Intradermal Botox A for treatment of enlarged pores, oily and acne prone skin
KS Jafri
Objective: The purpose of this study is to evaluate the effectiveness of intradermal Botox
A injections for the treatment and management of enlarged pores, oily skin and acne
prone skin in the facial area.
Design: A series of thirty consecutive patients presented with complaints of enlarged
facial pores, oily skin and/or recurrent acne on their cheeks, nose and forehead. Patients
were evaluated based on their subjective concerns, realistic expectations, overall good
health, and objective findings on exam. The patients would be treated and followed by
Dr. Kamran Jafri in his private offices in Manhattan, NY. Patients would sign informed
consent documents to undergo Intradermal Botox A injections with the understanding
that this technique is an “off-label” application of Botox A. Follow up intervals would be
at 2 weeks, 6 weeks and 3 months. Digital photographs of each patient from various
angles would be taken at each visit as would subjective / objective findings to be
documented on the medical record.
Materials and Methods: The experimental procedure consisted of clinical evaluation
documented by digital photography and subjective / objective findings of the patient and
as recorded in the medical record. Materials included Botox A (Cosmetic, Allergan
Corp.). The Botox A 100 unit vial was diluted with 5cc of preserved saline. After
thorough cleansing of the face, Intradermal Botox injections were performed with a 1cc
Luer lock syringe with a 30 gauge needle. The patients were made comfortable during
procedures by gentle technique and icing the skin prior to injection. Injections were
performed in a bevel up manner, angled at 45 degrees to the skin’s surface. Depth of
injection was limited to the dermis. Intradermal injections were spread apart by 0.5cm
and consisted of 2-3 units per area. Areas of injection included the “T Zone” – cheeks,
forehead and nose. Patients were advised not to massage or put pressure on the injected
sights for 24 hours following treatment, and to avoid alcohol, exercise and laying flat for
6 hours after injections.
Results: During follow up visits patients showed objective as well as reported subjective
improvement in the areas of concern. 2 patients (6.7%) reported no improvement or
change in their baseline concerns. Pore sized was reduced in 75% of patients. However
not all patients experienced the same degree of pore reduction. While 75% of patients
reported an “overall satisfaction” with the treatment, the subjective reduction in pore size
and appearance was variable between 50-90%. All patients (100%) reported subjective
improvement in the oiliness of their skin. Also noted was a smoother appearance and feel
of the skin areas injected. Acne breakouts were reduced in frequency as was the amount
of acne in the treated areas in 40% of patients. A higher level of satisfaction was reported
with reduction in the inflammatory sequelae of acne (PIH), with 80% of patients
reporting objective and subjective satisfaction. However patients with cystic, nodular or
moderate to severe acne showed no improvement from baseline. 28 patients (93.3%)
reported a positive impact on their sense of well being, approach to social and
professional interactions and overall satisfaction with treatment. There were no reports of
facial muscle weakness, facial asymmetry, skin irritation, excess dryness, increase in
acne or oil production, prolonged swelling or bruising, pain or infections in this study.
Conclusion: In a series of thirty patients Intradermal Botox A injections were shown to
provide consistent results with improvement in subjective / objective concerns in the
majority of the patients followed. Patients reported the greatest satisfaction with
reduction in oily skin (100% subjective satisfaction). The majority of patients felt
satisfaction in the reduction of pore size and pore appearance, however the degree of
improvement was variable. From a clinical standpoint, patients with thick, sebaceous skin
and large pores experienced less satisfying results than patients with mild-moderate pores
and thinner skin. In addition treatment of pores was subjectively more effective along the
cheek and forehead than on the nasal dorsum / tip. Based on the clinical results of this
study, Intradermal Botox may serve as an adjunctive therapy for mild, inflammatory acne
and the sequelae (PIH) associated with it, but should not be considered first line therapy.
Further clinical studies are required incorporating histological analysis of the skin treated
with Intradermal Botox as well as high quality digital photos to help fully assess the
clinical effectiveness and mechanisms of action of this exciting new application of Botox
A. In addition, further studies to investigate the effect of varying concentrations of
Intradermal Botox will further help our understanding of the clinical applications of this
treatment modality and perhaps help explain why patient variation exists in pore
reduction.