that is very likely the explanation, and it changes the conversation about expectations.
• Oily skin type. More active sebaceous glands generally means more of these.

What does not cause them: poor cleansing, not exfoliating enough, or the wrong moisturiser. People often arrive having escalated their routine considerably in an attempt to shift these, and that effort is misplaced.

What they are not

• Not milia. Milia are firm, white, dome shaped keratin cysts with no central dimple. They can be extracted. These cannot.
• Not whiteheads. A closed comedone is a plugged follicle containing debris. Squeezing it produces something. Squeezing sebaceous hyperplasia produces nothing.
• Not warts. Warts are rough, keratotic and viral. These are soft and glandular.
• Not dangerous. They are entirely benign, with the caveat above that the diagnosis needs confirming.

How the Neo Elite approaches them

The Aerolase Neo Elite is a 1064nm Nd:YAG delivering energy in 650 microsecond pulses. For this condition the relevant property is that 1064nm energy penetrates deeply enough to reach the sebaceous gland itself and is absorbed usefully by the vasculature supplying it, while passing relatively harmlessly through the pigment in the epidermis above. That last point is why this wavelength is a comparatively safe option across a wide range of skin tones for a lesion that sits below the surface.

Practically, treatment aims to reduce the volume of the enlarged gland so the bump flattens toward the level of the surrounding skin. Because the treatment works below the surface rather than removing tissue from the top, it avoids the open wound, scabbing and pigment risk that come with more destructive approaches.

What to expect realistically:

• Lesions flatten gradually rather than disappearing in one session
• Multiple sessions are normal, and larger or longer standing lesions take more
• Results look like smoother skin texture rather than a lesion having been cut out
• Some lesions respond better than others, and we cannot predict which in advance

Be realistic about recurrence

This is where we would rather be blunt than optimistic.

Treatment reduces the enlarged gland. It does not remove the gland, and it does not stop the process that enlarged it. The gland is still there, it is still yours, and the same age related mechanism that caused this is still running. Lesions can re enlarge over time, and new ones can appear in new places.

Anyone who tells you a single course will permanently clear sebaceous hyperplasia is either being careless or is selling. The honest framing is that this is periodic maintenance. Many people come in for a series, get a good result, and return every year or two for a top up. That is a perfectly reasonable arrangement and it is what we would tell a friend to expect.

The lesions we send to a doctor instead

We will not treat any lesion that has not been confirmed benign, and for anything single, new, changing or atypical we will insist on a physician’s assessment first. We do not treat during pregnancy. We do not treat over active infection or broken skin.

Julia, our Glow Specialist, runs most of these assessments with Jasmine. If either of them looks at a lesion and is not comfortable, you leave with a recommendation rather than a treatment.

How a session on these lesions runs

Sessions are short, often fifteen to twenty five minutes depending on how many lesions are being treated. There is no gel, no contact and no cooling attachment. Most people describe a warm snapping sensation and manage comfortably without numbing.

Afterwards the treated bumps often look slightly red or a little swollen for a day or so, which is expected and settles. There is no open wound and no scab, and most people go straight back to work.

What treating these lesions costs

Most lesions need a short series rather than one visit, and how many depends on size and how long they have been there. We assess and quote honestly at a free consultation rather than selling a package up front. Our full price list has everything else.

Aftercare for treated lesions

• Redness or slight swelling at treated spots for a day or two is normal
• No sauna, steam or hot yoga for twenty four hours
• No picking or squeezing treated lesions, which will not help and may mark the skin
• Pause acids and retinoids for about five days
• Daily sunscreen, since sun exposure is one of the contributing factors and protecting the area is genuinely preventive here

How the alternatives compare

Several approaches exist for these lesions and it is worth knowing the landscape, including where we are not the obvious answer.

• Electrocautery and hyfrecation. Effective and widely used, working by destroying the lesion with heat from the surface. The trade off is an open wound that scabs, and on some skin types a real risk of leaving a pale or dark mark where the lesion was.
• Trichloroacetic acid. A chemical applied directly to the lesion. Inexpensive and often effective, with a similar scabbing and pigment consideration.
• Oral isotretinoin. Can shrink lesions substantially, and is sometimes used where there are very many. Lesions typically return after the course ends, and the medication carries considerations that make it a physician decision rather than a cosmetic one.
• Surgical excision. Definitive for an individual lesion but leaves a scar, which for a benign cosmetic bump is usually a poor trade.
• 1064nm Nd:YAG. Works below the surface at the gland rather than destroying tissue from the top, which is why there is no open wound and comparatively less pigment risk. Slower per lesion, and usually needs a series.

If you have one large lesion you want gone in a single visit and you are not concerned about a mark, cautery in a physician’s office is a perfectly reasonable choice and we will tell you so. Where we think our approach earns its place is in people with many lesions, in deeper skin tones where post inflammatory pigment is a genuine concern, and in anyone who cannot accept visible healing on their face for a week.

The three sebaceous cases we see most

The one who has been extracting. Has spent months trying to squeeze these, believing they are stubborn whiteheads, and now has inflammation and marks on top of the original bumps. Explaining that there is nothing inside to extract is usually the most useful part of the visit.

The transplant patient. On long term ciclosporin, with widespread lesions that appeared over a year or two. We work with realistic expectations here, because the driver is ongoing and maintenance will be part of life.

The one with a single new bump. This is the person we most often send away. One new lesion behaving differently from everything else on the face gets a physician’s assessment before anything else happens.

What people ask us about these bumps

Are these dangerous?

Sebaceous hyperplasia is benign. The important caveat is that it can resemble basal cell carcinoma, which is why the lesion should be confirmed by a physician before cosmetic treatment.

Can I squeeze them out?

No. There is no plug or contents to extract, only enlarged glandular tissue. Squeezing causes inflammation and can mark the skin.

Will they come back?

They can. The gland remains and the underlying process continues, so periodic maintenance is the realistic expectation rather than permanent clearance.

Are they related to acne?

Not directly. Both involve sebaceous glands but the mechanisms differ, and acne treatments do not resolve these.

Will retinoids help?

Topical retinoids may modestly improve the appearance for some people and are sometimes suggested, but they generally do not clear established lesions. Oral isotretinoin can shrink them, though they typically return afterwards, and that is a physician decision with its own considerations.

Why do I suddenly have so many?

Age is the usual answer, sometimes combined with genetics. If you take ciclosporin, that association is well documented and worth raising with your prescribing physician.

Is treatment safe on darker skin?

The 1064nm wavelength is one of the safer options across deeper Fitzpatrick types because it is not strongly absorbed by surface melanin. We assess individually. See Aerolase for darker skin tones.

Will it leave a scar?

Because the approach works below the surface rather than destroying tissue from the top, it avoids the open wound and scab that carry most of the scarring and pigment risk with more destructive methods. No treatment is entirely without risk and we discuss this at consultation.

How many sessions?

It varies with lesion size and age. Some respond in two or three, others need more, and we will tell you honestly how yours are tracking rather than pre selling a number.

Where are you and how do I book?

46 Fort York Blvd in CityPlace, downtown Toronto. Consultations are free and booking is online.

Book a free consultation

Not sure what your bumps are? Milia, closed comedones and sebaceous hyperplasia all look similar and are treated completely differently. Bring them to a free consultation, or see our spot treatments page for benign lesion work generally.