Hey!! I'm stoked to find this topic because my situation is very like yours. I've had acne for six years or so, now. I don't get many actives, but the ones I do get are large, painful, hot, and leave marks or scars. I do have some indents in my cheeks now and even the ones that haven't properly scarred will sit on my face for a year as a bump. I still have painless bumps from old zits on my cheeks that have been sitting there since September last year.
Outside of that my entire cheeks are covered in blackheads and flesh coloured lumps that don't seem to contain anything, but are raised from my face and so numerous that they'd distorted the shape of my cheekbones. They were also invisible in certain lighting so it was really difficult to get doctors (NHS) to take me seriously until I started taking pictures in natural daylight to show them.
So while I don't have many active bumps or any cysts, the NHS referred me to a dermatologist who then immediately suggested accutane upon seeing that I've started to scar. I'm on my second week at the moment and have had no side effects outside of having some trouble concentrating. I'm on 25mg/day. I'm not on a super low dose course, I'm just quite small and light so 50mg will be my max dose and it'll start next month. Fingers crossed for the both of us!