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!
