Does Isotretinoin Make Your Nose Smaller?
No, isotretinoin does not make your nose smaller—it reduces sebaceous gland size in the skin, not nasal cartilage or bone structure.
Mechanism of Action on Sebaceous Glands
Isotretinoin's primary mechanism involves reducing sebaceous gland size and sebum production throughout the body, including facial skin 1. This effect is specific to oil-producing glands and does not affect structural tissues like cartilage or bone 1.
- The medication causes an 88.4% decrease in sebum production with marked histological reduction in sebaceous gland size after 16 weeks of treatment 2.
- This sebaceous gland shrinkage occurs in skin tissue only and is reversible after treatment discontinuation, with partial recovery of glandular activity observed 2.
Why the Confusion May Exist
The perception that isotretinoin "shrinks" the nose likely stems from its effects on nasal tissues, but these are entirely different from structural changes:
- Nasal mucosal effects: Isotretinoin causes significant nasal dryness, crusting, and epistaxis, with severity scores increasing from 0.47 at baseline to 4.28 by the third month of treatment 3.
- Mucociliary clearance: Nasal mucociliary clearance time significantly increases from 12.6 minutes to 15.9 minutes during treatment, indicating impaired nasal function but not structural change 4.
- Nasal resistance: Total nasal resistance increases slightly from 0.195 to 0.216 Pa/cm³/s, suggesting mild nasal obstruction rather than size reduction 3.
What Actually Happens to Facial Appearance
Any perceived changes in nose appearance during isotretinoin treatment result from:
- Reduction in inflammatory acne lesions on and around the nose (60-95% clearance of inflammatory lesions) 5.
- Decreased oiliness of facial skin, which may alter light reflection and visual perception 1.
- Resolution of sebaceous hyperplasia or enlarged pores that may have been present on the nose 1.
Clinical Bottom Line
There is no evidence in the medical literature—including comprehensive guidelines from the American Academy of Dermatology 1 and decades of clinical research 5, 6, 2—that isotretinoin affects nasal cartilage, bone, or overall nose size. The medication's effects are limited to sebaceous glands, with secondary mucosal drying effects that cause discomfort but not structural changes 3, 4.