Why People are Claiming This Acne Drug Gave Them a ‘Free Nose Job’

In a string of recent videos, social media user after user has co-opted a sound on TikTok that states the use of powerful acne drug isotretinoin, or Accutane, resulted in a “free nose job.” Currently there are about 40 videos of people sharing before and after photos of their noses pre- and post-acne treatment with noses that appeared to have changed.

So why is Accutane making people think their nose is shrinking? “First of all, it’s important to note that the use of Accutane outside of its prescribed use, usually for acne, is not recommended and highly dangerous,” says Smithtown, NY facial plastic surgeon James C. Marotta, MD. “Accutane works by inhibiting sebum production, or oil, in the skin and decreasing the sebaceous gland size. Theoretically, someone who has thickened skin, due to overgrowth of these glands in conditions such as acne or rhinophyma, could see some of the thickness of the skin improve with Accutane, but this is by no means a ‘nose-job.’”

“The skin of the nasal tip and Ala, or the nostrils, has a lot of sebaceous glands,” says Palo Alto, CA facial plastic surgeon Sam P. Most, MD. “Thus, it can cause these to shrink and thins the skin, which can lead to a smaller tip.”

“This is not new news,” adds Spokane, WA dermatologist Wm. Philip Werschler, MD. “It’s old actually. It only works for people with sebaceous gland hyperplasia, or big, overgrown oil glands, and not just in nose, but also the chin and forehead.”

When it comes to the drug’s ability to transform someone’s look, Dr. Werschler notes that it’s been a Hollywood staple for years. “This started in the film industry several decades ago,” he says. “Studio dermatologists would put young actors on low dose acctane for extended periods of time while filming to reduce oil production thus keeping makeup looking fresher longer.”

However, Dr. Werschler explains that Accutane does not target or treat bone or cartilage. “As you know, that is what defines the size and shape of the nasal infrastructure. However, it does target the oil gland-rich tissue of the nose and can, in cases of overgrowth, shrink the nose via shrinking the sebaceous tissue.”

Dr. Marotta adds that the term “free nose job” is rather misleading and users of the drug should not expect to see rhinoplasty results. “A rhinoplasty or a nose job involves changing of the underlying bone and cartilage and occasionally thinning of the skin of the nasal tip surgically. Accutane will do nothing to change bone and cartilage which are the main targets in rhinoplasty,” says the surgeon.

Dr. Most agrees and says don’t start on Accutane if you don’t really need it. “At least one study has shown that these effects are temporary,” he adds. “Certainly it seems that the risks—Accutane is quite toxic and must be used with caution in women of child bearing age—might outweigh the benefits on most cases. However, some patients with extremely oily and thick skin may benefit from use.”

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