Background Enlarged facial pores are becoming a matter of cosmetic concern. Injections of (botulinum toxin type A) have an increasing popularity among cosmetic procedures. Objective To determine the efficacy and safety of intradermal injection of botulinum toxin in treatment of excess sebum secretion and enlarged facial pores. Materials and methods This split face-controlled pilot study was conducted on 20 patients with enlarged facial pores and seborrhea. One cheek was treated by intradermal injection of botulinum toxin, and the other was injected by saline. Patient assessment was performed after 1 and then after 4 months. Results At 1-month assessment, both sides showed significant reduction in their sebum and pore scores (p = .001), with significantly more improvement on the botulinum toxin-treated side. Dermoscopy documented a significant decrease in the average size of facial pores (p < .001), and the OCT demonstrated a significant increase in the dermal thickness (p < .001) with non-significant deference between both sides. Four months after treatment, the botulinum toxin-treated side maintained its improvement in both scores. Conclusion Intradermal injection of botulinum toxin is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months.