Micro Botox for KPRF/rosacea? I have VERY red cheeks.

Anyone who has read my answers over the past few years will hardly be surprised to learn that I have time and again emphasized that, when it comes to rosacea-related facial flushing, that IPLs,V-Beams, fraxels and the other "next big thing" bells and whistles devices tend to be far more supported by device manufacturer marketing hype than hard science, as your lack of success with V-Beam once again bares. On the other hand, fortunately, we have two FDA approved vasoconstrictor topicals, Mirvaso and Rhofade, that have proven helpful for temporarily suppressing the flush of rosacea. Moreover, oral and topical tranexamic acid, especially when the latter is used in conjunction with medical microneedling, may also prove helpful in this regard. Finally, microdroplets of Botox, which I have been using for this for the past few years, placed in a grid pattern within the area of flushing have also proven to be effective for this purpose, with effects lasting up to four months. You would do well to consult with a board certified dermatologist. Best of m. 

Thanks for your question.  You very well might have some success with microdroplets of Botox in your areas of severe redness.   Also ask your dermatologist about tranexamic acid which is emerging as a promising management option for the right patients.  I would encourage a multi-modality approach, as the lasers also can have some effect on the blood vessels, depending on the type of laser used.  Please continue to see an expert for the condition, and best of luck!

There are (IMO) several ways to attack rosacea. Although sometimes people think they have rosacea and they may have multiple diagnoses. BBL can be used to reduce overall redness, 1064 for small vessels, intradermal Botox (microbotox)  topical treatments as needed.