Why your pores look the same after skin botox

"I had skin botox and my pores look the same." I hear this often in clinic. Because it is a few rounds of tiny injections and then it is over, many people wonder whether it does anything at all.

For people who come in with visible pores, makeup that lifts and more fine lines on the forehead and around the eyes, I use skin botox and Virtue RF. The two work at different depths, so I need to see which kind of pore it is before deciding which to use.

"My pores are big" can describe two different shapes in the mirror. That is why I first look at whether the pores are round or stretched vertically.

If the skin is oily, the pores are round and open, and makeup breaks down by the afternoon, the problem is closer to oil. Shallow lines on the forehead and around the eyes come from skin folding with expression. Both of these suit skin botox.

If the cheek pores look stretched vertically, acne scars are sunken and the jawline has loosened, the problem is in the dermis that supports the skin. That is where Virtue RF fits.

A treatment that does not match the cause leaves only the feeling that nothing worked. Among people whose pores stayed the same after skin botox, some had stretched pores like these.

Many people ask why a wrinkle drug is used for pores. Wrinkle botox goes into the muscles that make expressions and reduces their movement. Skin botox is the same drug, diluted, placed in many small points in the shallow layer of the skin instead of the muscle. It does not stop the large muscles, so the face still moves while the skin is refined.

It first reduces oil output. With less oil, pores look less open and makeup lasts longer. It also acts on the fine muscle fibres near the surface to soften shallow lines on the forehead and around the eyes, and is used to calm redness by limiting small blood vessels.

Where and how much goes in changes the result. A large amount near the mouth, where expression moves a lot, can make a smile look stiff. So less goes around the mouth or it is avoided, and the doses are spread across the forehead, around the eyes and the nose.

That skin botox can shrink pores has been measured. It did not shrink them equally for everyone.

A team at Ramathibodi Hospital, Mahidol University in Thailand enrolled 32 Asian adults with enlarged pores on both cheeks. One cheek had skin botox alone and the other had skin botox plus hyaluronic acid filler. Pore volume was measured with a 3D skin imaging device for six months. Pore volume and roughness fell on both sides, and at six months the botox-only side was slightly better.

On the botox-only side, 14 of 32 people (43.8%) improved by at least one pore grade. Of those 14, 78.6% had a history of oily skin, against 22.2% of the 18 who did not improve. Skin botox works on pores opened by oil and less on pores stretched by lost firmness.

The side that also had filler shrank less, and more than half of participants (56%) developed small palpable bumps there. Most settled within a few months. With 32 people, the study is better read for which skin responded than for its exact figures.

A 2024 meta-analysis pooling 10 studies and 153 people also found that intradermal botulinum toxin improved oil, pore size, redness, fine lines and texture. Skin hydration did not change, and the authors noted that every study was small and larger trials are needed before firm conclusions.

If dryness is the main concern, a skin booster fits better than skin botox.

When the cheek pores are stretched vertically, I bring up Virtue RF instead of skin botox. Virtue RF is a microneedle radiofrequency device made by Shenb. Fine needles enter the skin and deliver radiofrequency heat at a set depth.

With needle radiofrequency, where the heat lands depends on the needle and how the energy is delivered. I covered this in a lecture at the 2023 Autumn Grand Symposium of KACS, a Korean society for skin, obesity and cosmetic medicine.

Virtue RF keeps the surface it touches cool to protect the skin and reduce pain. It splits the energy into several smaller pulses rather than one burst. There are three handpieces, so the tip is changed for the whole face, for narrow sunken scars and for the eye area.

Needle depth can be set from 0.1 mm, so thin skin around the eyes is treated shallowly and thicker skin on the cheeks and jawline more deeply.

Heat in the dermis drives collagen and elastin renewal and tidies a loosened jawline and the area under the chin. Needle stimulation and heat together refine stretched pores and sunken acne scars. Heat delivered to the oil glands is also used to reduce recurring acne and inflammation.

Many people tell me their skin is oily and their cheek pores are also stretched. Both concerns sit on the same face.

Skin botox acts in the shallow layer and Virtue RF in the deeper dermis. Because they do not overlap, doing both on one day does not interfere. Oil and fine lines go to skin botox; stretched pores and the jawline go to Virtue RF.

That is why the two are often done together at YOON CLINIC.

Every consultation includes the question of when things will change. Skin botox shows gradually over a few days to two weeks.

Pore size is slower. In the study above, pore volume actually rose on both sides at one month, then fell, and was smaller than before treatment at six months. Judging pores two or three weeks after treatment can make it seem as if nothing happened.

Small raised bumps can appear briefly where the shallow injections went and usually settle within hours. Small bruises can also appear.

Virtue RF works by renewing the dermis, so texture changes over time. Redness, warmth and small needle marks can last a few days.

If there is an event or a flight home, the date is set with that recovery in mind. Booking early in a trip leaves time for marks to settle. The next session is timed by how the skin responds.

Sometimes a patient arrives for a booked session with skin that is red and reactive that day. On a sensitive or badly inflamed day no new treatment is added. If acne is inflamed, it is calmed first.

If an important event is only days away, I suggest treatments with shorter recovery first. If I judge that something is not needed now, I do not recommend it.