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How Your Skin Improves With Diluted Botox: TheSupporting Science

Writer: Nicole Wolfe
Nicole Wolfe
Aug 14
10 min read

What Is Microneedling With Diluted Botox (OnabotulinumtoxinA)?


When most people think of Botox, they think of injections that relax muscles to

smooth out deep wrinkles like frown lines and crow's feet. But there's a newer,

different approach: using very small, diluted doses of Botox delivered into the

skin itself (not the muscle) to improve overall skin quality — including pore size,

oiliness, skin texture, fine lines, and skin tightness.


This technique goes by several names: "microbotox", "mesobotox", or

"microtoxin". When microneedling is used as the delivery method, the tiny channels

created by the microneedling device allow the diluted Botox to penetrate into the

skin's surface layers (the dermis), where it can act on oil glands, tiny blood vessels,

and the superficial muscle fibers attached to the skin.


How Does Microneedling Deliver Botox Into the Skin?


Botox is a large molecule that cannot penetrate intact skin on its own.

Microneedling solves this problem by creating hundreds of temporary microchannels

— tiny openings in the skin's surface — that allow the Botox to pass through and

reach the dermis (the deeper, living layer of skin). These microchannels are

temporary and self-healing, closing within hours, which limits the window of

absorption and reduces the risk of over-delivery. Unlike laser treatments,

microneedling preserves the outer layer of skin (the epidermis), which means less

inflammation, less downtime, and lower risk of skin discoloration.


How Is This Different From Regular Botox?


Traditional Botox is injected deep into the muscle using a needle, targeting specific

muscles to stop them from contracting — which smooths out expression lines like

frown lines, forehead lines, and crow's feet. The goal is muscle relaxation.

Microneedling with diluted Botox works differently. Instead of going deep into the

muscle, the Botox is delivered into the skin itself (the dermis) at much lower, more

diluted concentrations spread across a wider area. At this superficial level, the Botox

acts on structures within the skin — oil glands, tiny blood vessels, superficial muscle

fibers, and the cells that produce collagen — rather than on the large muscles

underneath. The result is an improvement in overall skin quality (texture, pores,

oiliness, fine lines, tightness, and redness) rather than the targeted wrinkle relaxation

that traditional Botox provides.


Think of it this way: traditional Botox treats specific wrinkles; microneedling

with diluted Botox treats the skin itself.

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The following studies explain why diluted Botox improves skin quality when it

reaches the dermis. These studies used intradermal injection (tiny microdroplets

placed directly into the skin) rather than microneedling as the delivery method, but

the science applies equally — the key is getting the Botox into the dermis, and

microneedling is one effective way to do that.

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⭐ FEATURED STUDY ⭐


Crossover Clinical Trial: Microbotox for Lower Face and Neck Rejuvenation —

25 Patients (Awaida et al., 2018)

What they did: 25 patients who had previously been treated with the "Nefertiti"

technique (a traditional Botox injection pattern for the neck) were then treated with

the microbotox technique — hundreds of tiny microdroplets of diluted Botox injected

into the dermis of the lower face and neck. Results were compared between the two

techniques using validated photonumeric scales assessed by blinded evaluators

(doctors who didn't know which treatment was used).


How skin improved — measured results:

- Jowls: Statistically significant improvement — microbotox was more effective than

the Nefertiti technique

- Neck volume/fullness: Statistically significant improvement — microbotox was

more effective than the Nefertiti technique

- Platysmal bands at contraction: Statistically significant improvement

- 100% of patients were satisfied with the microbotox technique

- 100% of patients rated themselves as improved on the Global Aesthetic


Improvement Scale


Why this study matters: This is the only study that directly compared microbotox to

a well-known traditional Botox technique (the Nefertiti lift) for the same treatment

area. It showed that delivering tiny doses of Botox into the skin — rather than deep

into the muscle — was actually more effective for improving jowls and neck

fullness. Traditional injection was only better for platysmal bands (the vertical cords

that appear in the neck). This study provides strong evidence that the microbotox

approach offers unique benefits that traditional Botox cannot achieve.


Impact on skin: ✅ Strongly Positive

Strength of evidence: ⭐⭐⭐ Moderate — A crossover trial with blinded assessment

using validated scales. Level IV evidence.


Reference: Awaida CJ, Jabbour SF, Rayess YA, et al. "Evaluation of the Microbotox

Technique: An Algorithmic Approach for Lower Face and Neck Rejuvenation and a

Crossover Clinical Trial. Plastic and Reconstructive Surgery, 2018;142(3):640–649.

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Skin Texture, Pores, and Oil Control

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Study 1. Quantitative Clinical Study: Microbotox for Skin Texture, Roughness,

and Pores — 62 Patients (Diaspro et al., 2020)


What they did: 62 patients received diluted Botox injected intradermally (into the

skin, not the muscle) in a grid pattern across the forehead, cheeks, and jawline. Skin

was measured with a high-resolution scanning device at baseline and 90 days.


How skin improved — measured results at 90 days (all statistically significant,

p 0.0001):

- Skin texture: Significant improvement

- Microroughness: Significant improvement

- Pore diameter: Significant reduction

- Best results were seen in patients aged 36–53 years

- High satisfaction among both patients and physicians


Bottom line: This is the largest quantitative study on intradermal Botox for skin

quality. It proves that when Botox reaches the dermis, it objectively and measurably

improves skin texture, roughness, and pore size.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐ Moderate — The largest quantitative study on

microbotox with objective instrument measurements. No control group (Level IV

evidence).


Reference: Diaspro A, Calvisi L, Manzoni V, Sito G. "Microbotulinum: A Quantitative

Evaluation of Aesthetic Skin Improvement in 62 Patients." Plastic and Reconstructive


Surgery, 2020;146(5):987–994. Available at:

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Study 2. Retrospective Study: Intradermal Botox for Sebum Control, Face

Lifting, and Pore Improvement — 20 Patients (Park et al., 2021)


What they did: 20 patients received intradermal microdroplet injections of diluted

botulinum toxin across the face. Outcomes were measured using a Sebumeter (oil

measurement device), 3D facial scanner, and the Global Aesthetic Improvement

Scale at 1, 4, 8, and 12 weeks.

How skin improved — measured results:

- Sebum (oil) production: Significantly reduced, sustained through 12 weeks

- Facial pore size: Significantly improved

- Facial laxity (sagging): Significantly improved

- Jawline definition: Improved (mandibular length reduced, indicating a

tightening/lifting effect)

- Maximum improvement occurred at 4 weeks

- 100% of patients reported at least "improved" on the Global Aesthetic


Improvement Scale at 4 weeks

Bottom line: Intradermal Botox objectively reduces oil, shrinks pores, and tightens

the face — with peak results at 4 weeks and benefits lasting 3 months.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐ Moderate — Objective instrument measurements with

12-week follow-up. Small sample size and retrospective design.


Reference: Park JY, Cho SI, Hur K, Lee DH. "Intradermal Microdroplet Injection of

Diluted Incobotulinumtoxin-A for Sebum Control, Face Lifting, and Pore Size


Improvement." Journal of Drugs in Dermatology, 2021;20(1):49–54. Available at:

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Study 3. Clinical Study: Intradermal Botox for Oily Skin — 25 Patients (Rose

Goldberg, 2013)


What they did: 25 patients with oily skin received intradermal Botox injections in the

forehead region. Oil production was measured with a Sebumeter at baseline and at 1

week, 1 month, 2 months, and 3 months after treatment.

How skin improved — measured results:

- Oil production was significantly reduced at every time point: 1 week, 1 month, 2

months, and 3 months (p 0.001 at all time points)

- 91% of patients (21 out of 25) reported they were satisfied, rating their

improvement at 50–75%

- Results were sustained for the full 3-month follow-up period


Bottom line: Intradermal Botox produces a significant, sustained reduction in oil

production lasting at least 3 months, with over 90% patient satisfaction.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐ Moderate — Objective Sebumeter measurements with

3-month follow-up. No control group.


Reference: Rose AE, Goldberg DJ. "Safety and Efficacy of Intradermal Injection of

Botulinum Toxin for the Treatment of Oily Skin." Dermatologic Surgery, 2013;39(3 Pt

1):443–448. Available at: https://pubmed.ncbi.nlm.nih.gov/23293895

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Study 4. Clinical Study: Intradermal Botox for Oily Skin, Pores, and Post-Acne

— 12 Patients (Shirshakova et al., 2021)


What they did: 12 patients with oily skin, enlarged pores, and post-acne changes

received intradermal Botox injections over a 2-week treatment period.

How skin improved — measured results:

- Skin moisture: Increased by 4% (p ≤ 0.05)

- Pore size (porosity): Decreased by 7% (p ≤ 0.01)

- Skin grooves/lines (sulci): Decreased by 10% (p ≤ 0.01)

- Pigmentation: Decreased by 9% (p ≤ 0.01)

- Strong positive correlation between treatment duration and improvement in oiliness

(0.87), pigmentation (0.78), skin lines (0.84), and porosity (0.88)

Bottom line: Measurable improvements across multiple skin quality parameters —

pores, lines, pigmentation, and moisture — all from intradermal Botox.


Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐ Preliminary — Very small sample size (12 patients) and

no control group.


Reference: Shirshakova M, Morozova E, Sokolova D, Pervykh S, Smirnova L. "The

Effectiveness of Botulinum Toxin Type A (BTX-A) in the Treatment of Facial Skin

Oily Seborrhea, Enlarged Pores, and Symptom Complex of Post-Acne." International

Journal of Dermatology, 2021;60(10):1232–1241. Available at:

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Study 5. Expert Roundtable: Microtoxin in Clinical Practice — 1,867+

Documented Cases (Fabi et al., 2023; Wu, 2015)


What they did: A panel of international experts discussed their clinical experience

with intradermal microdoses of Botox ("microtoxin"). One of the panelists (Dr. Wu)

has documented over 1,867 cases of microbotox treatments across various facial

areas.

What they found — clinical experience across 1,867+ cases:

- Microtoxin effectively reduces pore size, oil production, acne, and fine lines

- Improves jawline and neck definition

- Improves horizontal neck lines

- Can help prevent and manage scars and keloids

- Typical dosing: 20–28 units per mL of solution, delivered as 100–120 tiny

injections per side

- High patient satisfaction among appropriately selected patients


Bottom line: The largest documented clinical experience with intradermal Botox

confirms consistent benefits across multiple skin quality parameters.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐ Moderate — Expert consensus based on extensive

clinical experience. Not a controlled trial, but the volume of cases (1,867+) provides

meaningful real-world data.


Reference: Fabi SG, Park JY, Goldie K, Wu W. "Microtoxin for Improving Skin

Quality: Literature Review and Expert Roundtable." Journal of Drugs in Dermatology,

2023;22(7):657–665. Available at: https://pubmed.ncbi.nlm.nih.gov/37410614


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Rosacea and Facial Redness

The following studies demonstrate that intradermal Botox is also effective for

reducing facial redness, flushing, and visible blood vessels — particularly in patients

with rosacea.

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Study 6. Randomized, Double-Blind, Placebo-Controlled, Split-Face Trial:

Intradermal Botox for Rosacea — 24 Patients (Kim et al., 2019)


What they did: 24 patients with rosacea-related facial redness were enrolled in a

randomized, double-blind, split-face study. One cheek received intradermal Botox

injections and the other received saline (placebo). Neither the patients nor the

evaluating physicians knew which side received which treatment. Skin was

measured at 2, 4, 8, and 12 weeks.

How skin improved — measured results:

- Redness (erythema index): Significantly decreased on the Botox side at weeks 4

and 8

- Clinician Erythema Assessment score: Significantly decreased on the Botox

side

- Skin elasticity: Significantly improved at weeks 2 and 4

- Skin hydration: Significantly improved at weeks 2, 4, and 8

- Oil production and water loss: No significant difference between sides

- Global Aesthetic Improvement Scale: Significantly improved on the Botox side


Bottom line: In this gold-standard double-blind, placebo-controlled trial, intradermal

Botox significantly reduced facial redness and improved skin elasticity and hydration

compared to placebo.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐⭐⭐ Very Strong — A randomized, double-blind,

placebo-controlled, split-face trial — the highest quality study design. Objective

measurements at multiple time points.


Reference: Kim MJ, Kim JH, Cheon HI, et al. "Assessment of Skin Physiology

Change and Safety After Intradermal Injections With Botulinum Toxin: A

Randomized, Double-Blind, Placebo-Controlled, Split-Face Pilot Study in Rosacea


Patients With Facial Erythema." Dermatologic Surgery, 2019;45(9):1155–1162.

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Study 7. Randomized, Double-Blind, Split-Face Trial: Intradermal Botox for

Rosacea Redness — 30 Patients (Dağtaş et al., 2025)


What they did: 30 patients with erythematotelangiectatic rosacea (the type

characterized by persistent redness and visible blood vessels) were enrolled in a

randomized, double-blind, split-face study. One side of the face received 15 units of

intradermal Botox, while the other side received saline injections. Redness was

measured at baseline and 1 month using a Mexameter (erythema measurement

device), dermatoscopy, and videocapillaroscopy (a microscope that visualizes blood

vessels).

How skin improved — measured results:

- Clinician Erythema Assessment scores: Significantly reduced on the Botox side

(p 0.05)

- Erythema Index (Mexameter): Significantly reduced on the Botox side

- Background erythema (dermatoscopy): Significantly reduced on the Botox side

- Vascular density (videocapillaroscopy): Significantly reduced on the Botox side

— meaning the treatment actually reduced the density of visible blood vessels

- No significant changes on the saline control side for any of these measures

- No serious adverse events


Bottom line: Another gold-standard double-blind trial confirming that intradermal

Botox significantly reduces facial redness and even reduces the density of visible

blood vessels — with no improvement on the placebo side.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐⭐⭐ Very Strong — A randomized, double-blind,

controlled, split-face trial with objective instrument measurements.


Reference: Dağtaş BB, Erdem O, Güneç Tİ, et al. "Effects of Botulinum Toxin Type

A Treatment on Clinical and Biophysical Parameters in Patients With

Erythematotelangiectatic Rosacea: A Prospective, Randomized, Controlled, Double-

Blind Study." Dermatologic Surgery, 2025;51(5):515–521. Available at:

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Study 8. Clinical Study: Intradermal Botox for Rosacea Erythema — 25

Patients (Bloom et al., 2015)


What they did: 25 patients aged 35–70 with facial redness from

erythematotelangiectatic rosacea received intradermal Botox injections to the nasal

area. Redness was graded by a blinded (non-treating) investigator using

standardized photographs at baseline, 1, 2, and 3 months.

How skin improved — measured results:

- Mean baseline erythema grade: 1.80 (moderate redness)

- Mean erythema grade at 3 months: 1.00 (mild redness)

- Mean improvement: 0.80 grade points — a 44% reduction in redness severity

- Improvement was statistically significant at 1, 2, and 3 months (p 0.05 at all time

points)

- The greatest improvement was at 2 months (p 0.001)


Bottom line: Intradermal Botox produced a sustained, significant reduction in

rosacea-related facial redness lasting at least 3 months.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐⭐ Moderate — Blinded investigator assessment with 3-

month follow-up. No control group, and only 15 of 25 patients completed all follow-up

visits.


Reference: Bloom BS, Payongayong L, Mourin A, Goldberg DJ. "Impact of

Intradermal AbobotulinumtoxinA on Facial Erythema of Rosacea." Dermatologic

Surgery, 2015;41 Suppl 1:S9–16. Available at:

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Study 9. Prospective Study: Botox for Rosacea With Quality of Life Impact —

33 Patients (Takahashi et al., 2024)


What they did: 33 patients with rosacea received superficial Botox injections on

Days 1 and 14, and were followed for 90 days. In addition to clinical assessment,

researchers measured quality of life (QoL) and self-esteem using validated

questionnaires.

How skin improved — measured results:

- 94% of patients reported improvement in their rosacea appearance

- Quality of life scores: Significantly improved (p 0.05)

- Self-esteem scores: Significantly improved (p 0.001)

- Rare adverse events — treatment was well-tolerated


Bottom line: Intradermal Botox not only improves the visible signs of rosacea but

also significantly improves patients' quality of life and self-esteem — the first study to

demonstrate this psychological benefit.

Impact on skin: ✅ Positive

Strength of evidence: ⭐⭐½ Moderate-Preliminary — A prospective study with

validated questionnaires. No control group (open-label design).


Reference: Takahashi KH, Utiyama TO, Bagatin E, Picosse FR, Almeida FA.

Efficacy and Safety of Botulinum Toxin for Rosacea With Positive Impact on Quality

of Life and Self-Esteem. International Journal of Dermatology, 2024;63(5):590–596.

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