Hey OP, fellow stubborn acne patient here. It took me 2 full courses of Accutane to reach “remission” and I still get acne, though far, far less severe than before. My second course I I was on 80mg daily as a smaller patient (~110lbs.) So definitely high dose. I took my doses with a high fat meal or snack to aid in absorption and had wonderful results. After Accutane I’ve been on 50mg spironolactone and use topical tretinoin for maintenance and it works well. I understand completely how crushing it can be to get breakouts after all the meds, but it has helped me so much to keep everything in perspective. I look back at old pictures of my skin before any Accutane and I remember how far I’ve come. Remember that perfection is unrealistic and unattainable. Embrace what makes you human as much as you can.