I just saw my derm two days ago and she said it's time for accutane. I took my first pregnancy test yesterday and I'll see her Feb. 3 for a follow up and to start the pills. I'm so excited but also nervous. I have bad cystic acne - mostly on my chin, sometimes on my forehead and between my eyes. My skin is also SUPER oily. Two hours after doing makeup I will be dabbing tons of oil off my face. I definitely think Accutane will help but my derm did say in adult acne she sees some people who have to go on it again. Sometimes they get 3 years or 10 years of remission. She said none of her patients have needed a third course though in the ten years she's prescribed it (unless they didn't get a full course before and stopped early). She said she likes to do higher doses as she finds less of those people have it return. I'm kind of nervous because I only weigh 115 and I can be sensitive to medications. I'm also nervous because I have MAV (migraine associated vertigo - in my case more low grade dizziness instead of vertigo) and it's at its worst in the cloudy winter months of Michigan. I really really hope accutane doesn't make it any worse or else I'm afraid I'll have to postpone it until the spring/summer when my MAV goes away. So I guess I'll see how the high doses go and if I need to go down or not (she wants to start at 40mg and then 80 mg the last two months - a total of 5 months).
As for things I've tried in the past.. proactiv, dan's regimen, all sorts of over the counter BHA and AHA face washes, birth control pills that are good for acne, antibiotics like minocyclen and bactrim, retinoids, cutting out cheese, natural supplements and herbs, etc.. The most useful med was definitely bactrim. I cleared on that this year but my acne came back with a vengeance this month and I had to get two cysts injected as they formed together 
Birth control worked well for about 2 years and then it just stopped working and cystic acne came the same time every month. I also had the most side effects from birth control pills. My last year on them I had headaches daily and could easily sleep for 12 hours straight every night. And then when I went back on on them after a break I woke up with MAV - so the headaches now also included dizziness yay! Also about 1/3 of my hair fell out when I stopped taking them. It grew back but it was scary for a while and of course my acne broke out the worst I've ever seen it for about 7-8 months afterwards. Really nasty things that birth control.
Benzoyl Peroxide would be the third best - but it really only helps smaller zits and it's so easy to over dry the face. My cysts are so far under ground my derm said only injections and oral medications could help them. Sucks.
Anyway - any encouragement is appreciated from fellow members. Please share your recommendations for accutane regimens too! I've already got a huge tub of Cetaphil and Cerave cream lined up 🙂
I'm a month in and my skin hasn't improved that much, but my skin type has been transformed. I welcome the drying effects so much, as I used to have ridiculously oily skin. If I didn't blot my face for 2 hours, I would look embarrassingly oily. Now 26 days into accutane (only 20mg), my skin produces NO oil! It's truly amazing and I think you'll love the oil reduction too. It's great to be able to apply oily day cream (cetaphil high tolerance moisturiser) and have no oil on my face 5 hours later.
My advice would be to try and forget about the passage of time as you take accutane. In other words, don't focus too much on other peoples' experiences at different points. After 3 weeks you may be almost clear (very unlikely), you might have a bad initial breakout or there may be no major changes yet. It works differently in different people and reading acne.org/focusing on how far into the course you are can make it frustrating when you don't get the results that you expect after a certain amount of time. It's easier to just go with the flow and focus on your life so time passes quickly- the medication does and WILL work, but it might take 3-4 months. Good luck! 
On 1/10/2016, 1059, anotherstar said:Thanks for your reply, chicanery :)! What side effects have you encountered so far?
I'm confident the accutane will work for me, even if it does take a couple months - just hoping I can tolerate it OK.
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So far my skin has been transformed to a dry skin type (no oil production, totally manageable with moisturiser). My lips are v dry. My eyes get a bit sore and dry now and then and I have random aches and pains during the day. NOTHING bad at all, but I am on 20mg. You should push for a low dose, it'll minimise the side effects (and will work well, but you'll have to be on it for longer).
People complain about things like fatigue and dizziness on accutane. To be honest, I do experience these things but I don't think it's due to the A - I experienced them before. It's hard not to read loads about side effects, especially on this site, but I'm a firm believer that something is only a true side effect if you'd notice it not having read about it. When I read about accutane causing extreme fatigue, I do think "damn, this is going to be a tough few months" because I'm always fatigued, but looking back, I felt that way before the accutane too - I'm always tired! :). The main side effects are dryness and everyone experiences this - very dry lips (managable with lip balm), dry scalp, dry eyes and dry skin. Joint aches are also a symptom of this dryness. Any other side effects are really quite rare and rarely an issue for people. That said, the dryness can of course get really unpleasant at higher doses - I don't plan to go higher than 40mg. But you should be absolutely fine
Ugh! my skin is insane right now. I have three cysts springing up on my face right now so that makes 9 cysts on my chin this month. I've been taking Aleve to help with the pain. so embarrassing too. I CANT wait to start accutane. I see my derm again Feb 3 so a little over a week and I can start!!!