It's been just over a month and a half on Accutane. I'm on 40mg once daily. My skin had an initial breakout when I first started that was really bad but only lasted about a week. Once my skin healed from that it was nearly flawless besides scarring and hyperpigmentation. Then once again my skin broke out last week, assumably from my period, and it's slowly starting to heal up now. I've also gotten a few closed comedones (?) their like little headless pimples on my cheeks. They aren't too bad but they are annoying. My forehead is probably the clearest. My skin is a lot less oily which I love because I don't have to worry about blotting my skin multiple times day. I got a few cysts last week that I tried not to pop but I gave in once I saw sign of them coming to a head. I know I shouldn't pop but they hurt so bad under the pressure. They've flattened now and just need to heal.
This happened to me as well! I had the first breakout and then another near my period. Also my forehead has cleared up, I'm left with painful spots around my mouth and side of my face. Every spot is a spot I have had in the past though as most of my underlying spots from acne I had years ago are finally starting to come out of my skin! Keep it up on the medication as long as you're feeling healthy and your skin will look even more amazing!
I'm sure as you adjust to 40, you won't get those painful cysts anymore. But take it from me, as someone who has had severe cystic marks...yours look very minimal and unnoticeable. 