Reduce large pores with BOTOX

BOTOX helps with large pores and oily skin

You ask yourself: what to do about large pores? On the nose? On the cheeks? How can I refine my pores? And get rid of the oily skin around them? My answer is: Botox! You heard me right. Botulinum toxin A, the well-known anti-wrinkle agent, can also very effectively shrink large pores. And improve blemished skin. This is the first time you hear this? I’m not surprised. Even your dermatologist may have only heard that botulinum toxin can be used as a therapy when large pores cover the nose, eye areas and cheeks. And the T-zone greasy shine. If you believe the colleague from Hamburg in this article in Harper’s Bazaar, then the method does not yet exist in Germany (which is obviously not true).

By improving oily skin, botulinum indirectly acts as an acne therapy. Because oily skin is almost always a necessary precondition of acne. However, acne therapy with botulinum toxin is indeed new and not yet widely used, that much is true. In this post, I’ll tell you all about how botulinum toxin can be used to shrink large pores and improve oily skin.

These are the topics:

  • Reduce large pores with BOTOX
  • How do large pores and oily skin develop?
  • What is Micro BOTOX?
  • How does the treatment work?
  • What does the treatment cost?

Botox for seborrhea and acne

First of all, I would like to clarify that I am not a dermatologist. Therefore, in case of acute acne, I strongly advise you to clarify with your dermatologist the elimination of any pathological causes that should precede the purely aesthetic treatment of large pores and blemished skin. Especially in the case of far advanced, inflammatory acne, the measures described in this article alone will not lead to success. In such a case, please be sure to seek consultation with your dermatologist.

Micro-Botox for oily skin

But now to our topic: large pores and oily skin (medical: Seborrhea) can be treated quite effectively with botulinum toxin in many cases. The procedure is new, as already written above. So new, in fact, that there is still no clear name for it among medical experts: Some call it Micro Botox (to which I belong), the others speak of Meso Botox (and they are not few), and still others call it Baby Botox (mainly in the USA). But whatever it is called, seborrhea therapy with botulinum toxin is in any case regarded as superficial applications in the skin very interesting. Because large pores on the face, often together with blemished and oily skin, are a common problem. And a direct precursor of acne. At the same time, seborrhea alone is not yet a reason for acne. As long as the excess sebum produced by the sebaceous glands in seborrhea is not broken down by bacteria and enzymes, inflammation of the kind that characterizes the skin typical of acne is rare. More on this below.

Creams and lotions often do not help

Treating oily skin is one of the many new uses of botulinum toxin that physicians have discovered in recent years. The target of the botulinum injections moved from the muscle to the skin. There, botulinum toxin opened up a completely new spectrum of therapies. Refining pores and improving blemished skin with the skin appearance typical of acne are only two of the therapeutic goals that can be successfully pursued with it. Another is, among other things, the reduction of excessive sweating. Botulinum can improve blemished skin much more effectively than many of the well-known acne home remedies and creams.

In fact, in most cases you can safely forget about the numerous tips against seborrhea that can be found on the net. All cosmetic products and measures aimed at shrinking pores can do nothing from the outside to reduce the increased sebum production. But that is exactly what matters! Creams, tinctures and lotions therefore refine pores temporarily at best and more visually than actually (one speaks of astringent effect). However, they do not get to the root of the problem.

Oily skin due to excess sebum production.

If excess sebum production is not inhibited, then shrinking pores and improving blemished skin will not work. Until now, your dermatologist could only use a drug called Isotretinoin which regularly proves to be very effective, but unfortunately is often accompanied by severe side effects. Botulinum toxin can also shrink large pores, as recent studies show. And even without side effects. It is therefore worthwhile to approach your dermatologist about the possibility of having large pores removed with botulinum and alleviating an already existing acne without side effects.

Superficially injected botulinum against blemished skin

Because the botulinum in this application is not injected into the muscle, but only into the skin above it, facial expressions remain completely intact. Thus, there is no risk of facial features freezing. The botulinum is not administered in this application to make muscles slacken. It is used to exploit the neurological mechanism of action of the toxin to specifically reduce sebum production. And thus to shrink the pores. As already written above, this has nothing to do with the muscles.

How do large pores and oily skin develop?

Blemished skin and large pores occur together

Oily skin and large pores almost always occur together. One speaks of oily skin or seborrhea when the skin surface has an increased content of lipids (Sebum). Seborrhea is widespread, first appearing with puberty and then accompanying one, often into advanced adulthood. Men are more likely to suffer from oily skin than women, and as a direct result, more likely to suffer from acne. However, it is primarily women who seek cosmetic medical help for seborrhea and acne. This certainly has to do with prevailing beauty ideals, which make a woman much more likely to want to refine her pores in pursuit of “peach skin.”

Seborrhea and acne often distressing

Seborrhea and acne are, however, disorders that can burden those affected, both privately and at work. Studies have shown, for example, that people with acne find it significantly more difficult to find adequate professional employment. In addition, acne-prone, oily skin puts a strain on many adolescents during puberty, a time when they are already busy coping with massive social and psychological changes. Depression and thoughts of suicide are therefore not uncommon and have been increasingly reported in connection with acne. No wonder, then, that entire rows of shelves in drugstores now boast that they can put a stop to pubescent acne and refine pores.

What exactly is seborrhea?

As indicated above, seborrhea is not initially synonymous with acne. The clinical appearance of seborrhea is oily shiny skin with large pores. Mostly, however, seborrheic skin is accompanied by the development of acne. In acne, in addition to shiny skin, there are also Comedones (blackheads) on and in hairy areas inflammatory skin changes at the hair follicles. Subcutaneous comedones, in which the opening of the hair follicle is completely blocked, are often only noticed by the sebum showing through and appear as small, whitish papules (“pimples”).

Pimples and blackheads

On the other hand, if the follicular opening is not completely closed, then dirt and melanin form a black-appearing plug (“blackhead”). Usually the two occur together and often enough they tend to become inflamed. As a long-term consequence, the formation of comedones leads to damage of the connective tissue and significant enlargement of the follicle, and thus ultimately to the appearance of “large pores”. So large pores don’t just look dilated – they actually are. In view of this fact, I would like to take this opportunity to once again advise all those affected to visit their dermatologist in good time in order to counteract the development described above at an early stage. Your dermatologist may be able to do more than just refine pores and fix other externalities, he may be able to put a stop to the progression of the disease as such.

Causes of seborrhea

Seborrheic skin is mainly attributed to hormonal causes, particularly the body’s response to androgens (male sex hormones). During puberty, under the influence of androgens, there is an increase in the volume of the sebaceous glands and an increase in sebum production.

Treating overactive sebaceous glands is key to shrinking large pores.

Sebum production in normal skin

Normally, sebaceous glands produce a certain amount of sebum, then burst and pour their contents into the pore-hair canal. During the next 6 days, the sebum rises to the exit of the pore channel, and from there it emerges onto the skin surface, keeping the skin supple and protected from pathogens.

Sebum production in seborrhea and acne

However, in response to androgens, the sebaceous gland cells produce too much sebum. There is an excessive amount of sebum in the pore channel, which makes fat-loving pathogens such as the Propionibacterium acnes or Coryne-bacteria provide an ideal breeding ground. They metabolize the sebum and break it down into various fatty acids. These in turn irritate the sensitive inner wall of the pore and stimulate it to produce new wall cells. When the mixture of dead pore cells and excess sebum clogs the pore, pimples and blackheads form.

Increased seborrhea during menstruation

A similar effect is often noted by dermatologists in women before menstruation, who then suffer from increased signs of acne. For example, in a study of women with oily and acne-prone skin, it was found that the maximum secretion of their sebaceous glands occurred in the week before menstruation. In addition to hormonal causes, external factors can also lead to increased sebum production and thus oily skin and large pores. These include UV radiation, increased body temperature, stress, and irritation triggered by certain chemicals. On the other hand, it has not yet been clinically proven that increased sweat production and the composition of the diet also contribute to seborrhea, as is often commonly assumed. So whether you eat a vegan diet in the future or continue to eat greasy food has no direct effect on whether your sebaceous glands normalize and your pores shrink.

What helps against oily skin?

Chemical Peel against large pores
Light peelings, microdermabrasion and microneedling can help against large pores (Photo: Manuel Jacob)

First, the obvious: as far as cosmetic measures against seborrhea are concerned, thorough yet gentle skin cleansing and care can certainly help. You don’t even need to consult your dermatologist for this.

Important: gentle cleansing

Well suited for cleansing seborrheic skin are mild washing syndets such as those available in drugstores, for example from NEUTROGENA, SEBAMED, EUCERIN or VICHY NORMADERM. Such cleansers eliminate excess sebum and remove dirt and dead skin cells. The same effect has the special cleansers of the well-known cosmetic brands, such as, among others, the cleansers of REVIDERM. REVIDERM also offers care products for oily skin, such as REVIDERM Recharge Day (and Night) Fluid, which also prevents inflamed skin thanks to the boswellic acids it contains. Similar products are also part of the range of all other cosmetic brands. At this point, I would like to expressly warn against drying creams and lotions. These mostly only damage the natural barrier function of the skin without influencing the sebum production as such. The paradoxical situation then arises where the skin is dry and oily at the same time and completely out of balance. Treatment then becomes even more difficult, and patients even more unhappy.

Non-comedogenic make-up

If you use makeup, then you should also make sure that it is non-comedogenic. This means that in terms of its composition, it doesn’t further clog already strained pores. But you probably knew all that already. And that’s why you also know that all these things, as well as numerous “tips” that you can search for on the Internet or marvel at so-called “influencers” on Instagram, don’t actually help very much. Or? In the vast majority of cases, these are astringent products, facial toners or lotions, for example, which do not shrink pores after cleansing, but at least tighten them for a few hours. Your appearance actually improves a little with this. But as mentioned before: only for a few hours.

Cosmetic treatments that help

Complementary measures that your dermatologist or beautician can use to help you fight seborrhea include microdermabrasion, enzyme peels and light fruit acid peels. All these measures remove the dead skin flakes and thus reduce keratinization problems. This can reduce large pores to a very limited extent, but no more. And not in the long term either. So what to do? Now let’s take a look at what Micro Botox is and how it helps against blemished skin and large pores.

How does botulinum work against blemished skin?

What exactly is Micro-Botox?

As I mentioned at the beginning, I call the therapy against large pores and oily skin Micro Botox. However, this does not mean a “special” botulinum toxin, but the classic active ingredient in a much higher dilution than usual. The highly diluted botulinum solution is also not injected selectively into the muscles, but into the skin.

Allergan Vistabel used as Micro BOTOX
VISTABEL, ALLERGAN’s botulinum toxin A for the cosmetic treatment of wrinkles, is also used in Micro Botox. However, in a significantly higher dilution and by means of a special injection technique into the skin.

Highly diluted and only into the skin

While conventional wrinkle therapy with botulinum toxin usually involves the intramuscular injection of 0.1ml of solution and thus 4 Allergan units of toxin per injection point, the method presented here works on a different principle: here, only a maximum of 0.05ml of solution and half an Allergan unit per injection point are injected into the skin, where initially wheals form. Due to the higher dilution, the active ingredient runs in a larger area around the injection point, the botulinum toxin spreads in the skin.

Area effect instead of targeted injections

Thus, a series of injection points, each 0.5 cm – 1 cm apart, can be used to treat a larger area of skin over a wide area by injecting into the skin in a sort of grid pattern and then relying on the solution to run and uniformly work through the entire grid pattern. In other words, with this actually meso-therapeutic With this technique, which appears to be mesotherapeutic, the intention is exactly what is to be prevented at all costs with the classic Botox wrinkle treatment. Namely, that the Botox runs in the tissue and then possibly unfolds its effect in completely different places than intended. In the classic Botox treatment this would be very undesirable, because you really want to hit the muscle that is responsible for certain wrinkles. In the variant presented here, on the other hand, the diffusion of the highly diluted Botox solution in the skin is targeted.

Chance, once again

Fun Fact: American dermatologist Anil Shah, who first reported in 2008 that botulinum toxin can be used to shrink large pores and improve oily skin, came across this possibility only by chance. He had actually injected his patients with botulinum toxin for “bunny lines” (wrinkles in the nose). Some then reported back very pleased that their skin appearance had also improved significantly. As you may know, botulinum toxin was “discovered” as a wrinkle treatment in a very similar way in the 1990s, when it was used to treat patients for facial spasms, still completely unaware of what was to come. Miracle drug of cosmetics one injected there.

Large pores on the nose and face

With this mesotherapeutic Administration of a highly diluted botulinum toxin solution can actually shrink large pores and significantly improve oily skin. In contrast to all the above-mentioned possibilities, this actually occurs via reduced sebum production.

Studies prove the sebum reductionn

Corresponding studies proving this have been conducted since 2008. Their results are convincing both objectively and subjectively: the authors observed a significantly lower sebum production of 50 to 75% and were also able to scientifically prove its reduction. Objectively, therefore, botulinum toxin, which is highly diluted and injected into the skin, is suitable as a means of reducing large pores. But more importantly, over 90% of the study participants stated on record that they were very satisfied with the visual results. And that, of course, is most important for practitioners like me. After all, patients go to a lot of expense and effort to feel more comfortable in their skin than before. So it seems only right to me that this feeling should actually come about after the treatment. Personally, I am primarily interested in how my patients rate the success of the treatment.

Mechanism of action not yet clearly understood

The exact mechanism of action by which botulinum toxin can reduce sebum production has remained obscure to this day. However, it is suspected that the toxin affects those muscles that erect the hair (the so-called “Musculi arrector-pili”) as well as the receptors of the sebaceous glands with which these react to androgens (the so-called “muscarinic acetylcholine receptors”).

What is the treatment process?

Painless wrinkle treatment with the thinnest needle currently available - LIPS and SKINReducing large pores with botulinum toxin is performed by me in Munich just like any other botulinum treatment:

  • A detailed self-disclosure of the patient is required to reveal possible contraindications.
  • In the subsequent patient interview, the possibilities of the therapy are discussed, as well as the risks and possible side effects.
  • The status quo is then documented by photo.
  • For the subsequent injections, I use the thinnest needles currently available on the market, called “invisible needle” by their manufacturer, and not without good reason. The punctures are made at an angle of about 45 degrees obliquely into the surface of the skin. They are hardly noticeable. However, most patients are sensitive on the nose. And during this treatment there are sometimes 10-15 punctures and more on both sides of the nose. Therefore, I usually numb the nose with the local anesthetic lidocaine before the injection.

After the treatment, patients are usually socially fit within 30 minutes. Redness of the skin at the injection sites should have disappeared by then. Slight wheals at the injection points may still be visible, but they too disappear a short time later.

BOTOX and Microneedling

An alternative way of introducing botulinum toxin into the skin is via a Microneedling. Microneedling involves puncturing the skin with a large number of needle pricks, to a depth of 1.5 mm. Through the thus created Microchannels the highly diluted botulinum toxin can penetrate the dermis and exert its effect there. This type of treatment has a number of advantages over regular botulinum injections, but is more expensive. Read a field report on BOTOX and microneedling in the Beauty Blog.

For the days after the treatment, the same advice applies as for the classic BOTOX injection: don’t do any sports or heavy activities, avoid sauna and solarium, take precautions against UV radiation with a high sun protection factor (SPF 50). However, since the superficial procedure for the treatment of large pores, in contrast to the punctual botulinum therapy, explicitly relies on the active ingredient running in the treated skin areas, restrictions regarding certain movements are not necessary. However, they should be all the stricter about visiting the sauna, solarium and gym. After all, they do not intend to sweat out the highly diluted active ingredient straight away.

What does the treatment cost?

Off-label treatment of large pores

The use of botulinum toxin to treat large pores and excessive sebum production is a so-called Off Label UseThis means that the active ingredient used has no official approval for this type of application. The explanatory discussion between doctor and patient therefore plays a particularly important role. This also applies to the costs, about which you as the patient must always be informed in advance.

In a limited area such as the nose, it is relatively easy to estimate how high the price will be. Even though this may vary in individual cases according to the Medical fee schedule (GOÄ) is billed. The complexity of the individual case and the number of injection points play an important role. In my practice in Munich, I usually charge for one ampoule of Vistabel, even if this should not be used up completely for the therapy of large pores. In this case, it is recommended to use remaining amounts for a classical wrinkle therapy in other facial regions, if indicated and desired. Otherwise, the remaining active ingredient will be disposed of, as I do not keep opened ampoules on principle for reasons of hygiene.

The price of a treatment in my practice is thus about 250 euros (guideline, the concrete billing is done according to GOÄ). With fourfold dilution, a very large area on and around the nose can be treated. If you prefer the treatment in combination with microneedling, then you have to reckon with costs totaling about 500 euros (guideline).