Macrocomedones?

Hi Doctor,

  I have been getting a good amount of what I believe are macrocomedones on my upper cheeks that do not respond to any topical medication I have been putting on it (differen, tazorac, a vitamin A product from the Vivant company).  I was wondering if there was any alternate method to get rid of these.  They tend to sit around forever in my skin and then eventually flare up into cysts or large pustules.  There are about 6-7 of them isolated in my cheeks that have been there since spring (when I tend to break out).  I've heard someone mention light cautery, but wasn't really sure if this is a common procedure and obviously don't want to do anything that would cause scarring ideally.  Any information would be great... thanks!