I weigh 62kg. I had no initial breakout, but continued to get spots for the first few weeks, with the frequency gradually declining. I actually found that I achieved 100% clarity *after* lowering my dose. I've now been on the lower dose for around 6 weeks and for the past few weeks I haven't had one spot.
One thing I have noticed is my skin isn't completely dry like before, so by the end of the day I notice a little bit of oiliness. But I think there's no harm in there being a bit of oiliness to keep your skin from becoming too dry (and this way I don't have any peeling or have to use moisturiser excessively).
If I find the oiliness starts to become excessive or causes breakouts again, I may increase my dose. But for now I think I have got the right balance with 40mg/week.
So, just to be clear, this is roughly how I did things:
Nov: 20mg/day (two weeks) - little noticeable change
Nov-Jan: 40mg/day (four weeks), then 60mg/day (two weeks) - skin much drier, less frequency of spots, but side effects
Jan: gradually tapered to 40mg/day, then 20mg/day (two weeks) - stayed clear, less side effects
Feb-Mar: 40-60mg/week (6 weeks) - 100% clear, no side effects
Currently sticking to 40mg/week (one 20mg every 3-4 days).
From my initial post -
let's just say it was bad enough to cause scarring and to make me very reclusive for a time (to the point of missing work some days). I would generally have at least one cyst, sometimes in very prominent places on my face, and 2-3 whiteheads.
The biggest issue for me was the scarring. My skin scarred quite severely and the damage has been permanent. I hope one day I can get off accutane and treat this somehow.
For now, low dose continues to work for me. No sign of any acne, and no side effects.
Just an update. I tried reducing my dose, and then stopping completely for a while, and found the oil very quickly returned (within two weeks). I'm now taking just one 20mg pill per week, and although I have a bit of oiliness at the end of the day, I have practically no acne, and zero side effects. My skin's sensitivity to the sun also seems to have normalised, which is a nice plus.
In all, I'm extremely satisfied with this solution, and see minimal risk from it given how low the dose is. I only wish I'd started sooner.
edit: and I should add - I cannot overstate the positive impact this has had on my life for the past six months. To no longer be cancelling going out because of acne, and to have the confidence to meet and make new friends. To no longer have the worry and the fear on my mind. It's fantastic.