Whiteheads and milia- comparing two women of differing ages. For medical education- NSFE.

For medical education- NSFE. Now that I have extracted more blackheads and whiteheads in the last few months than I have in my entire career as a dermatologist (!), I have noticed a pattern. Women tend to present more with whiteheads, aka as closed comedones, rather than blackheads. Maybe this is because we, as women, pay more attention in general to the skin on our face, and we will squeeze our own blackheads when we see them. The problem is that whiteheads are impossible to squeeze out unless you make a minor incision into the skin (here I use an #11 blade). I know I couldn’t do this personally to my own skin, so I can understand why women develop these and may seek out help from a dermatologist. These comedones present as fleshcolored or whitish, firm small bumps under the skin. Women who have oily, thicker more sebaceous skin, get more of these whiteheads trapped under the skin.
You can see in this video that the younger women has smaller whiteheads and the older women has larger whiteheads that have developed over time.
I make minor nicks in the skin with a sharp pointed blade, and I change the angle of my nicks in order to make these marks along skin tension lines, so as to minimize any noticeable break in the skin surface. There should not be any residual scarring from this type of procedure.

source