30 & still have acne & hyperpigmentation on my face, nothing helps? (Photos)

First, I am very sorry you are suffering so much. In my experience, your disappointment with treatment is a common complaint. I am not a fan of Roaccutane (Accutane in the U.S.) and stopped using it decades ago owing to the fact that despite promises of a cure, recurrences of acne are quite common after stopping it and I do not like its side effect profile. What's more, the use of Dermapen, RF microneedling, Hydrafacials, and Silkpeels all had little chance of being effective from the get-go. A series of superficial chemical peels, as part of combined use of at-home prescription topicals and in-office treatments, can be effective, but not generally as stand-alone treatments. And, I also agree with the hesitation to continue to use hormonal therapies that can make the entire body pay, simply for the "sins" of the face.
Clearly, you would do well to see an acne specialist dermatologist who can prescribe safe but effective topical medications and perform the necessary in-office treatments that are needed to achieve real, long-term control and prevent the development of disfiguring acne scars and skin discolorations. Best of luck.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

It can be very frustrating. It's important to consult with a dermatologist who can provide a personalized treatment plan based on your specific skin condition and history. Here are some potential options:
1. Topical treatments: Retinoids, such as tretinoin or adapalene, can help reduce acne and improve the appearance of hyperpigmentation. Topical antibiotics or benzoyl peroxide can also be beneficial.
2. Oral medications: If your acne is severe or resistant to topical treatments, oral medications such as antibiotics or isotretinoin may be considered.
3. Hormonal therapy: Since you mentioned that Spironolactone and Diane 35 were effective in the past, it may be worth discussing the possibility of a lower dose or intermittent use with your healthcare provider.
4. Procedures: Laser treatments or certain types of chemical peels might be beneficial for improving hyperpigmentation.
5. Skincare routine: It's important to use a gentle, non-irritating cleanser and to avoid excessive scrubbing or picking at your skin. Use a broad-spectrum sunscreen daily to prevent further hyperpigmentation.
6. Lifestyle modifications: A healthy diet, regular exercise, adequate sleep and stress management can also contribute to skin health.
Remember, everyone's skin responds differently to treatments, so it may take some time to find what works best for you. It's also important to remember that treatments often take several weeks to months to show improvement. Please consult with a dermatologist for an individualized treatment plan.

You will need at home peels and skincare to start with dermarolling and then in office lasers over time for improvement. At home peels like cosmelan, enlighten and aerify along with dermarolling (Emerageskin roller with anteage MD AERIFY ampules weekly) should be started now (see link to emeragecosmetics). If you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream. Acne scar treatment needs a combination approach for improvement. For the best results, one should target the acne scar type. As everyone has a unique pattern of acne scarring, the best solution is a tailored one. Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision. Subcision for depressed tethered scars. Vascular lasers like yellow laser, aerolase, excel V, BBL or IPL for redness or thick scars. And lasers such as fraxel, halo, moxi, pro fractional laser/erbium, co2 or fractional radiofrequency like venus viva, PiXel8, Morpheus, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring. Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision. All lasers are combined with microneedling and PRP to get even better results and improve healing times. The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician. It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome. Scars cannot be cured and will need life-long treatments to maintain and build on the results. For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments. Best, Dr. Emer.