Chemical Peel or Laser Resurfacing After Accutane Treatments

Accutane, or isotretinoin, is a very helpful oral medication for inflammatory acne that is resistant to conventional oral antibiotics and prescription acne creams. However, laser resurfacing or chemical peels should be avoided within 6 months of having completed Accutane and the medication may bring about abnormal wound healing, leading to possible hypertrophic scarring. Fractional CO2 laser resurfacing is the gold standard for acne scar revision and seek out a board-certified dermatologist or plastic surgeon who has performed at least 50 cases of your skin type.

Accutane is a go-to medication for patients with recalcitrant cystic acne. It can reduce pore size and also reduce sebum production in your skin, making it less oily; and in turn, dryer. Accutane can be used to control acne, but patients receiving the medication should be carefully monitored. In terms of skincare, always wear an appropriate sunscreen and reduce direct sun exposure. In my patients, I recommend a good ceramide moisturizer such as Elevase whenever they are on Accutane. This will keep the skin hydrated and reduce the oiliness of the skin that is associated with oil-based moisturizers.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Accutane or isotrentinoin is a profound drug. It is very effective for the long term control of severe nodulocystic acne. Accutane affects the oil glands and stem cells of the skin and inhibits angiogenesis, the formation of new blood vessels. Some of these changes appear to be permanent.
It is widely believe that Accutane has a long term effect on skin healing. While studies on this subject are limited, medical reports have established an association between current or recent Accutane use and unpredictable scaring after dermabrasion, laser treatment, and surgery, including rhinoplasty. Animal studies on the affects of recent Accutane treatment and wound healing are less clear. These studies fail to show that isotrentinoin affects collagen synthesis.
Generally, it is accepted that current or recent isotrentinoin treatment affects wound healing and increases the risk of delayed healing and keloid formation. For these reason, it is generally recommended that one wait 12 to 24 months before having a full face chemical peel, laser resurfacing, or elective surgery. In contrast, some clinicians feel that surgery is safe once the facial skin is producing oils. Given the potential risks it is prudent to err on the side of abundant caution in these circumstances.

There is a risk of increased scarring from any procedures for 12-24 months after Accutane.  I recommend waiting at least a year, as during that period of time the skin is more fragile and more likely to scar.

For a treatment modality to be effective for acne scarring, it needs to reach where the scar is.  Shallow acne scars may do well with a medium peel, but deeper scars will not be effected.  Deep chemical peels have a number of side effects, some of which are life-threatening, and with present technology there is no need for them.  Fractional erbium resurfacing does an excellent job with acne scars, and for individual, deep scars there are also subcission and dermal fillers.

No lasers or peels for a year after accutane is the rule, but there are milder treatments your skin can tolerate that can make an improvement. Weekly microdermabrasion (not dermabrasion!) can help you build collagen and soften scars with minimal skin injury. Your aesthetician can adjust your settings as you discover what your skin can tolerate. I would try this for the entire year. Subcision, punch grafting for deep ones.