Without a photograph that allows me to evaluate your skin and overall facial volume, I can only give you general advice. If the dimpling on the chin is due to an overactive muscle, then treatment with Botox or Dysport to weaken that muscle can work beautifully. If you have volume loss, for example, you see shadowing or marionette lines that run from the corners of the mouth to the chin and jawline, then a filler may be the way to go to replace a volume deficit and smooth out the skin. Laser resurfacing would not be my choice to treat this problem because causes of a dimpled chin include overactive muscles, volume loss, or, very commonly, both.
Let's talk about the pores around your nose and on your cheeks. The first thing you must understand is that pore size is determined by genetics and pore diameter is a fixed size and cannot be changed. All we can do is improve the appearance of pores.You state that you have enlarged pores, not acne scars. The fact that you took Accutane 30 years ago works in your favor because Accutane reduces the size and activity of sebaceous glands, which makes pores look smaller. As we age, we lose collagen - the main source of support in our skin - causing the skin to lose its firmness. We also lose overall facial volume, around 1 teaspoon a year starting at age 30, so overtime, our skin just isn't stretched as tightly over our faces. The loss of firmness and "loose" skin makes pores look larger. Any treatment aimed at increasing collagen production and increasing skin thickness can work to improve the appearance of pores. Options include fractional laser resurfacing, intense pulsed light (IPL), and medium depth or deep chemical peels. Any treatment must be maintained with a good home care regimen. A good sunscreen and a topical retinoid (over-the-counter retinol or prescription strength, such as Retin-A, Renova, Tazorac, or generic tretinoin or adapalene) are the two nonnegotiable elements of an effective skin care regimen.
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