My big pores are turning into wrinkles! Options? (photo)

Question

I’m 36, but feel like I look older. Do I look older? I’ve had large pores for years but I feel like in the last few months they are stretching and sagging and turning into wrinkles. What can I do!?

Raffy Karamanoukian, MD, FACS · Answer

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.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. 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

Anna Petropoulos, MD, FRCS · Answer

Hello and thank you for your question! The "stretching" and "sagging" you're noticing is likely due to loss of elasticity. From age 30, our collagen and elastin production slows down, contributing to the skin aging. RF Microneedling and Laser Resurfacing are two popular treatments for improving age-related skin laxity and enlarged pores.

RF Microneedling combines microneedling with radiofrequency (RF) energy to stimulate collagen and elastin production deep in the skin. The tiny needles create controlled micro-injuries, triggering the body’s healing response, while the RF energy delivers heat to the deeper layers, tightening the skin and improving texture.

Best for: Mild to moderate skin laxity, enlarged pores, and fine lines.
How it helps: Tightens skin, reduces pore size, and improves overall skin texture with minimal downtime.
Downtime: Usually 2-5 days of redness and mild swelling.

Laser treatments use focused light energy to remove the outer layers of damaged skin and stimulate collagen production. Ablative lasers (like CO2 and Er:YAG) remove layers of skin for more dramatic results, while non-ablative lasers (like Fraxel) heat the skin without removing it, promoting gradual rejuvenation.

Best for: Moderate to severe skin laxity, enlarged pores, wrinkles, and sun damage.
How it helps: Resurfaces skin, reduces pore size, and improves tone and firmness.
Downtime: Varies; ablative lasers require 1-2 weeks of healing, while non-ablative lasers have minimal downtime.

Both treatments improve skin firmness and texture, but RF microneedling is better for tightening and pore reduction with less downtime, while laser resurfacing is ideal for more intense resurfacing and rejuvenation.

I hope this helps! 
Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Danvers & Boston, MA

Barbara Padilla, MD · Answer

Thank you for your question! There are many options to minimize pores / wrinkles. For deeper lines we recommend filler for nasolabial folds. This will smooth the appearance of your skin and reduce the harshness of the lines. In regards to your pores stretching, there are many options you can choose from. Microneedling is an effective way to help with fine lines, wrinkles, and skin tone and texture. Microneedling will help increase collagen production. Chemical peels can also help with the appearance of pores, as salicylic acid helps minimize pores. This will also help with collagen production. Laser genesis is also used to minimize pores while heating the skin to increase collagen. Laser resurfacing is a great option for fine lines, wrinkles, and collagen production. At our practice we offer Juliet. The heat from this laser stimulates new collagen production, which firms mildly lax skin over time. This procedure has 3-4 days of downtime where your skin might be red and feel tight.

Nelson Lee Novick, MD · Answer

At least from the photos provided, there appears to be volume deficits in the border regions between the under-eyes and the upper cheeks, which would explain the pronounced depression there. If this is indeed so, then the appropriate choice of volumizing HA filler when injected properly in the hands of an expert, board certified cosmetic dermatology filler expert can smooth the transition region and significantly diminish the hollows seen there. A diminution in the smile lines would likely be a much appreciated secondary benefit of this treatment, as well..The results are typically immediate and dramatic, and the treatment usually engenders little to no significant post-treatment downtime. 
For general texture and pores, combining the daily, at-home use of Rx topicals, such as retinoids coupled with in a series of superficial peels using either high concentrations of glycolic or salicylic acid, Jessner's Solution or low concentrations of TCA would be quite helpful. 
Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for reaching out and sharing your concerns. It's not uncommon to feel self-conscious about changes in your skin, but there are several options to address large pores and the appearance of wrinkles.

Skincare Routine: Incorporating products with retinoids can help improve skin texture by promoting cell turnover. Additionally, using products containing niacinamide or salicylic acid can help minimize the appearance of pores.

Professional Treatments: Consider consulting a dermatologist or skincare specialist for treatments such as chemical peels, microdermabrasion, or laser therapy. These treatments can improve skin texture and reduce the appearance of pores and fine lines.

Microneedling: This procedure can stimulate collagen production, which may help tighten the skin and reduce the appearance of both large pores and wrinkles.

Hydration and Sun Protection: Keeping your skin well-hydrated and protected from sun exposure is crucial. Use a broad-spectrum sunscreen daily to prevent further skin damage.

Healthy Lifestyle: Maintaining a balanced diet rich in antioxidants, staying hydrated, and getting enough sleep can support overall skin health.

I recommend visiting a dermatologist to discuss your concerns and explore the best treatment options tailored to your skin type and condition. They can provide a comprehensive evaluation and develop a personalized plan to help you achieve your skincare goals.

Camille Cash, MD · Answer

From the description of your concerns you may want to consider Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  I've included a video on Morpheus8 that I hope you find helpful.

Leonard Grossman, MD · Answer

You are correct in your observation. In many patients with large pores or acne scarring dynamic wrinkles formas the skin becomes less elastic because of the pores. Your best approach and the treatment plan would consist of treating the nasolabial folds with some form of hyaluronic acid filler. I would treat the face with a CO2 laser, and you can also consider treating your face with Retinol-A to increase the amount of collagen and elastin fibers in the skin of the face. I hope this helps and good luck from Leonard Grossman MG organic Plastic Surgery.

My big pores are turning into wrinkles! Options? (photo)

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