Botox

How to Get Rid of Large Pores: Myths and Truths

05 October 2019

 

It’s true that large or ‘open’ face pores cannot be permanently shrunk. Even with lasers, face pores may still be visible, simply because they are the natural openings of the sweat and oil glands that release sweat and sebum onto the skin. It doesn’t help that with Singapore’s hot and humid weather, hyperseborrhea or oily skin makes our pores look greasy and bigger.

 

How can you get rid of your pores? I’ll be sharing with you guys what pores and comedones are and some of the treatments for treating enlarged facial pores in Singapore and my personal experience with using fractional CO2 laser for keeping my large facial pores at bay. Of course, I’ll also be sharing with you skincare actives you can look out for that will help with large facial pores and comedones. Once you understand the basics, you’ll understand which treatments work and which don’t.

 

In case this post is too wordy, you can skip to the bottom of the post where I’ll summarise these skincare actives and treatments for you in the conclusion 🙂

 

First things first: What really are ‘open’ pores? How are they related to blackheads and whiteheads?

 

Facial pores close up

   

The phrase ‘face pore’ or ‘skin pore’ refers to the opening of the pilosebaceous unit of the skin. The pilosebaceous units consist of three things- a hair follicle with an attached sebaceous gland and arrector pili muscle. The sebaceous glands are also known as the oil glands and secrete sebum which serves to lubricate the skin. The arrector pili muscle is a small muscle attached to the lower part of the pilosebaceous unit. When the arrector muscles contract, sebum secreted by the sebaceous gland is forced along the hair follicle and upwards to the surface of the skin. The arrector pili muscles also cause our hair to stand on its ends and the appearance of goosebumps.

 

Pilosebaceous unit/ follicle

 

Pilosebaceous units are found in almost every part of the skin except our palms and soles of our feet. These pilosebaceous units may seem like a nuisance, but they serve a vital role in protecting our overall skin health. Besides keeping the skin moisturised, sebum produced by the sebaceous gland has anti-bacterial; anti-fungal and anti-inflammatory properties1,2.

 

 

When these facial pores become blocked by dirt; bacteria; dead skin; and oil, they form little acne bumps on the skin called comedones. They are also known as whiteheads (closed comedones) and blackheads (open comedones). Comedones are part of the acne spectrum and eventually, acne can occur.

 

What’s so bad about enlarged facial pores?

 

Nothing really. They’re just unsightly. Enlarged facial pores are more of a cosmetic concern because of the uneven textural appearance of the face. Certain skincare or makeup products can make the pores look even larger.

 

 

There is some overlap between enlarged facial pores and oily skin. Both these conditions tend to come together and oily skin tends to make facial pores more visible. Enlarged facial pores are also an early sign of aging3,4. As we age and lose collagen in the skin, skin laxity dilates the openings of the pilosebaceous units to make the pores look larger.

 

Why Do I Have Large Facial Pores5-8?

 

The main factors for enlarged facial pores are:

● High sebum secretion i.e. oily skin

● Decreased skin elasticity around pores i.e. collagen loss and aging

 

And to some extent,

● Acne

● Hormones

 

Does heat open facial pores?

 

Going to debunk a popular myth here: Steaming or heat does not open facial pores. And neither does the cold close facial pores. Hot yoga fans, you can rejoice now.

 

The pores on our face do not have an in built thermostat function that allows them to close or open with changes in temperature. Rather, all the factors mentioned above- clogged pores, oily skin, hormones and acne make facial pores look open or enlarged.

 

Some of you may be wondering why your pores look large after a workout or hot yoga. Some of you might also be wondering why do beauticians steam and squeeze the face as part of facials. Here’s why:

 

 

Steaming the face softens the epidermis so that it helps with extractions. However, steaming the face is not such a good idea if you have sensitive skin, eczema, infections or rosacea- steaming may worsen these conditions. Besides, if you want to exfoliate to get rid of black heads and white heads, chemical peels are a safer and more controlled way. More about chemical peels in The Truth About Chemical Peels.

 

How To Treat Large Facial Pores: Skincare ingredients and medical treatment options for enlarged pores.

 

Some of the ‘natural’ or home remedies I came across online for treating large facial pores range from the bizarre (rubbing banana skin) to downright dangerous (baking soda- please do not try this despite what the pseudo-health websites say. Baking soda is alkaline and can disrupt the skin’s natural acidic barrier.)

 

One simple way to look at the treatment of large facial pores is by targeting the 2 main causes of large facial pores:

(1) high sebum secretion (oily skin); and

(2) collagen loss causing reduced skin elasticity.

Let’s look at these factors for large face pores individually.

 

1. Treating high sebum secretion or oily skin

 

Having oily skin is a double edged sword. Sebum is part of the skin’s protective barrier that defends the skin from bacteria and inflammation and it also keeps the skin moisturised. However, too much of sebum and you get large pores and acne. So striking the right balance with is crucial to maintain the skin’s defenses while keeping pores at an acceptable size.

 

Retinoids

One of the more potent skincare ingredients that help to reduce sebum production or skin is retinoids9,10.

     

 

Retinoids are well known ingredients in dermatology for treating acne and anti-aging and retinoids are a frequent feature in skin care products for treating acne, oily skin, fine lines and pigmentation.

Retinoids consist of retinol, retinaldehyde, retinoic acid and retinyl esters. Each of these members of the retinoid family have different potencies.

 

Regardless of the potencies of the respective retinoids and the severity of oily skin, the side effects of using retinoids are related to reduced sebum production e.g. dry skin, skin irritation and chapped lips11.

 

Some of the milder retinoids like retinyl esters and retinols can be purchased at low concentrations over the counter without a prescription. The more potent ones like retinoic acid can only be obtained with a doctor’s prescription in Singapore. My advice is to start with a mild retinoid at a low concentration before escalating. Retinols and retinaldehydes can cause skin irritation and redness so it’s better to let you skin adapt before escalating to stronger ones and higher concentrations. If in doubt, please seek your doctor’s advice.

 

 

Please also note that retinoids are not recommended for pregnant women and breastfeeding women. Retinoids should be used at night as it can cause skin irritation in the daytime. And don’t forget your sunscreen in the day, especially if you use retinoids.

 

Related posts:

My sunscreen recommendations- the Best, the Worst and the Unsafe

Pregnancy Skincare Guide: What’s Safe and What to Avoid

Niacinamide/ vitamin B3

 

Niacinamide is another skincare ingredient that you can get over the counter to reduce sebum secretion and oily skin. For an in-depth review on niacinamide in skincare and my niacinamide skincare reviews, please read my blogpost on Niacinamide.

 

Medical treatments for oily skin/ reducing sebum secretion.

Botulinum toxin (aka Microbotox or Mesobotox)

   

What is Microbotox or Mesobotox

Most of you might be familiar with the use of Botox or botulinum toxin for treating wrinkles but did you know that Botulinum toxin can also be used to reduce sebum secretion by the pilosebaceous units? You can learn about the mechanism of how Botulinum toxin works and safety issues surrounding Botox in this post 5 Things You Need to Know About Botox Safety.

 

How does Microbotox or Mesobotox work?

Botox is usually injected into the muscles of the face to remove wrinkles. Botulinum toxin or Botox has been used to treat excessive sweating (hyperhidrosis) in the underarms and palms and it can also be used to treat oily skin too by a similar mechanism12,13. Very small doses of botulinum toxin is injected into the skin of the face to target the pilosebaceous units. Botulinum toxin is also included in Skinboosters as part of a personalised Skinbooster cocktail to reduce skin oiliness and for overall skin hydration, glow and repair. For a detailed review of Skinboosters and to see how its done, please read this post on Skinboosters.

 2. Improving skin elasticity and collagen levels in the skin.

Collagen is a protein that is crucial for maintenance of healthy skin and support. The skin surrounding facial pores contains collagen to support the pore and keep the facial pores tight. When collagen in the skin is lost due to aging; exposure to UV rays; and smoking, the decreased elasticity in the skin can enlarge pore size5.

 

Skincare ingredients that increase collagen levels in the skin

One active ingredient that has been shown over the years to increase collagen production and cellular regeneration in the skin is- you guessed it: retinoids (again). Besides focusing on increasing collagen production in the skin; do not neglect the prevention of the breakdown of existing collagen in the skin by UV rays with sunscreen.

 

 

Sunscreens have been covered extensively in this blog and you can read my posts Sunscreen Reviews and Tips for Choosing Sunscreens and Sunscreen FAQs.

 

Fractional CO2 Laser

 

 

One of the most common ways to treat pores in Singapore is with fractional CO2 laser. Fractional CO2 laser is also used to treat depressed acne scars and signs of aging like fine lines by increasing collagen levels in the skin.

 

What is fractional CO2 laser?

Fractional CO2 laser is very different from no downtime lasers like the Q-switch laser, which I commonly use to treat pigmentation and acne. Fractional CO2 laser targets a deeper level of the skin called the dermis while the latter targets the epidermis. This post on Lasers for Pigmentation will explain how Q-switch laser works and some FAQs.

 

 

How does fractional CO2 laser treat enlarged facial pores?

As the word ‘fractional’ suggests, the CO2 laser beam is fractionated into microbeams while sparing areas of skin, to preserve little areas of normal, healthy skin. The microbreams of fractional CO2 laser penetrate the epidermis of the skin to accelerate new collagen formation in the skin. Fractional CO2 laser also firms up the skin to tighten pores by compacting the existing collagen fibres in the skin. All in all, these two effects of fractional CO2 laser help to shrink the facial pores and improve the texture of the skin14-17.

 

Is fractional CO2 laser safe? Is there downtime for fractional CO2 laser?

Clinical studies have shown that fractional CO2 laser is safe and effective3.

 

There is however some downtime associated with fractional CO2 laser. Depending on the condition being treated and the parameters of fractional CO2 laser chosen for the patient, the length of downtime will defer. During this time your skin may experience redness and increased sensitivity. For the first few days, no makeup is allowed to prevent dermatitis and skin infection. During

 

For most of my patients receiving fractional CO2 laser for enlarged facial pores, the downtime is approximately one week. this period of recovery, it is normal to expect the skin to look red, darker and scab. Your skin may also experience temporary dryness and sensitivity.

 

 

Besides medications to reduce the redness and shorten recovery time, I usually administer LED light therapy with a recovery face mask that contains antioxidants that reduce redness in my clinic immediately after fractional CO2 laser is performed. Most of my patients have given us feedback that with this recovery protocol that I have instituted, the redness; warmth and downtime have reduced.

 

I get fractional CO2 laser on my nose to treat my pores every 4-6 months. Allow me to share with you my recovery. Skip this if you find this squirmish.Please note that I recover very quickly in general, so your downtime and recovery may differ from mine.

 

Day 0: You can see the redness and grid marks on my nose immediately after fractional CO2 laser to my nose.

 

Day 1 after fractional CO2 laser to my nose: Redness and gridmarks are visible.

 

Day 2 after fractional CO2 laser to my nose: Redness and gridmarks are visible but less obvious.

 

Day 3 after fractional CO2 laser to my nose: Redness and gridmarks are visible only on close inspection.

 

Day 5 after fractional CO2 laser to my nose: Scabbing. Not obvious IMO.

 

What about using carbon laser to treat large facial pores?

You might have heard of carbon laser or ‘black face’ or ‘black doll face’ treatments that beauticians and some clinic offer to treat pores. These beauticians and clinics claim that carbon laser can shrink or close large facial pores without incurring the downtime and discomfort of fractional CO2 laser.

 

First, let’s understand what carbon laser is. Carbon laser is actually the Q-switched laser treatment performed with a layer of carbon suspension lotion on the skin. By adding this carbon suspension to the skin before zapping the face with Q-switch laser, it is thought that the skin’s absorption of the Q-switch laser energy.

 

However, several studies have shown otherwise that carbon laser does not confer additional benefit in treating pores as compared to Q-switch laser for treating face pores and carbon laser in fact increased the messiness, complications and treatment time18-20. I have performed carbon laser in a previous clinic in Singapore I used to work for years ago.

 

I have stopped performing carbon laser for my patients because I concur with the studies quoted above that carbon laser is not any more effective than Q-switch laser alone for pores. Carbon laser tends to be noisy, scary and messy for the patient too, especially when the carbon suspension splatters on to their clothes.

 

 

Q-switch Nd:Yag laser for facial pores

 

Q-switched Nd: Yag laser alone can be used to treat enlarged facial pores. The Q-switched Nd: Yag laser has been shown to trigger collagen formation in the skin to tighten pores and reduce sebum secretion21,22.

 

This makes the Q-switched Nd: Yag laser and attractive option for treating pores because the Q-switched Nd: Yag laser does not incur any downtime compared to fractional CO2 laser.

 

In my experience, I find that the Q-switched Nd: Yag laser can help to shrink large facial pores, but only to a small extent. Usually, if the patient relies on Q-switched Nd: Yag laser alone to treat shrink their large facial pores, they would require a long period of time and repeated sessions to see some results. I find that fractional CO2 laser and/ or Microbotox/ Skinbooster cocktail gives better results in 1-3 sessions compared to the same number of sessions for Q-switched laser.

 

 

Q-switched laser vs fractional CO2 laser for treating pores

I could not find published study that compares fractional CO2 laser vs Q-switched laser for pores. However, there is a study that looked at Q-switched laser vs fractional CO2 laser for the treatment of depressed acne scars23. This study showed that fractional CO2 laser achieved significantly greater improvement in the scars as compared to Q-switched laser for the treatment of depressed acne scars23.This is likely to be due to the fractional ablative properties of fractional CO2 laser which induces wound healing and collagen remodelling24.

 

Q-switched laser on the other hand, is absorbed by melanin or pigmentation in the skin, which makes Q-switched laser better for treating pigmentation25. If we extrapolate these findings and properties of fractional CO2 laser and Q-switched laser, it is safe to say that fractional CO2 laser is more effective for treating enlarged facial pores than Q-switched laser.

 

Skinboosters for large facial pores

 

Injecting Skinboosters for one of my patients.

 

Skinboosters has already been covered in great detail in my review Skinboosters- All You Need to Know. Essentially, Skinboosters is a treatment to improve skin hydration, glow and shrink pores with very fine microinjections of hyaluronic acid into the dermis of the skin with other ingredients like Botox. Skinboosters is very popular in Singapore and Asia with the quest for makeup free, glowing and dewy skin. There are many brands of Skinboosters available and all of them contain hyaluronic acid. Skinboosters looks set to take the world by storm with Juvederm Volite, Restylane Skinboosters and Teosyal Redensity growing steadily in popularity in Europe and the US.

 

Juvederm Volite is the latest Skinbooster to enter the foray.

 

The type of hyaluronic acid used for Skinboosters is different from the type of hyaluronic acid used for dermal fillers. Skinboosters uses low molecular weight (LMW) hyaluronic acid which increases promotes new collagen formation and increases skin hydration in the dermis of the skin. This allows Skinboosters to shrink large pores, reduce skin roughness and enhance skin elasticity26-28.Besides improving the appearance of large pores, Skinboosters was also shown to achieve additional brightening effects and pigmentation lightening to the skin29.

 

The consensus among doctors in Asia-Pacific is for Skinboosters to be performed three times with consecutive treatment spaced at 4 weeks intervals. Maintenance treatment can be repeated thereafter30.

Conclusion: Best treatment for large pores

 

Having a combination of medical treatments and skincare containing active ingredients that target large pores is probably the best way to treat your large pores and sustain the results of treatments.

 

In summary, the three main ingredients that show promise for shrinking large pores and maintaining the results of your clinic treatments are: sunscreen, niacinamide and retinoids.

 

Treatments that are effective for shrinking large facial pores are: fractional CO2 laser and Skinboosters with Microbotox. The question of whether which treatment suits you best will depend on several factors such as the severity of your pores and whether you have acne. It is best that you discussed your treatment choice for large pores with your doctor.

 

I hope that you have found this post on enlarged facial pores and the treatments useful. Have a good weekend 🙂

           

REFERENCES

1. Sebum free fatty acids enhance the innate immune defense of human sebocytes by upregulating beta-defensin-2 expression. Nakatsuji et al. J Invest Dermatol. 2010 Apr;130(4):985-94

2. Acne and sebaceous gland function. Zouboulis. Clin Dermatol. 2004 Sep-Oct;22(5):360-6.

3. Clinical and Histological Evaluations of Enlarged Facial Skin Pores After Low Energy Level Treatments With Fractional Carbon Dioxide Laser in Korean Patients. Kwonn et al. Dermatol Surg. 2018 Mar;44(3):405-412.

4. Analysis of the number of enlarged pores according to site, age, and sex. Jung et al. Skin Res Technol. 2018 Aug;24(3):367-370.

5. Facial Pores: Definition, Causes, and Treatment Options. Lee et al. Dermatol Surg. 2016 Mar;42(3):277-85.

6. Sebum, acne, skin elasticity, and gender difference – which is the major influencing factor for facial pores? Kim et al. Skin Res Technol 2013;19:e45–53.

7. Sebum output as a factor contributing to the size of facial Pores. Roh et al. Br J Dermatol 2006;155: 890–4.

8. The conundrum of skin pores in dermocosmetology. Uhoda et al. Dermatology 2005;210:3–7.

9. Isotretinoin revisited: pluripotent effects on human sebaceous gland cells. Zouboulis. J Invest Dermatol 2006;126:2154–6

10. Topical therapy in acne. J Eur Acad Dermatol Venereol. Gollnick and Schramm. 1998;11:S8–29.

11. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. Gollnick et al. J Am Acad Dermatol. 2003;49:s1–37

12. Use of intradermal botulinum toxin to reduce sebum production and facial pore size. Shah. J Drugs Dermatol 2008;7:847–50.

13. Safety and efficacy of intradermal injection of botulinum toxin for the treatment of oily skin. Rose and Goldberg. Dermatol Surg 2013;39: 443–8.

14. Skin-tightening effect of fractional lasers: comparison of non-ablative and ablative fractional lasers in animal models. Park et al. J Plast Reconstr Aesthet Surg 2012;65: 1305–11.

15. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Hantash et al. Lasers Surg Med 2007;39:87–95.

16. Fractional deep dermal ablation induces tissue tightening. Rahman et al. Lasers Surg Med 2009;41: 78–86.

17. In vivo histological evaluation of a novel ablative fractional resurfacing device. Hantash et al. Lasers Surg Med 2007;39:96–107.

18. Skin resurfacing utilizing a low-fluence Nd:YAG laser. Goldberg and Metzler. J Cutan Laser Ther 1999;1:23–7.

19. Skin rejuvenation with 1,064-nm Q-switched Nd:YAG laser in Asian patients. Lee et al. Dermatol Surg 2009;35:929–32

.20. Split-face comparison of long-pulse-duration neodymium-doped yttrium aluminum garnet (Nd:YAG) 1,064-nm laser alone and combination long-pulse and Q-switched Nd:YAG 1,064-nm laser with carbon photoenhancer lotion for the treatment of enlarged pores in Asian women. Wattanakrai et al. Dermatol Surg. 2010 Nov;36(11):1672-80.

21. Treatment of enlarged pores with the quasi long-pulsed versus Q-switched 1064 nm Nd:YAG lasers: A split-face, comparative, controlled study. Roh et al. Laser Ther. 2011; 20(3): 175–180.

22. Effects of various parameters of the 1064 nm Nd:YAG laser for the treatment of enlarged facial pores. Roh et al. J Dermatolog Treat. 2009;20(4):223-8.

23. Comparison of Q-Switched 1064-nm Nd: YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. Asilian et al. J Res Med Sci. 2011 Sep; 16(9): 1189–1195.

24. The Role of the CO2 Laser and Fractional CO2 Laser in Dermatology. Tokuya and Kayako.Laser Ther. 2014 Mar 27; 23(1): 49–60.

25. Overview of lasers. Patil and Dhami. Indian J Plast Surg. 2008 Oct; 41(Suppl): S101–S113.

26. Changes in skin physiology and clinical appearance after microdroplet placement of hyaluronic acid in aging hands.Williams et al. J Cosmet Dermatol. 2009;8:216-225.

27. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Wang et al. Arch Dermatol. 2007;143:155-163.

28. Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity. Taieb et al. J Cosmet Dermatol. 2012;11:87-92.

29. Effect analysis of intradermal hyaluronic acid injection to treat enlarged facial pores. Qian et al. J Cosmet Dermatol. 2018 Aug;17(4):596-599.

30. Consensus Recommendations for Optimal Augmentation of the Asian Face with Hyaluronic Acid and Calcium Hydroxylapatite Fillers. Rho et al. Plast Reconstr Surg. 2015;136:940- 956.

 

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