Questions Answered by Leading Local Doctors
It is completely normal to have visible pores, and it is generally accepted that the size of facial pores is inherited and we can't really change the size of them. We do know that pore size can increase or decrease over time due to a number reasons, so although no promises can be made, it is possible that perhaps we could modify some of the factors that could influence pore size. Enlarged facial pores are thought to be possibly related to 1) high oil excretion, 2) decreased elasticity around the pores, and 3) increased hair follicle volume. Studies have shown that aging and sun exposure decrease the structural support around the hair follicle, which increases pore size. In addition, a history of severe, inflamed acne could result in scars inside the follicle opening, which could indirectly lead to pores enlarging, as you mentioned may have happened to you. Hormones can play a role as well, as androgen activation can lead to increased oil production as well as increased hair follicle volume - which would then increase the visible size of pores. There aren't great evidence-based studies that certain medications and therapies will decrease pore size, but in theory we can try treatments to target various steps in the process that could lead to enlarged pores - either by reducing oil production, improving skin elasticity, or reducing hair follicle volume.
First and foremost, aggressive sun protection is essential to the prevention of aging of the skin, so that should be the first step! Next, I would recommend a trial of prescription-strength tretinoin, which is a topical retinoid that has multiple benefits on the skin. It decreases the formation of blocked pores by normalizing the life cycle of the cells that line the pore opening. When pores are less clogged, the pore volume is decreased, which can translate into smaller pore size. Tretinoin also increases collagen content in the skin, which can theoretically add support around the follicle and decrease the pore size appearance. Additionally, there are certain oral medications that can be prescribed that could decrease oil production, such as isotretinoin (accutane) or several hormonal therapies (combined oral contraceptives or spironolactone), but this is best discussed with an in-person provider as to whether this would be appropriate for you. Lastly, there are numerous cosmetic procedures which can be done in the office that can target sebaceous glands or hair follicles, which can theoretically help decrease pore size. Some of these treatments include photodynamic therapy (PDT), diode laser devices, nonablative radiofrequency devices, or intense pulsed light sources. In summary, there is no miraculous proven way to reduce pore size, but there are several options to consider that could potentially help! If all else fails, there are many great cosmeceutical products out there which can really help hide the pores and create the appearance of smoother skin.Dr. Jennifer Chiang