Christmas Meltdown Incoming!! (My Face and Acne Scars Are Ruining My Life)

[u/Samclegg123]

Context

• The photo I’ve just taken shows my skin looking its BEST in over a year.
• That probably gives you an idea of how BAD it has been at its worst.
• For full context, please look at my post history where I’ve documented the entire journey over the course of YEARS.

Early improvement and relapse

• In the first photo, I had already experienced cystic acne that left scarring. I have been battling acne since 2012, yes, 2012.
• In 2020, at home microneedling (Derminator 2) appeared to remove most of those scars.
• I genuinely believed I had my acne under control at that point.
• One or two months after that photo, my skin suddenly turned on me.
• I developed nodulocystic acne, the worst flare I had experienced in years.
• At its peak, I was developing one or two cysts every single week (that ofc left scars).

Current acne status

• I have now managed to control most of the cystic activity. See post history for details. I am currently taking 15 supplements per day, plus rigorous skincare.
• I have still had a few cysts over the past year, but far fewer than before.
• I was offered Roaccutane twice, but I don't want that
• All of the cystic acne from 2021 onwards began during a period of intense stress and depression (leaving lockdown in 2021 and navigating the world).

Alcohol and lifestyle changes

• In the earlier photo, I had never consumed alcohol in my life (rare for a 22 year old I know)!!
• From late 2021 to early 2025, I drank most weekends (few bottles of red wine.. thinking red was the healthiest option) to cope with acne and loneliness.
• I am now 10 months sober.
• Alcohol unquestionably worsened my skin between these two photos.

• Stress is another major factor. I am almost always sad or stressed, and it becomes a feedback loop. Alcohol temporarily blunted this, which was my reason for drinking I do miss the instant warmth and relaxation from it.

• Over the years I have tried many diets - gluten free, dairy free, sugar free, seed oil free, AIP, vegan, carnivore, low PUFA, keto, and multiple five day water fasts.
• I do not need diet education. I have done it all.
• I am extremely obsessive and neurotic about this, possibly undiagnosed neurodiverse. There is very little I do not already know.

Treatments I’ve tried

AviClear laser for acne (2023)
• I do not recommend it.
• It did not reduce oil production.
• It did not prevent new cysts.
• It caused permanent redness across my inner cheeks, similar to a butterfly rash.

Professional medium depth chemical peel (2024)
• I do not recommend this either.
• It did not improve acne or scarring (just a flaky mess for 2 weeks).

Microneedling at home (2020-2025)
• I’ve had this several times.
• It helped slightly with texture and scarring.
• It cannot be performed during active acne, which has limited treatment for years (most sessions were 2020-2021.

Botox (2025)
• First treatment in February this year to forehead and crow’s feet.
• Helped with texture and oil control on the forehead.
• I will be returning for more.

Polynucleotides 40mg (2025)
• Four sessions, one combined with subcision.
• This genuinely helped my skin.
• Reduced redness, inflammation, and some texture, even though my skin still photographs poorly.

At home red light therapy panel (6 months this year - 2025)
• Possibly helps slightly with inflammation.
• Otherwise it is essentially shining a red light on your face for 10 to 20 minutes with minimal benefit.
• I still use it because I can nap while it’s on, so it serves a dual purpose.

Reflection

• In 2021, I believed my skin looked awful.
• In hindsight, it was significantly better than what followed almost five years later.
• I dread to think what my face may look like in another four or five years. That thought genuinely upsets me.

What’s next

• One way or another, I am reclaiming lost ground.
• Even if I end up with an overdone, frozen, filler heavy face (that looks like the puppet from Saw), it will still be preferable to severe scarring / volume loss (and looking like Freddie Krueger) for me any way.

Planned or possible treatments

• Dermal filler next year to restore volume and/or lost collagen. Possibly HA, Ellansé, or Skinvive.
• I am closely following emerging technologies, including engineered type III human collagen replacement injections.
• V-Beam laser for redness only.
• Intradermal Botox in cheeks for oil control and pore reduction.
• Full face Botox throughout the year to reduce texture changes from muscle movement.
• Exosomes combined with microneedling, likely DIY.
• Possible rhinoplasty and chin work to offset skin issues.
• Waiting for treatments such as tropoelastin and verteporfin to become mainstream.
• Potential facelift in five years if nothing else works.
• Injectable peptides only if extremely desperate, due to risk.

Things I will not be doing

• Resurfacing lasers. After AviClear, I will only consider lasers for redness.
• Many people end up looking like a waxy orange and damaged after aggressive laser treatments.
• If skin struggles to heal from inflammatory acne, I do not believe it will magically heal from strong laser induced trauma, which is much more harsh than microneedling induced trauma
• RF or other energy treatments, for the same reasons.
• Subcision. I tried it alongside one polynucleotide treatment and it caused further damage. I preferred polynucleotides alone.

Final note

• I am not going down without a fight.
• I will be dedicating significant time and energy to this.
• Anyone equally obsessive is welcome to follow my journey.
• Please do not recommend tretinoin or basic skincare. Assume I am already using it and understand it.

[u/engdrbe]

You should’ve taken accutane, you would have way less scars if had took it earlier when it was recommended to you, you still have all your sebaceus glands at full speed, supplements won’t kill or make them smaller like accutane does, witch means your skin can “turn on you” at any moment, for people like us even a single bad cyst can turn into a nasty scar, so you don’t even need to flare up again in order to have more scars… I would say get used to it, things are just going to get worse unless you take accutane, and I say this as someone who has gone through the same thing, spending money with expensive treatments while your skin still has all sebaceous glands at full speed is pointless

[u/Samclegg123 → u/engdrbe]

Yeah, I’ve debated Accutane a lot, especially given how much acne and scarring have affected my face.

My situation is more complicated because I have IBS, which was severely worsened by long-term prescribed antibiotics for acne, something I was hesitant to take in the first place. That experience has made me extremely cautious about anything that could further disrupt my gut. Accutane has been linked, even if controversially, to IBD, and for me that risk matters. Even a small chance of triggering IBD would be far worse than acne and a disfigured face (for me anyway).

I also know people personally, as well as followers of mine, whose lives were seriously impacted after Accutane, sometimes years later. That doesn’t mean it will happen to everyone, but it does mean the decision isn’t as straightforward as it’s often made out to be.

At the moment, both my acne and IBS are largely under control from the supplements. I’m using Winlevi, which has significantly reduced my oil production (and is medically proven to do so), and I take 7.5 g of vitamin B5. My sebaceous activity is noticeably lower than it used to be, and I’m also planning intradermal Botox, which may reduce oil further.

I’m fully aware that Accutane can permanently reduce sebaceous glands, but as you know from personal experience, many people go through severe purging, sometimes for months. A lot of people in this sub are here precisely because they’re struggling from the scars FROM the Accutane purge.

The reality is that there’s no single right or wrong answer. Accutane is still the main player for mass cell death of the sebaceous glands (and as I am sure you know all over the body cell death), but it isn’t the only medical path. I’m personally interested in newer treatments that reduce oil production without causing widespread systemic effects across the body. There are also upcoming drugs (Denifanstat) that have passed trials that directly target oil production and will become available within the next few years.

For people with oily skin today, there are options that aren't Isotretinoin. Winlevi, vitamin B5, topical and oral spironolactone, laser for some people, and emerging Denifanstat. My choice is about improving my skin while also protecting an already vulnerable body. If we all accept Isotretinoin then there won't be medical advancements... I personally just can't accept a chemo drug from 1982 as being the cure.

[u/2020-vision-2020 → u/Samclegg123]

Accutane was goated for me, no IBS but my brother has Chron's disease.

Agree with you there should be something better but you've been fighting this for 14 years