Recurrent cyst formation at a prior excision site can present a therapeutic challenge, particularly when the lesion is located on the face and the patient wishes to avoid additional procedural intervention. Complete surgical excision remains the standard definitive treatment for epidermal inclusion cysts; however, recurrence may occur when the cyst wall is incompletely removed. In cases where patients decline re-excision, clinicians may need to consider individualized medical management, especially when concurrent acneiform disease is present. We present the case of a 44-year-old male with Fitzpatrick type VI skin who developed persistent cyst formation near a prior left cheek excision site. The patient declined repeat excision, incision and drainage, and intralesional therapy initially, preferring medical treatment. He was managed with oral isotretinoin and adjunctive therapies, with substantial clinical improvement and an approximately 75% reduction in cyst size by follow-up. This case highlights the potential role of individualized, off-label isotretinoin therapy in select patients with persistent cystic facial lesions who decline definitive surgical treatment, while also emphasizing the need for further studies evaluating medical alternatives for recurrent cyst formation.