There's A New Way To Treat Rosacea — & It Might Surprise You

Photographed by Collins Nai.
If you experience flushing rosacea — the skin condition triggered by an abundance of large blood vessels — a reddened complexion doesn’t just signal the start of winter. It lingers year-round, and getting it under control can be a frustrating and bumpy road.

But currently, dermatologists and cosmetic surgeons are using cutting-edge rosacea research along with their trusty Botox vials to thwart the skin condition’s best efforts to flush faces. And unlike with more conventional treatments, the redness-reducing benefits can last for months on end.

Here’s the idea: By injecting tiny amounts of neuromodulators (you know them by the brand names of Botox, Dysport, and Xeomin) into more superficial layers of the skin, the toxin may help interfere with the blood vessels' ability to dilate. This can slow the surge of blood flow to the skin and quiet the redness that many patients experience. And according to dermatologist Erin Gilbert, MD, early adopters are seeing impressive results.

“Injecting small quantities of neuromodulators superficially into the skin has been a life-changing treatment for some of my patients,” says Dr. Gilbert. Those who have seen benefits from the treatment notice a reduction in flushing for three to four months after a single treatment — a timespan with which no single use of a topical can compete.

Dr. Gilbert isn't exaggerating when she calls the effects life-changing: Some with flushing rosacea experience not just a change in skin color, but suffer pain from the condition, too. “Burning is the most common complaint, as is [histamine-induced] swelling. This is largely due to the dilation of the blood vessels that creates a sensation of heat,” she says, adding that neurotransmitters released in the flushing process may also cause a pain sensation.

With Botox, Dysport, and Xeomin being used in many off-label ways (example: to minimize armpit and scalp sweating), it can seem like there’s little that the injectables can’t solve. But Dr. Gilbert and other MDs note that this treatment isn’t for everyone. Those with rosacea types outside of flushing (such as acneic rosacea, which is characterized by itchy eyes, or the rosacea involving broken blood vessels), such superficial injections won’t help. And as anyone who gets Botox every four months can attest, keeping up with treatments can become a pricey pursuit — and fast. (Gilbert charges about $1200 for a full-face treatment, which includes injections in cheeks, forehead, nose and chin. Some patients require treatment in fewer places on the face, which minimizes the price.)
Further, for those recently diagnosed with flushing rosacea, a topical skincare product (like PCA Skin Dual Action Redness Relief) may get the job done in a much more affordable and less invasive way. “The ideal candidate for this treatment is a patient with a known diagnosis of flushing who has not been cured by available topical or oral medications. These are generally less expensive,” says GIlbert.

Dermatologist Elizabeth Tanzi, MD, agrees. “If a patient has tried everything and is not getting relief for the flushing, I think Botox, Dysport, or Xeomin is a reasonable option, provided the person understands it’s not a permanent result and it can get expensive to do, depending on the amount of toxin that’s needed,” she says.

Finally, cosmetic surgeon Alexander Rivkin, MD, offers one more caveat: It’s important to remember that this treatment is relatively new and there’s still a lot to learn about its efficacy. “Based on some recent preliminary studies, flushing rosacea does seem to respond to microdoses of Botox, though these studies are small and not definitive,” he says. “Further research with larger, more definitive studies are needed. However, I’m comfortable in my practice offering microdose Botox for temporary improvement of the symptoms of flushing rosacea.”

Because the treatment is so cutting-edge, those looking to try it should take particular care in finding a doctor who has plenty of experience under his or her belt. Dr. Rivkin, for example, has not only used such toxins injected in superficial layers to help quell flushing, but he’s also used the technique to minimize the appearance of large pores. And superficial injections are a growing part of Dr. Gilbert’s practice, as well. But your average day spa staffed with Botox-certified RNs is most likely not equipped to deliver the neurotoxins correctly. “It's very important to be sure that the person injecting is familiar with how to perform these injections, because deeper injections over sensitive areas of the face can result in unwanted side effects on the underlying muscles, like asymmetrical expressions,” Dr. Gilbert warns.

It’s a lot to consider. But for those desperate to ditch an always-red complexion, a superficial shot of Botox may be just the thing.


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