It’s undeniable that the words Botox and wrinkles are inextricably connected in most peoples’ minds. While the injectable has many applications, its claim to fame, hands down, is its ability to treat expression lines. But recent research has found that botulinum toxin not only can smooth your complexion but may help clear it too. Using Botox for acne is a growing topic of interest—one that, according to the dermatologists we spoke with, is legitimate. Still, that doesn’t necessarily mean that Botox injections should take the place of your salicylic acid spot treatment quite yet. Here’s what you need to know.
How are Botox and acne connected?
There’s definitely a link. “There are both in vitro and in vivo studies that connect Botox and acne,” says Dr. Amelia Hausauer, a board-certified dermatologist in Campbell, California. There’s also plenty of anecdotal evidence. “I started researching the connection because my patients kept telling me that they would start breaking out after their Botox wore off,” points out Dr. Hausauer.
It’s important to note that while we’re using the word Botox as shorthand here, any of the injectable neurotoxins currently available on the market have a similar effect. “The studies on toxins and acne were done with several brand names,” notes Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York. “In the U.S., we have Botox Cosmetic, Xeomin, Dysport, and Jeuveau. Any of them would have the effect described,” she says. (More on that exact effect in a moment.)
In order to understand the link between botulinum toxin and acne, it’s first important to understand the pathogenesis of the latter. There are four key factors at play in the development of acne: Increased and altered sebum production; bacteria; abnormal skin cell proliferation and adhesion that leads to clogged pores; and inflammation, Dr. Hausauer explains.
The majority of the current research on neuromodulators and acne shows that they work on the first of those four factors—sebum, or oil, production. “Botulinum toxin blocks the release of a neurotransmitter known as acetylcholine, which binds to certain cells,” says Dr. Hausauer. When Botox injections are used to treat wrinkles, blocking acetylcholine ultimately prevents the muscles from contracting and forming those wrinkles. But our sebaceous glands also use acetylcholine in a number of different ways throughout the entire sebum production process, Dr. Hausauer says. By targeting the way the sebaceous gland works, you’re instantly addressing one of the primary acne-causing culprits, she points out. Additionally, it’s also thought that botulinum toxin affects oil glands by causing paralysis of the arrector pili muscle of the follicular unit—the combination of the hair and oil gland—that normally contracts to secrete sebum onto the skin’s surface, adds Dr. Waldorf.
That being said, Botox may also impact some of the three remaining acne-causing factors. Dr. Hausauer notes that one study found that botulinum toxin prevents the release of an inflammatory substance known as substance P, essentially acting as an anti-inflammatory, she says. “In the case of acne, this could help resolve some of the inflammation in the disordered hair follicle,” she adds. And finally, there’s also evidence to suggest that botulinum toxin may even change the way in which skin cells overproliferate and start to get “sticky,” mitigating the likelihood of clogged pores, she says.
What type of acne does toxin work best for?
All that being said, a recent review of six studies that looked at botulinum toxin’s effect on acne found that in every case, the primary effect was a reduction in sebum rather than on comedones, acne papules, nodules, or cysts, notes Dr. Waldorf. In other words, Botox has been shown to decrease oil production, which, yes, definitely plays a role in acne formation, but its ability to actually clear up pimples remains more anecdotal than anything. Either way, given that its primary mechanism of action involves the sebaceous glands, it stands to reason that it would be more effective for comedones that are more oil-related—blackheads, whiteheads—than for deep cysts. In other words, using Botox for cystic acne probably isn’t going to be a thing anytime soon.
What kind of botulinum toxin injections help with acne?
Interestingly enough, in the existing studies, the injections were both intramuscular and intradermal, and the doses used ranged widely, notes Dr. Waldorf. Still, “based on the location of the targeted sebaceous glands and the large area to treat, intradermal, microdroplet injections [small doses placed in the dermis rather than muscle] make the most sense,” she adds. Dr. Hausauer agrees: “When you inject Botox into the muscle, you do get some amount of diffusion—meaning, it can potentially get to the sebaceous gland—but the better effect is achieved when it’s microdosed on a more superficial level.” Similarly, she says her patients who come in for traditional wrinkle-smoothing Botox injections find that it has the best skin-clearing side effect on the forehead. It makes sense, given that the muscle is much closer to the surface of the skin there than in other areas of the face that are injected, such as the glabella or masseter, she explains.
So is Botox good for acne?
It certainly won’t make matters worse, though both dermatologists we spoke with are quick to note that Botox is definitely not a stand-alone acne treatment. For starters, it doesn’t improve comedones, papules, cyst, or nodules directly, says Dr. Waldorf, who also underscores the fact that there are no studies comparing its efficacy to that of other acne treatments. “I’d suggest it as an adjunctive treatment, which is how many of my patients use it,” adds Dr. Hausauer. “We always have much more success with acne when we target it with multiple different things. This is another option that we can now use, although it doesn’t have the decades’ worth of data that we have for other acne medications.”
There are also some potential drawbacks. Neurotoxin injections for acne have to be repeated every few months; Dr. Hausauer says the effects typically last approximately four months, about the same as its wrinkle-smoothing duration. There’s also the potential that if too much toxin is injected or if it’s injected too deeply, you can wind up with unintended muscle paralysis, cautions Dr. Waldorf.
Can Botox get rid of acne scars?
It might help, but it definitely isn’t a magic bullet. “There is some data that botulinum toxin can help with collagen proliferation and modeling, so in that sense, it could improve the quality of the skin,” says Dr. Hausauer. She adds that Botox injections have been shown to help hypertrophic scars, which acne scars sometimes are. Still, “it wouldn’t be the first thing I recommend for acne scarring,” she says.
