Which would be better: Long term microdose or another full round of accutane? (photos)

this is more rosacea and needs lasers and lights regularly in the office, proper skincare, and you can be on accutane long term sometiems 10-20mg twice weekly is all that is needed.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation, I would suggest a combination approach of
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant or moxi regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8/pixel8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Thanks for your question and helpful photo. You might very well be a good candidate for long term, low dose accutane. Please discuss this with your dermatologist. If you have also taken spironolactone and had not had great success with that, accutane might be your best bet. Please see and expert, and best of luck!