Why does Botox make my skin appear smoother?

Question

I have noticed that when I get injections of botox (along the horizontal lines of the forehead and the 11's), that the skin on my forehead appears smoother and my pores appear less noticeable. I say "appear" because I wonder if it's in my head. I know that pores don't have muscles and don't really "open" and "close" like advertisers claim they do. I am the only one who has noticed this? For the record, I have large pores and fairly thick skin to begin with.

Aldo Guerra, MD · Answer

Hello Robin and thank you for your question. Botox and Dysport are neurotoxins which lead to a temporary relaxation of the facial muscles. These muscles are usually under constant tension and when relaxed the overlying skin is stretched out leading to a smoothing effect and less pores. Best, Dr. ALDO

Yannis Alexandrides, MD, FACS · Answer

Hello, Botox works by temporarily paralysing the underlying muscle. As a result the skin appears smoothed out on the surface and this is why you may notice a change in the skin. Whilst Botox doesn't specifically shrink your pores, Intradermal Botox can improve the appearance of them by reducing oily skin. As a result, your skin looks more matt and softer.

Matthew Brace, MD · Answer

Great observation. You are right, Botox not only relaxes the muscles in the treatment area to eliminate wrinkles, but the same thing happens to oil and sweat glands in your skin, Botox makes them less active. This will cause a decrease in the oils being produced in your skin and with less active the glands your pores will not be as open. Some people even describe an improvement in their acne because of the decreased oil production.

Jason Emer, MD · Answer

Yes, with the relaxation of muscles, Botox can make the skin's appearance in those areas smoother. Large pores can be further improved with lasers, microneedling/prp and skin care. Best, Dr. Emer

Alex Eshaghian, MD, PhD · Answer

Thank you for your question robinacolina. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.The appearance of frown lines is variable from person to person. Usually they are in a vertical orientation but sometimes they can be oblique and sometimes a horizontal line is seen across the upper portion of the nasal bridge. The most common variation is to have two parallel lines, hence the common term "11's" to describe them. But some people have one, three, or more lines. Some people also will see a bulge in the area when contracting the muscle. This bulge is smoothened out after a Botox treatment.
  
The pivotal studies used 20 units of Botox in the glabella area between the brow to address the frown lines and 20 units of Botox in the forehead area above the brows to address the horizontal lines seen when one raises the brows. These studies demonstrated that the peak results are seen 14 days after the treatment and most people enjoy their results for 3-4 months. At that point, a maintenance treatment is recommended. While some people start to see results as early as the next day, it can take two weeks for full results so patience is important. We have our patients return two weeks after their treatment to assess their results via photographs. At that time additional units may be added if necessary. The pivotal studies for the horizontal lines on the upper forehead were published many years after doctors had been using Botox. In these studies, 20 units of Botox were used to treat this area. However, in my experience I find that anywhere from 10 to 20 units works well in this area. For patients with narrow foreheads a lower dose may be used and those with a broad forehead generally require higher doses. I have also found that the full results in this area are seen by two weeks. Therefore, we have our patients return two weeks after their treatment to assess the results via photographs. At that point additional units may be used if further enhancement is desired.
  
When patients present with concerns about specific wrinkles in the upper face such as the frown lines, I always assess and usually treat the other wrinkles in the upper face including the horizontal forehead wrinkles and crow’s feet. The reason is to maintain a harmonious and natural balance to the appearance of the upper face. The muscles in the glabella which are responsible for the formation of the frown lines serve to pull down on the inner brows when a person frowns. Similarly, the muscles around the eyes which are responsible for the formation of the crow’s feet seen when smiling (orbicularis oculi) are also responsible for pulling down on the brows, but in this case the outer brows. On the other hand, the muscle in the upper forehead which is responsible for the formation of the horizontal forehead wrinkles when a person raises the brows (frontalis) serves to pull the brows upward. If one of these muscles is relaxed with Botox and the others are not, the other muscles will still be active. This will lead to an unbalanced and unnatural appearance of the upper face where the brow can be elevated, depressed, or uneven in shape or position. Therefore, I recommend that my patients take a global approach to the upper face when receiving Botox treatments and treat all three of these areas. Sometimes bunny lines on the bridge of the nose are also treated.One of the side effects that people notice when they get Botox to treat their wrinkles is an improvement in the appearance of the pores. The Botox can also decrease production of oil in the glands to reduce the size of the pores and to treat oily skin. For such a purpose Botox is used slightly differently. The Botox is diluted more than normal and spread out over the skin surface. Therefore, there are many injection points rather than just a few. Also, the Botox injections are placed in the very surface layers of the skin so that it can best reach the oil glands, in contrast to deeper placement of Botox when used to relax muscles. Usually about 40 units of Botox are used for the entire face. The results of such a Botox treatment are seen in a few days and most people enjoy their results for three to four months.
With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
    
Please consult with a doctor for specific recommendations. Good luck!

Hardik Soni, MD · Answer

Thank you for your question. Botox works by relaxing the muscles giving the appearance of smoother skin in the treated area. Botox does not change your pore size. Best of Luck!

Sharon Scherl, MD · Answer

Your observations are correct! Botox targets and relaxes the underlying muscles that contribute to the appearance of horizontal lines across the forehead. There are also small muscles that it can relax in the glands that surround the pores thereby decreasing their size and decreasing oil production.

Richard Wellington Swift, MD · Answer

Dear Robin, Your observation is correct. In addition to smoothing the lines on the forehead and the 11's, by relaxing the underlying muscle, many patients observe that they have smaller pores. Best wishes, Dr. Richard Swift

Neil Sadick, MD · Answer

Botox does not just effect the muscles of facial expression. It also has an effect on the pilosebasceous units and the piloerector muscles of the skin. So when its injected into the more superficial layers of the skin &mdash; and in wrinkle-free parts of the complexion like the T-zone, cheeks and chin &mdash; botox does not affect muscle-nerve communication, but instead, tightens enlarged pores, making the skin look smoother and younger.

Jordan P. Farkas, MD · Answer

Botox weakens the muscles beneath your skin helping in improving the coarse creases in your skin that come with frequent muscle contraction. This helps to give the appearance of smoother skin. Hope you enjoy.

Why does Botox make my skin appear smoother?

Answers (16)