If you have spent any time on TikTok lately you have probably seen it. Someone finishes a course of Accutane and their nose looks slimmer, sharper and less swollen than before. The clips get tagged as a free accutane nose job. In fact, it has become one of the most searched questions about the drug. However, beyond the hype there’s little evidence backed information. In this article we review why your nose might look smaller after a course of accutane and whether isotretinoin can really shrink your nose. We also review alternatives.
Where Did the “Accutane Nose Job” Trend Come From?
The phrase spread through social media, where before and after photos showed thinner, less puffy noses after a course of isotretinoin (the the generic name for Accutane or Roaccutane). This prescription only oral drug is licensed to treat severe acne that has not cleared with other treatments. It works by cutting oil production, calming inflammation and clearing the blocked pores that drive spots. A nose tends to look its most congested when the skin is oily and the pores are full. So when the amount of oil drops, the nose can look cleaner and smaller. That is the effect people are filming.
Does Accutane Actually Make Your Nose Smaller?
Up to a point, and only in a particular way. Isotretinoin is the most powerful treatment we have for reducing sebum, the oil the skin produces. It can cut oil production by as much as 90% and shrink the sebaceous glands that make it. The nose holds the highest concentration and the most active oil glands on the face, so it responds more visibly than anywhere else. Less oil means a less shiny, less puffy and smoother nose. Full pores empty and tighten, which refines the surface and sharpens the outline of the nose further.
There is also clinical interest behind the impression. Surgeons treating thick, oily noses have studied this effect for years, and the rhinoplasty literature describes oral isotretinoin thinning the skin and soft tissue envelope of the nose by controlling the oil glands. Crucially, it does this without altering the bone and cartilage underneath. So the nose can look smaller. However there is no real change in the size of the nose and as such this doesn’t compare to a surgical nose job.
Who Might Notice the Biggest Difference from an “Accutane Nose Job”?
Not everyone sees on isotretinoin sees any change to their nose. In fact, most people don’t. However, the people who do tend to have one thing in common. The effect is largest in those who started with very oily skin or overgrown oil glands, a pattern dermatologists call sebaceous hyperplasia. It is most striking of all in rhinophyma, a thickening and enlargement of the nose that develops in long-standing rosacea. Low-dose isotretinoin can reduce that thickening and is sometimes used to slow it or delay surgery. If your nose was never oily or thick-skinned to begin with, there is little for the drug to refine, and you are unlikely to notice much change in its appearance at all.
Is the Effect Permanent?
Unofrtunatley the accuatne nose job is usually temporary effect. That’s because the oil glands are suppressed during treatment, not removed. These are largely surface changes, and after the course ends the glands gradually become active again, although often not quite to the level they were before. For some people the smoother texture and lower oiliness hold reasonably well. For others the shine and the fuller pores return over the months that follow. The honest answer is that any slimming you see while taking isotretinoin tends to soften once the oil comes back.
So is it a Real Nose Job?
There is no comparison between what accutane does and a real surgical nose job (rhinoplasty). Surgery changes the bone and cartilage that give the nose its shape. Isotretinoin does none of that. It just changes the skin on top, by way of the oil glands, and nothing underneath.
It is also not a drug to take lightly and certainly not for cosmetic reasons. Isotretinoin is prescription only and for very good reason. It is started and supervised by a dermatologist and reserved for severe or scarring acne. This is because it is a systemic medication that carries serious risks. It may cause mood changes, liver injury and even tendon problems. Isotretinoin also causes birth defects so it is prescribed under strict pregnancy prevention rules. It also dries the skin and the lining of the nose, and nosebleeds are common. No responsible doctor would prescribe it to slim a nose. If structural change is what you are after, that is a surgical question for a plastic surgeon or at the very least non-surgical rhinoplasty with dermal filler.
Can Topical Skincare Also Refine Your Nose?
This is where most people actually have room to act. You cannot get the oil-gland shrinking power of oral isotretinoin in a cream, and it would be wrong to suggest otherwise. The evidence that topical retinoids suppress oil the way the tablet does is far from settled. But a nose looks larger mainly because of oil, congestion, full pores and rough texture, and those are exactly the things a good topical skincare routine can improve.
A topical retinoid such as retinal or prescription options like tretinoin can help keep the pores clear, smooth the surface and refine their appearance over time. In one study, tretinoin cream reduced facial pore size after ninety days of daily use. For skin that runs red and thickened, as it does in rosacea, hight strength azelaic acid can also help calm the inflammation behind it. Niacinamide is also helps with oiliness and shrinks pores, which helps reduce the prominence of a shiny oily nose.
None of these however reshapes the nose. What they do is take an oily, congested, coarse-looking nose and make it cleaner, smoother and less obvious. This is what most of what people are chasing when they search for an Accutane nose job in the first place. Unlike isotretinoin, topical skincare tends to be safer and more accessible but the effect may be less dramatic.
Accutane can make the nose look smaller and sharper through it’s indirect actions on reducing oil production and congestion. However, it does not give you a new nose which only a surgical rhinoplasty can do. Furthermore, the result is often temporary and due to the potentially serious side effects of this prescription only medicine it is only suitable for severe acne. There are however some topical treatments that can also help control oil, shrink pores and improve the appearance of the nose by making it look less prominent.
Oral isotretinoin is not something we offer and you will need to see a dermatologist to assess your suitability for this. If your sole concern is the size or shape of your nose, then it’s best to consult with a plastic surgeon who can advise on your full treatment options.
At City Skin Clinic, we are passionate about personalised skincare. Through our online clinic, our doctors design safe and effective topical custom acne and rosacea treatments using ingredients like tretinoin, azelaic acid, clindamycin and spironolactone where appropriate. To start your plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
