It is not uncommon for severe cystic acne to flare when starting isotretinoin. Prednisone is appropriate, and will help to decrease pain and inflammation until your acne improves. Once your acne has improved your doctor should be able to increase you to a standard dose which is generally 1 mg/kg.
I agree that Tylenol or acetaminophen would be fine during your second treatment, but you should make sure you tell your treating physician you have done so. I would recommend you let them know how much pain you had, especially if you have stretch marks. Arms can be more sensitive but heat can build up over the stretch marks if the applicators are not placed properly.
Discomfort directly under the treated area is unlikely to start this late after your treatment, but is possible if the pain is superficial or outside of your muscle. If the pain is coming from under your muscle, it is not from your SculpSure treatment, as the energy cannot penetrate deep enough to cause true intra-abdominal pain. You should see your physician to evaluate this if it is mild to moderate and persistent. You should visit the emergency room if this pain intensifies or is severe.
It is very unlikely that the microdermabrasion is responsible for your asymmetry. It takes about a week for the Botox to start to work, so the Botox is responsible and the timing of the microderm is coincidental. I would not recommend microderm for the 1st 24 hours after a Botox injection, because theoretically you could move the Botox from it's injection site with deep pressure or massage in that period. By 1 week, however, the Botox is bound to the muscle receptors and cannot move around. I would give the Botox another week. If your smile is still crooked, go back and your doctor can touch up the other side to match.
