Samantha B. Conrad, MD, FAAD

This is a common question with an easy answer.  A superficial removal, meaning not involving the deeper structures of the hair follicle, usually does not impede hair growth unless there is a thick scar that the hair has trouble getting through.  Otherwise if there is a true surgical excision, in which both the skin and the hair follicle are removed there will be a small scar but there shouldn't be a large area of missing hair.  The scalp heals well and quickly in most cases in general.

For my patients with more sensitive or rosacea prone skin I generally recommend Azelaic acid in addition to hydroquinone and IPL therapy (depending on skin type).  The lightening effect with azelaic acid is more subtle than with the more aggressive therapies but if the patient is diligent in the use and very patient I think improvement can be made.  It is important to note that improvement with any melasma regimen may take 3-6 months and that unless sunlight and extra hormones (estrogen medications) are avoided it can be much harder and frustrating to treat. 

Hair loss in women is frequently caused by a shift in hormones around middle age.  Many things can contribute to the hair loss.  Often spironolactone, which blocks some of the androgen hormone effects, can be helpful for this kind of hair loss.  It is taken long term with relatively low doses and the side effects for most people are minimal.

As use of estrogen supplementation (which can also be helpful) has fallen off over the last years due its possible role in cancers and clotting disorders, spironolactone use has increased steadily.  

Bell's Palsy can be frustrating and incapacitating for prolonged periods of time for many reasons.  It is often helpful to "balance" the unaffected side of the face with low doses of neuromodulators (Botox, Dysport, etc).  Not only does this lessen the physical differences between the sides, but it can also cause muscles and nerves on the affected side to react differently to the new symmetry which may be helpful for some of your symptoms.

 I would be hesistant to inject the affected side from the get go, but would work on the balancing first and then reassess from there at 4-6 weeks post injection.  

You will definitely see results on 40mg/day, most likely by the end of the first month or so.

However, those results might not last on a long term basis if the course of the low dose treatment isn't long enough.  Therefore it is not whether the 40mg/day will help but if it will be helpful long term and provide you with the target total dose necessary for that long term improvement in cystic acne.

Generally the target dosage for Isotretinoin is 120mg/kg (total dose) of the patients body weight.  Ideally, this is done over a 5-6 month period but it can be extended if a patient is unable to tolerate higher dosages due to side effect or elevated liver enzymes. 

Therefore, if you stay on the 40mg dose you will need closer to 7 months of treatment to achieve your "total dose".