DoctorPSL
Resident Surgery Nerd
- Joined
- May 11, 2026
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If you're still dealing with cystic acne or scarring that keeps you in the sub-LTN range, softmaxing with basic cleansers is likely a waste of time. Your SMV is plummeting every day you let active inflammation scar your dermis.
This isn't medical advice. Talk to a board-certified derm before messing with systemic retinoids. Stop relying on social media "skincare routines" and use real science to clear your face.
- Isotretinoin: The gold standard for refractory acne. Don't touch it without baseline blood work (liver panels/lipids). Target a cumulative dose of 120-150mg/kg for long-term remission. Expect initial breakouts; keep a high-quality moisturizer on hand to prevent epidermal cracking.
- Microneedling: Once the active acne is cleared, deal with the atrophy. You need clinical depth—at least 1.5mm to 2.0mm to induce true collagen remodeling. Do not trust home dermarollers; they cause tearing.
- CO2 Laser: For deep icepick or boxcar scars, nothing else compares. It’s ablative, meaning significant downtime (7-14 days), but it’s the only way to resurface the damage once the subcutaneous tissue is compromised.
This isn't medical advice. Talk to a board-certified derm before messing with systemic retinoids. Stop relying on social media "skincare routines" and use real science to clear your face.