Facial Flushing 6 months after facelift laser combo - how can I treat this? (Photos)

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. What you’re describing—persistent flushing and burning after a facelift combined with profractional laser, starting a couple of months post-procedure—can occur even in patients with no prior rosacea. This may represent a post-procedural inflammatory or vascular response, sometimes called persistent post-laser erythema, or a form of iatrogenic rosacea-like dermatitis triggered by laser trauma, surgical inflammation, or skin barrier disruption. Management usually focuses on restoring the skin barrier and calming inflammation: gentle non-irritating cleansers and moisturizers, topical anti-inflammatories such as metronidazole, azelaic acid, or calcineurin inhibitors, and sometimes oral anti-inflammatories like doxycycline at sub-antimicrobial doses. Avoiding triggers (heat, sun, harsh products, alcohol, spicy foods) can help. Some patients benefit from low-fluence non-ablative vascular lasers or IPL, but these should be approached cautiously since your skin is already sensitized.

The timing and pattern point to two drivers that often coexist after resurfacing with surgery• Prolonged post resurfacing erythema with a weakened barrier that magnifies redness and sting• A neurovascular component sometimes called neurogenic rosacea like reactivity that sustains flushing and burning
A stepwise plan is usually most effective
1. Reset the barrier and remove triggers first• Simplify to a bland routine with a gentle cleanser a ceramide rich moisturizer and daily mineral SPF• Pause potential irritants like retinoids strong acids scrubs alcohol based toners• Avoid heat hot showers saunas spicy foods alcohol heavy exercise in heat• Use cool compresses during flares and protect from wind and sun
2. Clarify contributing factors• Review all products and adhesives used since surgery. Consider patch testing if contact allergy is possible• Examine for features that suggest Demodex overgrowth if scale or follicular roughness is present• Ask the medical team to review medications and systemic causes that can trigger flushing. Basic screening and history guide this step
3. Calm first treat vessels later• Repeating high energy sessions while burning persists often disappoints• Once baseline redness and sensitivity improve consider a series of gentle vascular treatments. Use test spots conservative parameters and 4 to 6 week spacing• Device choice can include vascular lasers or IPL selected to your skin type and response history
4. When burning feels out of proportion• Discuss non procedural strategies that modulate vascular tone and neuropathic sensitivity with your physician. These do not replace skincare yet often reduce flare intensity and improve comfort• Topical options that constrict vessels can be used selectively in expert supervision when rebound has been considered
5. Expectations and tracking• Improvement is typically gradual as the barrier recovers and neurovascular reactivity settles• Standardized photos in consistent light help measure change even when day to day symptoms fluctuate
The information here is not enough for a precise plan. A short review of your photos current routine and history of triggers would allow a tailored algorithm and help decide if and when to test gentle vascular treatments. If useful a complimentary conversation with a coordinator can be used to collect these details before any medical evaluation.
Wishing you calmer skin fewer flares and steady comfort as recovery continues.Güray Yeşiladalı, MD