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.

It is great that you are done with Accutane. However, Accutane can significantly inhibit healing. Therefore, you should wait at least 6 months after finishing Accutane before considering a peel or a laser treatment. In my practice, I prefer patients to wait one full year.
The complications from treating a patient too early after Accutane are numerous and far outweigh the benefit. In terms of which treatment is better, it is important to get an idea of where you are in your Acne treatment. First of all, peels or lasers will only treat acne scarring NOT acne. In addition, you should wait until your acne is mostly resolved or under very good control before you get a peel or a laser. The reason is that new acne causes new scarring. In my experience, laser treatment is far more powerful for acne scarring.
I personally use the Fraxel line of lasers and am very pleased with the result. Good luck!

Ablative fractional lasers are currently the best treatment for deep/severe acne scars. My preference is fractional erbium but fractional CO2 or YSGG are also excellent. Resurfacing post accutane is safe when the oiliness returns to the face - the scientific literature (of which I wrote some of!!) suggests to wait at least 6 months post completion of treatment and up to 2 years.

If you've had a full course of Accutane, my recommendation is to wait 2 years until getting a deep chemical peel or ablative laser resurfacing. Better to be safe. It sounds like you are hoping to start treatments for you acne scars now and you can. Depending on the type of scarring, other treatments may include punch grafts and punch excisions, fillers, subscision etc.

Some guidelines suggest waiting 1 year after discontinuation of accutane. If you have a resurfacing procedure too soon after accutane, the risks are that the healing may not occur as quickly, and there is an increased risk of scarring from the procedure. You ought to have a face-to-face consultation with a dermatologist or plastic surgeon to determine the best procedure for you. Some of the new fractionated CO2 resurfacing lasers, e.g. Fraxel repair, Active/Total Fx can be pretty effective for certain kinds of acne scarring. Chemical peeling can also be effective, but I would seek someone with experience treating acne scars with chemical peels if you are going to go this route.

In general you need to wait a year after Accutane treatment before you can do any kind of resurfacing treatment on your skin, otherwise you are risking severe scarring and damage. Once you wait, you might want to check out Active FX and Deep FX laser treatment. We have been really happy with the results for acne scarring.