Lynette, you have done a lot of hard work on a difficult image.
these are some things which I do that might be helpful to use along with your methods.
1. first, eliminate bad colors on the skin (anything that is not skin colored) by using the reduce noise filter's remove color noise option
-- increase the 'remove color noise' option considerably (all other settings are set at 0) except the 'remove jpeg artifact' option - or use any preferred method to eliminate bad colors.
2. remove noise by using the same reduce noise filter and increase strength amount to high, set all other options to 0; -- or try surface blur with gua blur.
3. repeat step 2 until artifacts are blended away.
4. use a mask on the reduce noise layer & paint in smoothness where needed,
5. if artifacts are still a problem, place a blank layer above for healing; try setting the mode to lighten or darken, whichever is needed. The patch tool is also useful.
6. Small Gua blur the layer which was used for healing.
7. select some skin tones from the repaired area & use low opacity brush on a separate layer to add hue or color if needed. Small amt of Gua blur on the painted layer. Add a mask & paint in where needed. merge.
8. use http://www.photoshopsupport.com/photoshop-blog/09/cs4-02/skin-texture-photoshop-tutorial.html
to add some texture.
9. Tonal variation might be lost doing the above edits, if so, use curves (or dodge & burn) to restore some highlights, etc. Might even try match color, using the skin of another which has good color & tones. (add a mask to the layer & paint in color and/or tone where neededI hope some of the tips above help.
If you have a question that I might be able to answer, please send a pm.
Keep up your good work.