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She raised her eyebrows for emphasis and said “it will go away when you are older. Just stop focusing on it. Besides, you shouldn’t base your self-worth on your face.”

If you are interpreting this as a smug remark, then I have conveyed it correctly. My dermatologist-who looked like she just walked out of a magazine–dropped this gem after telling me she would not prescribe me Accutane (again). Accutane, the heavy-duty drug also known as Isotretinoin, is the last-ditch hope for those with untreatable acne. More powerful than antbiotics, it decreases the body’s oil production and for about 80% of patients, it clears their acne completely, often for the rest of their lives.*

I started getting pimples at age thirteen. By seventeen, my cheeks, chin, and jaw were barely visible under the swollen, angry cysts that covered my face. Antibiotics helped a little, but they always stopped working. After five years, I was ready to take the scortched earth approach to getting rid of my acne. Accutane was the obvious choice, as my skin was only getting worse.

I couldn’t help but gesture at her face and say “that’s easy for you to say. I don’t base my self-worth on my face, but I don’t like walking around with it either.” Once people saw my acne, they did not see me anymore. No amount of “not focusing on it” was going to make me feel any better about it. I was seventeen, in the best shape of my life, and I couldn’t bear to look at myself in the mirror.

My attempts to heal my acne in the next ten years ran the gamut. I applied benzol peroxide, salicylic acid, and aloe. I drank green tea exclusively for three months. I tried all the brushes, pore cleaning strips, toners, and clay masks I could get my hands on, and refused to eat cheese and refined sugar for seven years. I hustled my dermatologist for antibiotics. When those did not work, I consulted a Chinese medicine woman. She sold me a dried herb and fruit powder to mix in water. That might have worked, but I couldn’t choke down enough to find out.

After nearly ten years of ever-increasing doses of antibiotics, I did some long overdue doctor-shopping and found a dermatologist who prescribed me Accutane. Expecting a fight, I brought to the appointment pictures of myself (the few that existed) from over the years to demonstrate my acne’s development, a report I had written about the various risks and benefits of Accutane and why it was in my best interest, and my mother, who is very persuasive. I didn’t need any of that; he took one look at my face and the next thing I knew I had a prescription.

I can share my experience on Accutane in a separate post, but suffice it to say, it worked. It was absolutely worth the six months I spent shedding my skin like a snake and losing my hair as my oil glands shut down. It bought me three years of clear skin before the acne came back. When it came back, my (new) dermatologist suggested I try an androgen suppessor, which has been helpful, but requires continual use. Oils and chemical exfoliators are now critical touchstones of my skincare routine. My acne story is still ongoing, but each chapter is becoming better than the last.

*Just a note: I am not a medical professional. This is not medical advice or a medical endorsement of Accutane.