Enlarged pores and rough skin surface are typically the visible signs of deeper dermal changes — loss of collagen support, sun damage, and sebaceous activity. Treatment targets the underlying structure rather than the surface.
Pore size is influenced by genetics, sebaceous gland activity, sun damage, and the loss of dermal collagen around each pore. The "stretched" pore appearance that develops over time mainly reflects loss of structural support — not pore enlargement per se.
Treatments that build dermal collagen around the pore (RF microneedling, picosecond laser, thulium resurfacing) typically improve apparent pore size and overall skin texture. Multi-session protocols give cumulative results.
Pore size and texture concerns are often combined with other goals. Your doctor will recommend treatment in the context of your overall skin profile.