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Objectives: Objectives 1. Diagnose irregular skin texture, dilated facial pores and acne lesions 2. Formulate a combined protocol to improve irregular skin texture, dilated facial pores and acne lesions 3. Manage a combined. protocol of Carbon-assisted Q-switched Nd: YAG laser and Microneedling Delivery of Botulinum Toxin Introduction: Carbon-assisted Q-switched Nd:Yag laser treatment has been used in order to improve skin texture, superficial wrinkles, acne lesions and dilated pore. This technique consists of applying a topical carbon suspension all over the face followed by irradiation with a Q-switched 1064 Nd:YAG laser. The injection of multiple microdroplets of dilute Botulinum toxin A (BTX-A) into the dermis, has been investigated as a tool for facial rejuvenation. The aim of this study is to assess the effectiveness of the combined treatment with botulinum toxin and carbon peel laser. Materials / method: All patients were subjected to 3 sessions of Carbon-assisted Q-switched Nd: YAG laser and Microneedling Delivery of Botulinum Toxin, 3 months apart from the other. To assess the improvement we used Fitzpatrick Wrinkle Assessment Scale (FWAS), the Physician Global Aesthetic Improvement Scale (GAIS), a photographic scale for the pore assessment and the Investigator Global Assessment of Acne (IGA). Face Q was also administered (Rasch Measurement Theory analysis was used). The scores obtained were compared using a paired T test. A p value < 0.05 was considered as a a cut-off for significance. Results: Twenty patients were recruited. Difference of pre and post-treatment scores of the FWAS were statistically significant (p-value =.000349) demonstrating an improvement of the of thin and deep lines on the face. The GAIS showed a very good overall improvement of the aspect off the face. A significant difference between pre and post-treatment scores of the photographic scale for the pore assessment was observed. IGA scores for the classification of acne lesions, significantly improved after treatment. A statistically significant difference between pre and post-treatment scores of the Face Q was Conclusion: Carbon-assisted Q-switched Nd: YAG laser and Microneedling Delivery of Botulinum Toxin could be considered as an adjunctive tool in patients suffering from acne lesions, dilated pores and irregular skin texture. The high versatility of this combined protocol allows customized treatment with minimum discomfort and high tolerability in patients.