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There’s no denying that acne is...less than ideal. Sometimes, even worse: A 2017 study found that breakout sufferers have higher rates of depression and anxiety. So, it’s fair to assume that the opposite is true, too—that having a clear complexion can be a huge confidence boost. After all, what’s better than being complimented on flawless skin, right?
That’s exactly what happened when I met plastic surgeon, Kamakshi Zeidler, MD FACS, founder of Aesthetx in California’s Bay Area. It should come as no surprise that a plastic surgeon has beautiful skin—and I let her know how I felt about her glowing complexion. What surprised me most about her response was the method she swears by to keep her skin clear: Botox.
After a journey of unpredictable breakouts throughout the years, first relying on oral contraceptives and then trying other medications like spironolactone, Dr. Zeidler learned about Aquagold-style treatments. “Aquagold is a microinfusion treatment that uses a device with extremely fine, gold-plated needles to create tiny channels in the superficial layers of the skin while simultaneously delivering customized ingredients directly where they're needed,” explains Alexandra Bowles, D.O., a board-certified dermatologist at MONA Dermatology. In this case, it’s botulinum toxin, the active ingredient in Botox and other neurotoxins.
Meet the experts: Kamakshi Zeidler, MD FACS, is the founder of Aesthetx in California’s Bay Area. Alexandra Bowles, DO, is a board-certified dermatologist at MONA Dermatology. Elisabeth Dzhandzhikyan, MSN, FNP, is an aesthetic nurse practitioner at Collective Beauty Med Spa in Calabasas, CA. Jessica Weiser, MD, is a board-certified dermatologist and founder of Weiser Skin MD in NYC and Aspen.
“Since incorporating these treatments into my routine, my skin has become much clearer and more stable,” says Dr. Zeidler. “I now rely much less on systemic medications or daily topical acne treatments to maintain clarity.”
Curious to learn more about how Botox can be used in this way to treat acne, I tapped Drs. Zeidler and Bowles, along with other professional injectors, who share the ins and outs of Aquagold microneedling—and who the best candidates for these treatments would be.
How does Botox work to prevent acne?The key is how the neurotoxin is delivered into the skin, says Elisabeth Dzhandzhikyan, MSN, FNP, an aesthetic nurse practitioner at Collective Beauty Med Spa in Calabasas. Although AquaGold is often compared to microneedling, it’s very different. The goal isn’t to create micro-injuries, but to place microdroplets of ingredients evenly and superficially into the skin. “When a neurotoxin is delivered very superficially through microinfusion, we're not trying to relax deeper facial muscles the way we do with traditional Botox injections,” says Dr. Bowles.
Instead, she explains that the neurotoxin—whether Botox or one of its competitors such Dysport, Xeomin, or Daxxify—acts on structures within the superficial skin. “This can reduce oil production, minimizing the appearance of pores, decreasing shine, and creating a smoother skin texture,” explains Dr. Bowles. In fact, one study found that patients injected with intradermal microdroplets of toxin experienced a decrease in oil production that lasted for up to four weeks.
Another way that Botox can minimize breakouts is by addressing excess sweat, adds Jessica Weiser, MD, a board-certified dermatologist and founder of Weiser Skin MD in NYC and Aspen. “Neuromodulators help to reduce sweat production, and sometimes sweat sitting on the skin surface can clog or congest pores leading to acne breakouts,” she says.
Will Botox injected this way also smooth wrinkles?In short, no. “Microinfused neurotoxin can improve skin quality and soften very fine, superficial lines, but it is not a replacement for traditional neurotoxin injections if the goal is to treat dynamic wrinkles such as forehead lines or crow's feet,” says Dr. Bowles. Because Aquagold creates microchannels to infuse Botox superficially, it’s not able to reach and relax the muscle as traditional Botox does.
This is actually a good thing because if someone is only looking to treat their acne, they won’t have to worry about looking frozen in their pursuit of clearer skin. On the other hand, it does mean if you’re already getting neurotoxin injections for their smoothing benefits, you’ll need to continue to get them injected the traditional way, deeper in the muscles, to continue seeing wrinkle-reducing benefits. “Aquagold injections aren’t meant to ‘freeze’ the face,” says Dzhandzhikyan. “Think of it more like a skin-polishing effect: less shine, softer-looking pores, and a smoother-looking complexion.”
The best candidate for using Botox to treat breakouts.This approach is ideally suited to someone with oily skin, enlarged pores, and mild to moderate acne or frequent inflammatory breakouts, says Dr. Bowles, “Patients whose acne is largely driven by excess oil often respond particularly well,” she adds.
Dr. Zeidler says she recommends the treatment as part of a quarterly maintenance plan for patients young and old, as “it’s gentle, superficial, and highly customizable.” The customization part is a huge boon, too, as your injector can create a cocktail of ingredients to treat your individual concerns. “The most common ingredients include Botox to tighten pores and control sebum production, a very light hyaluronic acid product [such as the HA filler, Juvederm] for hydration, as well as antioxidants, growth factors, PDRN (aka, salmon sperm), or other customized skin boosters to target individual concerns,” explains Dzhandzhikyan.
If someone has a few small, isolated breakouts, your treatment provider may be able to work around those areas and still treat the rest of the face safely, explains Dr. Zeidler. But, it is important to note that when the skin is actively infected or very inflamed, aggressive needling can irritate the skin further and may theoretically spread bacteria. “If a patient has widespread inflamed acne, pustules, or open lesions, we prefer to first calm the acne with medical skincare or dermatology-directed treatment before doing microneedling or microinfusion across the skin,” Dr. Zeidler adds.
And if you have severe cystic or nodulocystic acne, where inflammation occurs much deeper in the skin, Dr. Bowles says the Acquagold treatment with Botox wouldn’t be her first line of defense as that kind of acne often requires prescription medications, hormonal management, or isotretinoin.
The treatment timing for the best results.Dr. Wiser says that many of her patients see instant improvements in skin radiance with smoother texture taking effect within a few days. “The glow and hydration can show up quickly, often immediately,” echoes Dzhandzhikyan. “Oil control and pore-refining benefits usually become more noticeable over the first one to four weeks,” she adds, noting that she recommends acne clients give their skin “at least one full skin cycle before judging the result.” The final result for breakout-prone skin types: “they may notice less of an “oily” shine, less congestion, and fewer small breakouts over time.”
As for how often you should do the treatment. Dr. Zeidler says, “Many patients like doing it every four to six weeks, especially if they notice their oiliness and breakouts start creeping back around the one-month mark.” She shared with me that her breakouts are like clockwork and that when she sees one cropping up, that likely means that it’s been four weeks since her last treatment. That said, she notes that results vary. “Some studies on microinfused toxin show benefits lasting longer than a month, but clinically, I like to customize frequency based on how the patient’s skin responds.”
So, if you’re someone who struggles with pesky breakouts and congestion, it can be worth it to inquire about the Aquagold treatment with Botox. “Waking up with clearer, smoother, more refined skin gives many patients a real sense of confidence,” says Dr. Zeidler.
Lisa DeSantis is a freelance writer, editor, and brand consultant in the beauty, wellness, and lifestyle spaces. Lisa has been in this field for over ten years, collaborating with some of the top experts in the space and trying thousands of products along the way. Getting her start at QVC as an intern while she attended Drexel University, Lisa learned the ins and outs of working in media. After graduating, she began contributing to many top women's lifestyle magazines, including Fitness, Allure, Health, and Real Simple, before starting her freelance career. She has also made TV appearances on Good Morning America and the Today Show, among other news segments. Some of Lisa's most recent work can be found on Byrdie, Cosmopolitan, and Glamour. Lisa currently resides in Nashville, where she is training to become a Pilates instructor while contributing to many of her favorite New York-based magazines and digital sites. Find her on Instagram at @lisa_desantis_ or check out her website: lisadesantis.co.
Brian Underwood is beauty director at Women’s Health, where he oversees content strategy for the brand across all platforms, including digital, print, and social. Underwood previously served as beauty and wellness director at Oprah Daily and O, The Oprah Magazine. During his tenure leading beauty content for the Oprah brand at Hearst, stories Underwood commissioned were awarded the Skin Cancer Foundation Media Award and a Fragrance Award for Editorial Excellence (his second). He was the launch Beauty Director of Dr. Oz THE GOOD LIFE, and has held additional editorial positions at Fitness, Organic Style, Good Housekeeping, Life & Style Weekly, and Woman’s Day and has written for Self, Shape, Seventeen, Redbook, Cosmopolitan, and many more. Underwood previously served on the Skin Cancer Foundation’s gala committee and as partnerships director of the Trans Beauty Clinic, a New York-based charitable organization that provided beauty services and workshops to the city’s trans community.