On average, do patients have a lesser breakout than the first time or is it about the same as the first?

I find that patients definitely
break out far less on their second round of Accutane. Very few of my patients
require a second round however. Approximately 95% of my patients get a long
term cure with their first round. The key is in the total cumulative dose of
isotretinoin (Accutane) they receive. If the dose is not high enough, the
likelyhood of an incomplete cure is much higher. In that your acne flared with
isotretinoin, I would start you on a low dose, allow you to acclimate, then
accelerate your dosing monthly in order to achieve the desired total cumulative
dose in 5-6 months. The dosing you describe above seems too low unless you are
a very tiny person. The dosing is based on weight. The goal should be to
achieve a life long cure of your acne with a second treatment course.