Does Accutane Make Your Nose Smaller? Face, Pores & Lips

No. Accutane (isotretinoin) does not change the structure of your face. It does change how your face looks, and the difference is real enough that people photograph it, but all of it happens in the skin rather than in the bone underneath.

What Does Accutane Do to Your Skin?

Accutane (isotretinoin) is a systemic, oral medication, meaning it works from inside your skin and body. Every visual change relates to one core mechanism: your sebaceous glands shrinking and producing dramatically less oil.

Paichitrojjana et al. (2023). Drug Design, Development and Therapy

Without this surface oil, your skin holds light differently: it’s less slick, less noticeably oily, and has clearer pores. What’s more is that the inflammation is also taken care of: redness, swelling, and puffiness from active breakouts and unhealthy skin resolve, adding to the overall visual change.

The trade-off is a real side effect load. Dryness is the visible part of it: the outermost layer of your skin thins and holds less water, which is why lips, eyes and nose all dry out. Past that, isotretinoin can raise blood lipids and liver enzymes, which is why bloodwork is checked before and during a course, and the label carries a warning about mood changes.

It also carries the strictest safety program in dermatology. Isotretinoin causes severe birth defects, so in the US it is prescribed through iPLEDGE, which requires monthly pregnancy testing and two forms of contraception for patients who can become pregnant. None of that makes the drug unusable. It does mean this is a supervised course of treatment rather than a cosmetic procedure.

US Food and Drug Administration (2002). Accutane (isotretinoin) prescribing information

Does Accutane Shrink Your Nose?

If you’ve noticed facial changes while taking Accutane (isotretinoin), you probably aren’t imagining it.

The reason why your nose might appear smaller while taking Accutane (isotretinoin) is not because there’s a structural change happening in the bone or cartilage, but there is a significant reduction in oil, swelling, and inflammation in the skin, as well as thinner and healthier skin overall.

This means things like redness and puffiness show up less. Skin texture improvements can also contribute. Some patients notice an “Accutane glow” with healthier, tighter, smoother, and more defined skin. In combination with lighting changes, this can lead to skin looking very different, especially in the nose. Some patients report subjective changes in the jawline and overall face as well.

And not everyone will even notice these changes; those with aggressive inflammation, swelling, redness, or oil are most likely to notice.

Does Accutane Cause Nosebleeds?

Yes, this is a nose-related change that’s actually documented: Accutane (isotretinoin) can increase the risk of nosebleeds.

The same drying effect we talked about earlier also happens inside your nose. Less moisture means cracks form more easily, so minor bleeding can be common, especially in the mornings, in dry weather, or after blowing your nose.

In a systematic review of 11 randomized trials, ear, nose and throat complaints were about twice as frequent on isotretinoin as on control, making up 11.6% of the adverse events reported and attributed largely to drying of the nasal and oral membranes. No participant withdrew from a trial because of them.

Vallerand et al. (2018). British Journal of Dermatology

The key to managing this side effect is saline spray or a thin layer of ointment inside the nostrils. A humidifier can also help. The most important thing is to leave the nose alone; don’t pick or irritate it; that prevents most of the problems that do come up.

If you notice heavy bleeding, communicate with your provider.

Does Accutane Make Your Lips Bigger?

Similar to the nose, Accutane (isotretinoin) doesn’t structurally make your lips bigger. What does happen is a side effect called cheilitis, or dry, inflamed, peeling lips. This is one of the most common side effects of isotretinoin, and shows up in nearly every patient on the medication.

US Food and Drug Administration (2002). Accutane (isotretinoin) prescribing information

The same review described cheilitis and dry skin as very common on isotretinoin, but rarely severe enough to stop treatment: 2 patients out of 372 left a trial because of cheilitis.

Vallerand et al. (2018). British Journal of Dermatology

This inflammation can make your lips look temporarily swollen or fuller, but there’s no real “volume gain” or any structural changes. This change resolves as the cheilitis does, and can be supported with lip balm.

Does Accutane Shrink Your Pores?

While Accutane (isotretinoin) doesn’t shrink pores themselves, when there is less oil and gunk inside, they can appear almost invisible. The difference is especially drastic if you’re someone coming from previously bad skin.

When you prevent sebum, like with Accutane (isotretinoin), and pores are no longer clogged, the pores don’t show up as much.

Paichitrojjana et al. (2023). Drug Design, Development and Therapy

Does Accutane Make Your Bones Green?

Accutane does not turn your bones green. The claim circulates widely and there is nothing behind it: bone discolouration appears nowhere in the label or in the literature.

Isotretinoin does have some documented skeletal effects, though. Musculoskeletal aches and joint pain are somewhat common as a side effect. Vigorous exercise can raise creatine kinase, a marker of muscle strain. Extra bone growth along the spine has been reported with long-term high doses, and premature closure of the growth plates is a rare finding described mainly in patients who are still growing.

None of these relate to facial bones or cartilage, though.

US Food and Drug Administration (2002). Accutane (isotretinoin) prescribing information

Is Accutane Permanent? What Lasts and What Doesn’t

Accutane (isotretinoin) does have some long-term changes in terms of acne remission, but for anything dramatic like the supposed “free nose job”, the answer is likely no. Generally, the most extreme visual changes will level off after discontinuing the medication because there are just so many factors with isotretinoin driving positive visual results that are hard to achieve without being on the medication.

That said, most patients do experience long-term remission after a single course. In a 2025 study of nearly 20,000 patients, around 77% did not relapse.

Lai & Barbieri (2025). JAMA Dermatology

Does Accutane Permanently Shrink Oil Glands?

While taking the medication, your oil glands shrink and oil production is limited. This slowly recovers after discontinuation, but for many patients the level of oil is well below the baseline prior to starting isotretinoin.

This is also why long-term maintenance is so important. Keeping up with proper skincare, medication, and supporting habits can help keep skin looking great after an isotretinoin course. Topical retinoids like tretinoin are great for maintenance, without the monitoring requirements or the systemic side effects that come with isotretinoin.

For how these changes arrive over a course, see our month-by-month timeline.

How to Get Prescribed Isotretinoin (Accutane) Online

If you’re wondering how or where to get isotretinoin, Happyglow connects you with US-licensed physicians who decide whether starting isotretinoin is right for you, entirely online.

1. Start your visit. Answer a few questions about your health and goals (~5 min).
2. A physician reviews. They determine whether isotretinoin is appropriate for you or recommend a better fit.
3. Delivered to your door. If approved, your prescription ships free, with refills coordinated with your monthly check-ins.

See if isotretinoin is right for you→

Not approved? You’re refunded in full.