Enlarged Pores

Treatment of Enlarged Pores

Visible, enlarged pores are cosmetic concerns for both men and women, and unfortunately there is no cure. To understand why, you need to have an understanding of skin anatomy.

A pore is a full thickness hole in the skin containing a hair shaft and its associated follicle located in the subcutaneous tissue. Even though no hair may be outwardly visible, it is a shaft accommodating a potential hair follicle. Sebaceous glands surround the hair follicle and are stimulated to grow from hormones at puberty. That’s why pre-pubertal children have smooth skin, with no visible pores, in addition to their great skin tone and elasticity, keeping the pores closed tight so they are unseen. Sebaceous glands secrete “sebum” or oils mixed with skin cells, which passes through the pore and hydrates the skin, creating a lubricated barrier that protects it from the environment and keeps it hydrated. In addition, it is a source of fresh new skin cells, explaining how the face heals so well from aggressive resurfacing procedures.

Everyone has pores. Pores size and visibility is related to many factors including genetics, location (nose, forehead, central face), environment, sun damage, oily skin, hormones, and aging. Faces you see in the media look smooth-skinned and “pore-free” because of lighting and editing, not because they are lucky individuals and have no pores and naturally perfect baby-smooth skin. There is no such thing as skin that is pore-free.

There are multiple reasons why pores may appear more visible. Debris that accumulates in pores can make them more noticeable. “Debris” can be a combination of dead skin cells, makeup, dirt, and sebaceous oily material. When a pore is full, it stretches, dilates, and becomes more noticeable. Sun damage also magnifies the appearance of pores. Constant sun exposure can heap up skin cells along the rim of a pore, exaggerating the hole size similar to a volcano. As you age, your pores also look larger. This is because you loose collagen and elastin in your skin as you age, which are bands of fibers that keep your skin tight and your pores looking small. As you age, you loose collagen and elastin in your skin and your pores stretch wider and become more noticeable.

So how do we keep our pores as small and inconspicuous as possible?

First, following a morning and night regular skin care routine is essential for both men and women. Keeping your skin clean will remove excess oil, environmental debris, and makeup or cosmetics that build up each day. Regular moisturizer and sunscreen is mandatory for all skin types. Many patients with oily skin are hesitant to want to use moisturizer and sunscreen, incorrectly assuming that their skin is moist enough already. However, your skin produces increased amounts of oils in response to a lack of moisture and as a response to dryness, not the other way around. Patients prone to acne, blackheads, or whiteheads may need treatment with benzoyl peroxide or salicylic acid which helps remove excess oil and dead skin cells, which prevents pores from clogging. Also helpful in these cases are topical acne creams with sulfur like sulfacetamide or resorcinol. Toners and astringents are also helpful to remove excess oil and residue after cleansing the face.

Any anti-aging skin care product will also help the appearance of pores. These products stimulate collagen and elastic fibers and help the pores from stretching. The best product to use is Retinol or RetinA (a Vitamin A derivative). It not only stimulates collagen and elastin, but also is “anti-comedogenic”, reducing sebum production and skin cells from accumulating and building up in the pore. Retinols improve skin texture and cause exfoliation, which helps the appearance of pores. Ideally you should use a .5% to 1% concentration applied nightly if tolerated. Skin irritation can occur but is usually transient. RetinA should not be used while pregnant or nursing and can make the skin more sensitive to sun, so daily sunscreen is required. Vitamin C and other antioxidants are useful adjuncts.

Any exfoliating process will also help keep the skin clean while removing dead skin cells and excess sebum. These procedures can include microdermabrasion, loofah pads, clarisonic (www.clarisonic.com), light chemical peels with glycolic or salicylic acid, or dermaplaning (skin shaving) procedures. Side effects can occur from more aggressive treatments so make sure you are going to an experienced practitioner. For most people, a home skin care program in combination with regular visits to a facialist, dermatologist, or plastic surgeon 5-6 times per year gives the best results. Facials and regular extractions can unplug debris beneath the skin surface, remove blackheads, and draw the pores closed. Extractions done correctly can prevent pore dilation associated with faulty exfoliation of cells lining the shaft or follicle, leading to “plugs”. When this debris is exposed to oxygen it oxidizes and turns “black”, hence the term blackhead (open comedones):

However, if extractions are poorly executed, surrounding tissues can be damaged, sebaceous glands can rupture and your skin can look worse or it can contribute to a sudden acne flare-up.
When the sebaceous glands continue to produce sebum that accumulates behind the plug, the pooling of undrained material is a wonderful medium for bacteria like Propionibacterium acnes, bacteria that naturally resides in healthy pores. The damage caused by Propionibacterium acnes makes the surrounding tissue susceptible to Staphylococcus aureus and Staphylococcus epidermidis, which can form pus and surrounding tissue redness or inflammation=white heads/acne/cystic acne. So no more talk about acne that is a whole other topic for discussion. Let’s get back to treatment options for pore size.

Any resurfacing treatment that tends to tighten the skin potentially helps the appearance of pores. Laser resurfacing with the carbon dioxide laser is an aggressive treatment and works well in fair complected individuals. Fractionated carbon dioxide laser resurfacing (Fraxel) may help, but results can be variable and multiple treatments are usually required. Resurfacing treatments can remove top layers of skin while tightening underlying collagen. It can smooth surface texture, but these treatments do not remove the pore; remember, the pore is full thickness through the skin. These procedures are expensive with downtime, and may be a lot to go through just to make pores look slightly smaller. They work better for fine lines, surface texture, and irregular pigmentation issues.

Surgical dermabrasion is also not expected to reduce pore size, but helps to smooth skin irregularities and is a procedure done in the operating room with weeks of down time. Other lasers and skin tightening devices may also may pores looks slightly smaller, but again results can be highly variable and temporary. Microneedling or dermarolling involves a physical method to inflict microinjury and may stimulate collagen synthesis and skin tightening to make pores look slightly smaller. Botox also helps smooth the skin, but the results on pore size may be subtle, variable, and temporary.

Pores are a normal part of skin anatomy. Some patients have pores that are more visible than others. In my opinion, the best treatment is a daily skin care routine, cleansing, toning, moisturizer and sunscreen. Medical grade skin care products purchased at your dermatologist, aesthetician, or plastic surgeon’s office are advised. Retinol products work best and should be used nightly if tolerated. Regular facials will keep your skin looking its best. Don’t believe the advertisements for creams and treatments that sound good, but honestly have no proven benefit.

I have consulted with various makeup artists over the years for advice on how to conceal visible pores. So from my personal experience only, I use primers from both the smash box line, (https://www.smashbox.com/products/6038/Face/Primer/index.tmpl)and MAC products (https://www.maccosmetics.com/index.tmpl), which are applied on a clean face and work beautifully to smooth irregularities and hide the appearance of pores. Some products are formulated with sunscreen and can be used for both men and women. Many other product lines offer similar primers to hide pores and smooth skin texture, creating the appearance of smooth flawless skin. Even though I am not a fan of heavy makeup, and prefer a natural look, it really can do wonders to even skin tone and surface irregularities in a subtle, light, and natural manner.

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