Aesthetic Options for Patients with Rosacea

This is a question I get asked about a lot. The medical term for “broken” vessels or capillaries is “telangiectasias”. These appear as linear red lines. When they are diffuse, they give the skin a ruddy complexion. They are usually seen on the nose and cheeks. People with fair skin and of Celtic or Northern European descent tend to have the most. The redness is usually due to excess sun exposure and is commonly associated with a medical condition called “rosacea”.

At Lumen, our approach is to educate our patients about the underlying mechanisms that led to the broken vessels as well as discussing the ways to get rid of them. Removing the lines can be effectively done with our Fotona vascular laser or our Syneron Candela Intense pulsed light (IPL) device. It typically takes 1-2 sessions and is an easy procedure. Once treated, however, it is also important to address the underlying factors that led to them in order to help reduce the chance of them coming back.

Rosacea used to be called “acne rosacea”, but over the past few decades, dermatologists have determined that the causative mechanism behind rosacea is different from that of acne. Rosacea can present in different ways. The most common categories are “vascular” rosacea, “papular” rosacea and “rhinophymatous” rosacea. Some people can have more than one type.

All types of rosacea are made worse by ultraviolet light so sun protection is important. Picking the right sunscreen is particularly important for patients with rosacea for at least four reasons. First, it is important to protect the skin to avoid a UV-induced flare of rosacea. Second, the people that tend to get rosacea are also the ones that are higher risk of getting skin cancer (fair skinned people middle-aged or older). Wearing a broad-spectrum sunscreen is important to help reduce the risk of skin cancer as well as to reduce the risk of photoaging. Third, people with rosacea tend to be very sensitive to some sunscreen ingredients and develop allergies more easily. Finally, some sunscreens contain products that actually absorb UV photons, rather than reflect them. These products can heat the skin and actually make rosacea worse, rather than better! It is important to talk with your dermatology provider to sort out which products will best serve you. Sometimes it takes a few trials to find what one works best.

For popular rosacea, there are prescription creams and oral medications that can control the “bumps”. Vascular rosacea is harder to manage with prescriptions. There is a product that can temporarily vasoconstrict the capillaries in the skin called bromonidine. Its effects last around 8-10 hours. Long-standing clearance typically requires laser or IPL, but even these treatments will require periodic “touch-ups” to keep them away.

Rhinophyma is best treated with either laser resurfacing or with dermabrasion. This involves numbing the skin and then removing/ablating the fleshy skin that has brown over the normal anatomy of the nose. It is a fairly quick procedure with a “downtime” of around 5-7 days. As aesthetic procedures go, rhinophyma correction is one that I find the most rewarding. The is usually a significant improvement with a big “bang for the buck”.

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