Can Roaccutane really make the nose thinner?

Key points to remember.

Roaccutane (isotretinoin) is a medicine prescribed for severe or treatment‑resistant forms of acne, when standard treatments prove insufficient.
Its efficacy is based in particular on a marked reduction in sebum production and in the size of the sebaceous glands, as well as an anti-inflammatory effect.
Certain studies suggest that isotretinoin may slightly reduce the thickness of the skin of the nose, which may give the impression of a more refined nose in some individuals.
These effects have mainly been investigated in the context of rhinoplasty, in order to improve aesthetic outcomes in patients with thick nasal skin.
The scientific data remain limited and heterogeneous, and there is currently no robust evidence to state that isotretinoin can permanently slim the nose.
Roaccutane remains a powerful medicinal treatment, associated with side effects and requiring strict medical monitoring.
It must never be used for cosmetic purposes, but only when its use is justified for the treatment of certain dermatological conditions such as acne.

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Roaccutane: above all, a treatment that must not be taken lightly.

Roaccutane, whose active ingredient is isotretinoin, is a medicine used in the treatment of severe or treatment-resistant forms of acne, when conventional treatments (antibiotics, topical therapies) prove insufficient. This retinoid acts on several mechanisms involved in acne. It markedly reduces sebum production by decreasing the size and activity of the sebaceous glands, limits blockage of hair follicles, has an anti-inflammatory effect, and slows the proliferation of Cutibacterium acnes. The aim of the treatment is to reach a cumulative dose, that is, a total amount of isotretinoin given over the full course, generally between 120 and 150 mg per kilogram of body weight, which helps to maximise efficacy and reduce the risk of relapse. A course of Roaccutane usually lasts between 4 and 10 months, depending on the daily dose taken.

In recent years, some dermatologists have observed an increase in isotretinoin prescriptions.

Augmentation des prescriptions d'isotrétinoïne. — Increase in isotretinoin prescriptions.
Source: VEGA A. & al. Use of isotretinoin (Accutane) in the United States: Rapid increase from 1992 through 2000. Journal of the American Academy of Dermatology (2002).

Several factors may explain this trend: better knowledge of the medicine and its effectiveness, a desire to prevent acne scarring by intervening earlier, and an increasing demand from patients for rapid and effective treatments. Isotretinoin remains, in fact, one of the most effective treatments for severe acne. However, studies show that around 30% of patients may experience a relapse after the course of treatment. In most cases, the acne returns in a milder form, and it is sometimes possible to undertake a further course if necessary.

Despite its effectiveness, Roaccutane remains a powerful treatment that should not be taken lightly. Isotretinoin can lead to numerous side effects, the most common being marked dryness of the skin and mucous membranes (chapped lips, dry skin, irritated eyes, etc.). Other, less common but potentially serious, adverse effects may also occur and require regular medical monitoring. The medicine is particularly strictly contraindicated during pregnancy, due to its teratogenic effect, which necessitates strict contraceptive measures in women of childbearing potential and a monthly blood test to confirm the absence of pregnancy.

Side effects	Frequency
Hyperglycaemia	Common
Hypercholesterolaemia	Common
Skin dryness, itching, eczema	Very common
Irritation and dryness of the eyes	Very common
Joint and muscle pain	Very common
Headache	Common
Anxiety	Rare

The main side effects of isotretinoin.

Source: Vidal. Isotretinoin: Mechanism of Action (2015).

Isotretinoin must always be prescribed and monitored by a dermatologist and accompanied by careful medical follow‑up. This medicine is, moreover, only available on prescription, and its dispensing is conditional on the presentation of a negative pregnancy test carried out within the previous three days.

Note : The term Roaccutane is often used to refer to this treatment, but it is in fact a brand name. Isotretinoin is also marketed under other names, including Contracné, Curacné, Isotretinoin Acnetrait and Procuta.

Does isotretinoin have any effects on nose size?

In recent years, the idea that Roaccutane could slim down the nose has been widely circulating on social media, to the point that some people even speak of "Accutane rhinoplasty". This hypothesis is based on a biologically plausible mechanism: isotretinoin markedly reduces the activity and size of the sebaceous glands and decreases sebum production, which gradually leads to a thinning of the skin, particularly in individuals with thick, oily skin. As the skin of the nose contains numerous sebaceous glands, some patients feel that their nose appears slightly slimmer during the course of treatment.

Several scientific studies have indeed observed changes in the thickness of the skin of the nose under isotretinoin. For example, a study carried out in 40 patients with acne treated with isotretinoin (0.25 or 0.5 mg/kg/day) for four months assessed the thickness of the nasal skin by ultrasound. The results showed a significant decrease in the thickness of the dermis and subcutaneous tissue in different areas of the nose, regardless of the dose used. At the same time, elastography measurements revealed an increase in skin elasticity at the fourth month of treatment, suggesting an improvement in certain mechanical properties of the skin. However, the study did not include post-treatment follow-up: it is therefore not known what happens six, eight or twelve months after stopping Roaccutane.

That said, these observations are of particular interest to surgeons in the context of rhinoplasty. In patients with thick nasal skin, isotretinoin can sometimes be used before or after the operation to improve the definition of the nasal contours. A scientific review published in 2024 suggests that the use of isotretinoin around the time of surgery could improve patients’ aesthetic satisfaction during the six months following the procedure. However, the results remain variable: only a few studies report a lasting benefit beyond one year, and the protocols used differ markedly from one study to another. The authors emphasise that the scientific evidence remains limited, in particular because of the small sample sizes and the lack of long-term follow-up.

It is therefore important to emphasise that, although certain changes to the skin of the nose may occur during treatment with isotretinoin, this medicine is not intended to alter the shape of the nose.

Roaccutane remains above all a medical treatment for severe acne, prescribed within a specific dermatological context and under medical supervision. In certain particular situations, such as rhinophyma, the reduction in sebaceous gland activity may improve the appearance of the skin. However, isotretinoin must never be used for a purely aesthetic purpose, and its benefit–risk balance must always be assessed by a healthcare professional.