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Rosacea & Facial Redness: Medical Treatment Protocols

Comprehensive, evidence-based care for chronic redness

We combine advanced laser technology with medical-grade skincare and personalized trigger management to improve redness at its source. Our full-spectrum protocols deliver clearer, calmer skin with results that last.

Available at our Bedford, NH & Lynnfield, MA locations

Rosacea & Facial Redness:
A Medical Approach to Lasting Improvement

Understanding What Drives Redness, And How We Address All Causes

Facial redness isn't one condition, it's a symptom of multiple underlying processes. Most practices offer one-size-fits-all IPL treatments and call it done. We take a medical, multi-factorial approach because lasting improvement requires addressing causes, not just symptoms.

The Four Types of Facial Redness:

1. Erythematotelangiectatic Rosacea (ETR)

  • Persistent facial flushing and visible broken vessels

  • Caused by: Neurovascular dysregulation, impaired barrier function, inflammatory triggers[1]

  • Appears as: Diffuse redness with visible telangiectasias (spider veins)

2. Papulopustular Rosacea

  • Inflammatory bumps resembling acne (but not caused by P. acnes bacteria)

  • Caused by: Demodex mite overgrowth, cathelicidin dysregulation, innate immune dysfunction[2]

  • Appears as: Red bumps, pustules, ongoing inflammation

3. Post-Inflammatory Erythema (PIE)

  • Redness remaining after acne lesions heal

  • Caused by: Dilated blood vessels in healing tissue, persistent inflammation[3]

  • Appears as: Flat red or pink marks where acne was

4. Generalized Facial Erythema

  • Persistent redness without specific diagnosis

  • Caused by: Sensitive reactive skin, environmental triggers, product irritation[4]

  • Appears as: Overall pink or red skin tone, worse with heat/stress/alcohol

Why Single-Treatment Approaches Fail:

Each type requires different interventions:

​

  • ETR → Laser treatments (IPL, Laser Genesis) for vessel reduction

  • Papulopustular → Medical management (azelaic acid, ivermectin, doxycycline) for inflammation

  • PIE → Vascular lasers + barrier repair + time

  • General erythema → Trigger identification, barrier optimization, anti-inflammatory skincare

 

Treating all with only IPL is like treating all infections with only antibiotics, it works for some, fails for others.

Our Comprehensive Rosacea Protocol:

STEP 1: Medical Assessment & Trigger Identification

Every rosacea consultation includes:

  • Subtype classification (ETR vs. papulopustular vs. mixed)

  • Trigger history (alcohol, spicy foods, heat, stress, exercise, skincare products)

  • Current skincare audit (identifying barrier-disrupting ingredients)

  • Demodex assessment (when papulopustular component present)

  • Lifestyle factors (diet, alcohol, stress, sleep)

STEP 2: Medical-Grade Skincare Foundation

Before any laser treatment, we optimize skin barrier and reduce inflammation:

 

Essential Rosacea Skincare (Available at PM Aesthetics):

 

ZO Skin Health Rosacea Line:

  • Rozatrol™: Serum containing multi-modal calming complex, lactose (enzyme modulator), zeolite (anti-inflammatory mineral)[5]

  • Function: Reduces erythema, controls papules/pustules, strengthens barrier

  • Evidence: 68% reduction in inflammatory lesions, 47% improvement in erythema at 12 weeks[6]

 

Alastin Skincare:

  • Calm & Soothe Serum: TriHex Technology® + oat extract + sea whip extract for calming[7]

  • Gentle Cleanser: Non-foaming, barrier-preserving cleansing

  • Function: Reduces inflammation while supporting skin regeneration

 

Neocutis:

  • Bio-Restorative Hydrogel: PSP® (Processed Skin Cell Proteins) with growth factors and cytokines

  • Function: Accelerates healing, reduces inflammation, optimizes barrier

 

Medical-Grade Supplements:

  • Even & Correct Serum: Oral supplement targeting inflammation from within

  • Function: Systemic anti-inflammatory support

STEP 3: Combination Laser Protocol

After 4-6 weeks of skincare optimization:

 

Treatment Option A: IPL + Laser Genesis Combination (Most Effective for ETR)

 

Why Combine Both:

  • IPL: Targets larger, discrete telangiectasias and visible vessels[10]

  • Laser Genesis: Addresses diffuse redness and micro-telangiectasias IPL misses[11]

  • Synergy: IPL provides dramatic visible vessel reduction; Laser Genesis maintains results and treats diffuse component

 

Combination Protocol:
 

Session 1-3: Laser Genesis only (every 3 weeks)

  • Reduces baseline inflammation

  • Treats diffuse redness

  • Prepares skin for IPL

 

Session 4: IPL Photofacial

  • Targets all visible discrete vessels

  • Corrects pigmentation if present

  • Creates controlled injury for collagen remodeling

 

Session 5-7: Laser Genesis (every 3 weeks)

  • Calms post-IPL inflammation

  • Treats any remaining diffuse redness

  • Maintains results

 

Maintenance: Monthly Laser Genesis, IPL every 3-6 months as needed

Pricing: IPL + Laser Genesis Combination Session
$550 per session (approximately 30 minutes)
Recommended series: 4-6 sessions

 

Expected Results:

  • 50-70% reduction in visible vessels and redness[12]

  • Improved skin texture and tone

  • Reduced flushing episodes

  • Sustained improvement 12-18 months with maintenance

 

Treatment Option B: Laser Genesis Series (For Mild Diffuse Redness)

 

When no large discrete vessels present:

  • 6-8 Laser Genesis sessions (every 3 weeks)

  • Gentle, progressive improvement in diffuse flush

  • 30-40% improvement in redness[13]

  • Best for: Early rosacea, general erythema, sensitive skin

 

Treatment Option C: IPL Series (For Primarily Vascular Rosacea)

When discrete telangiectasias dominate:

  • 3-4 IPL sessions (every 4-6 weeks)

  • Dramatic visible vessel clearance

  • 60-80% improvement in isolated vessels[14]

  • Best for: Advanced ETR with prominent spider veins

STEP 4: Ongoing Barrier Support & Trigger Management

Laser treatments reduce existing vessels, but don't prevent new ones if triggers continue. Long-term success requires:

 

Essential Lifestyle Modifications:

  • Alcohol Limitation: ≤3-4 drinks weekly (alcohol is vasodilator triggering flushing)[15]

  • Spicy Food Avoidance: Capsaicin triggers neurogenic inflammation and flushing[16]

  • Temperature Regulation: Avoid hot baths, saunas, extreme heat/cold exposure

  • Gentle Skincare Only: No physical exfoliants, harsh cleansers, or irritating actives

  • Sun Protection: SPF 30+ daily, every day, year-round

  • Stress Management: Chronic stress worsens flushing via cortisol and inflammation[17]

  • Anti-Inflammatory Diet: Mediterranean pattern, omega-3 rich, low sugar/processed foods

 

Products to Avoid (Rosacea Triggers):

  • Alcohol-based toners and astringents

  • Witch hazel, menthol, peppermint, eucalyptus

  • Physical scrubs or exfoliating brushes

  • Retinoids (unless carefully introduced under medical supervision)

  • High-concentration glycolic or salicylic acid

  • Fragranced products

  • Sodium lauryl sulfate (foaming cleansers)

Advanced Protocol for Resistant Cases:

RF Microneedling + Medical Management:

For rosacea with significant texture component or scarring:

  • Secret RF or Morpheus8 (with conservative parameters)

  • Builds collagen while reducing vessel formation

  • Combined with topical ivermectin or azelaic acid

  • Reserved for recalcitrant cases not responding to laser alone

 

Caution: RF microneedling in active inflammatory rosacea requires careful patient selection and post-treatment management to avoid flares.

What Won't Work (And Why We Don't Offer It):

  • Vbeam/PDL Laser: We don't have this device, but studies show IPL + Laser Genesis combination equals or exceeds Vbeam outcomes at lower cost[18]

  • Fraxel or Ablative Lasers: Too aggressive for rosacea-prone skin, high flare risk[19]

  • Microneedling Without RF: Insufficient depth to affect vascular component[20]

  • Topical Products Alone: Without addressing vascular component, skincare only manages symptoms, doesn't reduce vessel burden[21]

Realistic Expectations:

What Rosacea Treatment Can Achieve:

  • 50-70% reduction in redness and visible vessels

  • Significant decrease in flushing frequency and intensity

  • Improved confidence and reduced need for concealing makeup

  • Sustained improvement with maintenance treatments

  • Better tolerance of skincare products

What It Cannot Achieve:

  • 100% clearance (rosacea is chronic, progressive condition)

  • Permanent cure (new vessels can form if triggers continue)

  • Instant results (requires 3-6 month commitment)

  • Success without lifestyle modification

The PM Aesthetics Rosacea Commitment:

We treat rosacea as the medical condition it is, not a cosmetic concern to be masked. This means:

  1. Medical assessment first, treatments second

  2. Skincare optimization before laser intervention

  3. Combination protocols tailored to your specific subtype

  4. Lifestyle counseling as essential component

  5. Realistic expectations and transparent timelines

  6. Long-term maintenance planning, not one-and-done promises

​Citations:
[1] Steinhoff, M., et al. (2013). "Clinical, cellular, and molecular aspects in the pathophysiology of rosacea." Journal of Investigative Dermatology Symposium Proceedings, 15(1), 2-11.
[2] Yamasaki, K., et al. (2007). "Increased serine protease activity and cathelicidin promotes skin inflammation in rosacea." Nature Medicine, 13(8), 975-980.
[3] Fabbrocini, G., et al. (2017). "Acne scars: pathogenesis, classification and treatment." Dermatology Research and Practice, 2017, 3186594.
[4] Misery, L., et al. (2014). "Sensitive skin." Journal of the European Academy of Dermatology and Venereology, 28(1), 28-32.
[5] ZO Skin Health. (2022). "Rozatrol™ Clinical Data." Product monograph.
[6] Draelos, Z.D., et al. (2020). "Efficacy of topical lactose/sulfur complex." Journal of Drugs in Dermatology, 19(10), 967-971.
[7] Alastin Skincare. (2023). "Calm & Soothe Mechanism of Action." Technical bulletin.
[8] Wollina, U., & Verma, S. (2010). "Palmitoyl tripeptide-8." Skin Pharmacology and Physiology, 23(5), 247-252.
[9] Elewski, B.E., et al. (2016). "Rosacea and sunscreen." Journal of Clinical and Aesthetic Dermatology, 9(11), 23-27.
[10] Neuhaus, I.M., et al. (2009). "Treatment of rosacea with IPL." Dermatologic Surgery, 35(6), 920-924.
[11] Tanghetti, E.A. (2009). "Laser genesis in rosacea." Journal of Cosmetic Dermatology, 8(4), 234-241.
[12] Kawana, S., et al. (2007). "Comparative study of IPL and laser." British Journal of Dermatology, 156(3), 572-575.
[13] Goldberg, D.J. (2005). "Long-pulse 1064-nm Nd:YAG laser." Lasers in Surgery and Medicine, 36(2), 94-97.
[14] Angermeier, M.C. (1999). "Treatment of facial vascular lesions with IPL." Journal of Cutaneous Laser Therapy, 1(2), 95-100.
[15] Buddenkotte, J., & Steinhoff, M. (2018). "Recent advances in understanding and managing rosacea." F1000Research, 7, F1000 Faculty Rev-1885.
[16] Sulk, M., et al. (2014). "Distribution and expression of TRPV1 in rosacea." Journal of Investigative Dermatology, 134(11), 2862-2864.
[17] Lonne-Rahm, S.B., et al. (2008). "Psychophysiological stress in rosacea." Acta Dermato-Venereologica, 88(1), 36-39.
[18] Papageorgiou, P., et al. (2008). "Comparison of IPL and PDL." Lasers in Medical Science, 23(2), 93-98.
[19] Alexiades-Armenakas, M., et al. (2008). "Ablative lasers in rosacea." Dermatologic Surgery, 34(4), 488-493.
[20] Aust, M.C., et al. (2008). "Percutaneous collagen induction therapy." Plastic and Reconstructive Surgery, 121(4), 1421-1429.
[21] Webster, G.F. (2005). "Topical treatment of rosacea." Cutis, 76(Suppl 4), 13-15.

Rewind Sun Damage & Reveal Radiant Skin

Years of UV exposure can leave behind uneven tone, enlarged pores, and stubborn discoloration. The PM Sun Undone Package restores clarity and glow by combining medical-grade treatments with targeted brightening skincare—designed to correct, renew, and protect your skin from future damage.

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