What to do about poor/rough looking skin texture and very large pores? (photo)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

I would recommend medical grade skincare that involves Vitamin C and Retinol. In addition, I recommend Morpheus 8. Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting. Best of Luck, Dr. Nima!

 I suggest seeing a cosmetic dermatologist to get you on a long term plan with lasers, microneedling/prp, Cosmelan, peels, facials and skin care. Best, Dr. Emer.

You have already done 'gentle' peels, although we find these are relatively ineffective for more serious concerns.  If you are starting with a peel, which is a good idea, I would go with a medical-grade one in a doctor's office.  These will be much deeper and more effective, although there is downtime involved, depending on the peel used.
After this, the easiest and most cost-effective solution for you is to consider either microneedling or RF-microneedling for a few sessions.  These will resurface your skin, build collagen and improve surface texture safely and effectively.  Make sure the practice is using a good technology and an experienced practitioner.  They even work on more serious concerns such as stretch marks on the body, so your face will be relatively easy to treat.
Good luck!

Great question and thanks for posting pictures! You have a wonderful skin type to improve, but you're spending a lot of money in dribs and drabs on things which promise a lot and help very little, if at all.Although it may cost more in a single session, please see a medical office where someone can get you started on prescription skincare like Retin-A and a program of IPL / BBL and lasers, possibly with PRP as well. In the meantime, make sure you use a great zinc or titanium sunscreen every single day.

You have enlarged pores that are made more visible by surrounding pigment. I would recommend a combination of treatments:
1. Using medical grade skin care products, depending on your skin type: a 10% glycolic acid cleanser used once/day (and leave that on for 1-2 minutes once a week), skin lightening serum (I recommend Skinmedica Lytera though there are a few others that are effective), vit C serum and a retinol.
2. Microneedling with Biopelle Growth factor serum or PRP
3. Light fractional non-ablative laser (Clear and Brilliant is most well known, but there are a couple other 1927nm lasers)
This will help to get rid of the pigment, reduce pore size and maintain your skin long term. 

I can understand your frustration.  You have tried many solutions. One of the most effective ways of helping your skin is fractional nonablative lasers. It can be combined with IPL for maximal benefit. Pores, pigment, and wrinkles can all be addressed. Minimal down time and proven results. You should find a practitioner and discuss your options.