Would you recommend botox for rosacea?

Question

I have struggled with rosacea for awhile now, and I mostly have flushing in my cheeks. I have tried IPL, pulsed dye, beta blockers, and mirvaso. Mirvaso does get rid of the flushing, but I experience severe rebound flushing from it. A cosmetic dermatologist in my area agreed to try botox, but would not do it in my cheeks. They were worried it would "drop" my cheeks. Is this that large of a risk, and are there any doctors out there experienced in doing this in the cheeks?

Monica Boen, MD · Answer

If you would like to try Botox for rosacea, I would suggest micro-Botox, or very dilute Botox dosages. This has helped some patients with rosacea, but it is not a home run for all patients. Some patients with flushing from rosacea have had good luck with Rhofade, a topical medication that has a much lower change of rebound flushing than with Mirvaso. Schedule an in-person consultation with a board-certified cosmetic dermatologist for further assessment and the best treatment recommendations for you.

Jessie Cheung, MD · Answer

Botox has been shown to help with the flushing from rosacea - it is injected very superficially, in very dilute amounts, and usually with a microchanneling device, such as the Aquagold. Your pores will look smaller and your texture will improve, and the muscles shouldn't be affected. However, there are better options for the treatment of rosacea - the ones you've already had don't really address the underlying inflammation and skin barrier issues that trigger rosacea - commonly used topicals are azelaic acid, metronidazole, ivermectin, and sulfur, and the prescription pills doxycyline, minocycline, and tetracyline treat the inflammation, while zinc and B vitamin supplementation can also help. See a dermatologist to figure the out best plan  - get your skin under control first, and then you can use lasers to erase the broken blood vessels.

Paul Flashner, MD · Answer

In my professional opinion there is NO way that botox or any neurotoxin would help with rosacea. A neurotoxin is used to relax muscles resulting a decrease fine lines. I would however, highly recommend a series of IPL treatments to help reduce rosacea. You will also want to be careful with any exfoliations you may be using at home that can make your rosacea worsen. Hope this helps.

Nelson Castillo, MD · Answer

Thank you for sharing your excellent question and I am sorry to hear of your difficulties with rosacea.  Unfortunately botox will not improve your symptoms of flushing and I would continue to pursue the other treatments for steady improvement.  Hope this helps.

Anteneh Roba, MD · Answer

Botox is a treatment meant to improve wrinkles by relaxing muscles in the face. It will do nothing for Rosacea.

Kim Meathrel, MD, JD, MBA · Answer

When Botox is injected for Rosacea it is injected very superficially into the skin using the Aquagold microinfusion device. Because it is so superficial it should not impact on the muscles of your face. It will only last 3-4months. I personally use Botox in the Aquagold for Rosacea but there are other options available to you.

Michele S. Green, MD · Answer

Botox is the most popular injection but it will not treat your rosacea.  The flushing reaction that you are describing is a vasovagal reaction and not one that can be treated with Botox.  Please consult an expert in Rosacea for the bet cosmetic results.  Best, Dr. Green

Alex Eshaghian, MD, PhD · Answer

Thank you for your question surfsuncali. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Rosacea is a condition characterized by the appearance of redness or flushing typically in the central face, but it can spread to the entire face or even the neck. Often times triggers can be identified. Common triggers include heat, sun exposure, alcohol consumption, spicy foods, exercise, and emotional stress. The first thing to do is try to avoid these triggers. The flushing is caused by sudden blow flow to the skin. Therefore treatments that target blood and blood vessels are the gold standard for rosacea. These include IPL, pulsed dye, and other lasers. It is important to understand that rosacea is a condition that we control. not cure. Therefore a series of treatments is recommended and maintenance treatments will be required after that.If I had a patient with the concern described here I would recommend a series of IPL photofacial treatments.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Jack Peterson, MD · Answer

Botox is not something that I would recommend for the treatment of Rosacea.  IPL treatments and topical prescriptions or a topical product such as Colorescience All calm are my recommendations.

Shaun Patel, MD · Answer

No, I would not recommend Botox for treatment of rosacea. Topical creams and gels, oral medications and vascular lasers (VBeam, Excel V) or IPL will help with the rosacea.

Would you recommend botox for rosacea?

Answers (16)