Bobbak (Bobby) Mansouri, MD

If you really want to get rid of those wrinkles, you might want to consider treatment with fractionated lasers or microneedling. These options are a more permanent solution that fillers and are much safer for use on the forehead. These treatments are also more optimal for addressing fine lines and wrinkles than fillers.

In general, the labs your physician obtains while you're taking Accutane will include a lipid panel (cholesterol, triglycerides, etc.), a complete metabolic panel (CMP), and a complete blood count (CBC). For female patients, a monthly pregnancy test is also required. For your lipid panel, you really should be fasting. That being said, not all physicians will require monthly labs (or even all of the labs stated above). Personally, there is only good evidence to check labs before initiating treatment and two months into treatment. If my patients are doing well at those two time points, I generally don't check labs for the rest of their treatment unless something comes up or their labs are abnormal on the initial checks. Hope that helps!

You will be fine. Accutane works because of the total dose that you take, not necessarily the consistency with which you take it. If you miss one day here or there (or even take it a few hours later), it isn't really a big deal because the total dose of the medication over time is what matters. Don't worry about taking it at 1 am. Make sure to continue taking your doses at the regularly scheduled time from now on.

Please do not listen to anyone who responds stating that you need filler or Botox for this issue. In all likelihood, there is one of two things going on: 1) you may be developing linear morphea as you mentioned or 2) this may be a more prominent tract for a vein that is becoming more pronounced as it appears somewhat matted down. For either scenario, you need to see a board-certified dermatologist in your area for full consultation. Linear morphea is a serious issue that needs to be treated aggressively early on in the course of the condition. Matted down veins on the forehead have been reported to be seen in some concurrent skin conditions, including a form of hair loss called lichen planopilaris or its variant, frontal fibrosing alopecia. You need a full, in-person evaluation from a board-certified dermatologist to ensure this new skin finding is not related to something more concerning. Good luck!

In general, the best treatments for rhinophyma are surgical including loop cautery and CO2 laser. Topical treatments, such as retinoids, can also be used. And, as you mentioned, Accutane can be helpful. The problem is, depending on your skin type, laser and other surgical procedures could leave behind permanent pigment change on your skin. My best advice would be to get in with an area board-certified dermatologist and go over all of your options and limitations to the treatment. Seeing someone with a strong cosmetic background could be a good idea as well, as they will likely have more lasers to utilize for darker skin types. All the best!

Congrats on getting through the initial stages of Retin-A micro. Retin-A products are one of the three best products any person can use for their skin. For all of my patients, I recommend daily sunscreen SPF 50 at least, Retin-A, and Vitamin C serum. It sounds like you're doing all the right things. In terms of waiting to restart some of your other cosmetic products, it really depends on your skin. If you feel your skin is still sensitive at this point, I would maybe hold off another week or two to make sure your skin won't be too sensitive for all of those products. The other option is to re-introduce products one at a time to make sure your skin can tolerate them. And as always, please call your dermatologist if you have burning questions. That's what we are here for... to answer your questions and make sure your skin is doing well!

Based on the picture you've shown, that skin lesion most likely represents a macular seborrheic keratosis. However, it's difficult to give a definitive diagnosis with a picture of that image quality. The best course of action would be to see a board-certified dermatologist in person. Whether that lesion is a macular seborrheic keratosis, mole, or other lesion, your dermatologist can direct your care appropriately. 

I'm sorry that you haven't had success reaching your goals as of yet with cosmetic treatments. I think the best way to approach it is to get in to see a reputable Dermatologist or Plastic Surgeon. I was a bit concerned about your statement that you have had Botox around your mouth to correct this problem. I'm also noting a bit of facial asymmetry on the left lip. I'm not sure if that is from the Botox or from a prior nerve palsy. In either case, I think a full evaluation with a physician would be helpful. You do have areas of volume loss that can be addressed with filler, and I do think that the down turning of your mouth can be addressed with filler as well. 

Botox has been used for many types of muscle dystonias, including cervical dystonia. See link here!

The best type of physician to see for the issue would be a Physical Medicine and Rehabilitation doctor, or a physiatrist. They are the ones who typically see patients with dystonias and use Botox frequently for treatment.

Blonde hair, unfortunately, does not respond to laser hair removal. The better option for you would be electrolysis which targets the hair follicle directly. Laser hair removal is a bit more of an indirect way to target hairs. For laser hair removal, the target of destruction is not the hair itself, but the brown pigment (or melanin) in the hair shaft. Therefore, if you have blonde hair (or essentially no melanin), then laser hair removal will not work to destroy the follicle.