Written By Tatiana Bido
For years, neurotoxins like Botox Cosmetic, Xeomin, Dysport, Jeauveau and Daxxify have been synonymous with wrinkle reduction. But one trick up an injectors sleeve is also using these same injectables in more delicate, surface-level ways to subtly refine the skin itself..
This new approach, often called microtox, uses highly diluted doses of neurotoxin to treat the skin’s surface instead of targeting deeper muscles. The result? A complexion that looks refreshed and polished.
How Botox Helps Improve Skin Quality
The science behind this trend comes down to how neurotoxins interact with the skin. When injected superficially, they temporarily reduce muscle pull in the tiny fibers that attach to hair follicles and pores. This softens texture and helps the skin appear more even.
“The suppression of acetylcholine stimulation of the sebaceous glands decreases pore size and improves skin quality,” says New Orleans dermatologist Mary Lupo, MD. “There is a similar effect on the capillaries and results in vasoconstriction and therefore decreased redness and flushing.”
Newport Beach dermatologist Jennifer Channual, MD adds that this technique can work on fine lines and uneven texture as well. “Toxins can help smooth fine lines, wrinkles, and uneven skin texture—especially in areas such as the frown lines, forehead and crow’s feet,” she says. “Microtoxuses tiny, precisely placed doses of Botox to refine facial lines and pores while maintaining natural movement and expression.” Unlike wrinkle-relaxing injections, microtox treatments require much smaller, diluted doses spread across larger areas. The goal isn’t to freeze movement, but to subtly refresh the skin’s surface.
These microinjections can even enhance other skin treatments. “Hyperdilute Botox, whether delivered by needle or a microdelivery device like AquaGold, can improve skin texture and smoothness and provide a transient glow,” explains Fort Lauderdale dermatologist Dr. Matthew J. Elias. “This is great for skin smoothing after nonablative resurfacing lasers and can be used throughout the face.”
Where Dermatologists Are Using It
The treatment isn’t limited to the forehead or crow’s-feet. Increasingly, dermatologists are using microtox to rejuvenate areas that traditional Botox doesn’t reach. “I do more dilute Botox or Xeomin on the chest to help with the crepiness and sleep lines,” says Ashburn, VA dermatologist Brenda Dintiman, MD. “It can also be used along the tech lines of the neck and also the crepiness of the neck.”
San Francisco dermatologist Caren Campbell, MD often uses microtox for rosacea and enlarged pores. “For neurogenic rosacea on the cheeks I’ll perform microinjections across cheeks with 20 units of hyperdiluted Botox,” she explains. “Minimal improvement for pores but some patients are happy with it, usually five to eight units hyperdiluted for the nose. Repeat every three to six months.”
“Injecting neurotoxins superficially in areas like vertical cheek lines or crepey skin on the neck can help relax the muscle and smooth the appearance of these lines,” says Shreveport, LA dermatologist Skylar Souyoul, MD. “Another popular treatment is AquaGold or the ‘Botox Facial,’ which infuses Botox superficially into the skin to reduce oil production and improve the appearance of pores, giving patients the coveted glass skin appearance.”
Some injectors also treat the chin to smooth a pebbled or “orange peel” appearance that comes from overactive mentalis muscles says West Palm Beach, FL dermatologist Jacob Beer, MD. “A small amount of neurotoxin here can soften dimpling and create a smoother contour.”
Combining It With Filler
For those seeking a more pronounced result, Ontario dermatologist Dusan Sajic, MD says some providers are combining microtox with biostimulatory fillers. “For those seeking a more noticeable and comprehensive rejuvenation, we often use what’s now being referred to as the ‘Gold Protocol’—a single-syringe combination that includes microbotox, Radiesse and hyaluronic acid filler. This approach simultaneously addresses three of four key parameters of skin quality much more noticeably and robustly.”
What to Expect
The effects aren’t permanent, but they last long enough to keep skin looking refreshed. Most patients begin to notice the smoothing and glow within a week, with results typically lasting three to six months, says San Francisco dermatologist Caren Campbell, MD. Over time, the skin may start to regain its natural movement and oil production, which can make pores and fine lines gradually more visible again.
For those curious about long-term use, many dermatologists view microtox as an easy, repeatable way to maintain polished skin year-round. “Of all the brands of neurotoxins, Daxxify seems to give the best skin quality results, possibly due to the addition of a peptide that is unique in their formulation,” adds Chicago dermatologist Amy Taub, MD.
As Dr. Sajic notes, microtox isn’t meant to transform, it’s designed to subtly refine. “It’s an excellent entry point for smoother texture and refined pores, especially for patients who want a fresh, radiant look without a major procedure.”
