Rachel Dean, MD

Accutane is an excellent medication for all types of acne. The amount of time a patient is on Accutane varies as the treatment is usually weight-based. There is generally a total dose of Accutane the physician is trying to achieve depending on the patient's weight. I tell my patients, on average, it takes about 6 months to achieve that weight-based therapeutic range. However, it may take less time or more time depending on the patient's tolerance of the medication and response to the medication. It is not uncommon for inflammatory acne (pimples, cystic acne) to get worse before getting better after starting Accutane. After patients have been on Accutane  2-3 months, I begin extractions at their monthly visits to rid the comedonal acne. 

You had a combination treatment with Halo + BBL. These 2 devices work differently, so I'll address each one separately. The BBL (BroadBand Light) uses light to target small blood vessels, red & brown spots in the skin. BBL typically requires 3-5 treatments to completely clear these spots. After a BBL treatment, you can expect the brown spots to appear darker (like pepper flakes), these usually come to the surface and slough off about day 7-10. Mechanical exfoliation with dermaplaning at 1 week after BBL treatment can aid in the sloughing of the "pepper flakes". Halo is a resurfacing laser that uses 2 different wavelengths to treat the skin. One wavelength heats the skin in the deeper layers to stimulate collagen production, which improves texture of the skin. It takes time for collagen production, so you generally see continued improvement in the texture of the skin 6 weeks to 6 months after the treatment. The other Halo wavelength ablates the skin in pixels (tiny dots) across the superficial surface of the skin, which improves the appearance of fine lines and pigment. These are the tiny scabs that are created during the Halo treatment. These typically slough by day 5-7. Combining the BBL + Halo allows you to achieve improvement in the texture of the skin and improved treatment of the brown spots. However, it is best to think of the BBL as a series of treatments. You will likely need at least 2 more BBL treatments to clear the brown spots completely.