Still blushing very easily after 2 V Beam treatments for Rosacea. What should I do?

There are many more parameters that need to be taken into account when laser treatments are used for rosacea.  I suggest seeking another dermatologists opinion, one who is fellowship trained in laser treatments.  You likely need the fluence to be lowered and the pulse width to be increased, however, you may need to change the laser to the Excel V or to add in oral medication such as doxycycline and topical medication such as elidel for a short time as your "cause" of rosacea is from steroids (as you reported) and this is much more difficult to treat than the typical genetic or triggered type.  I wish you the best of luck, Dr. Emer.

Vbeam laser is an excellent modality for patients who have rosacea, blushing of the skin, facial and body telangiectasia, spider veins, redness, post surgical redness, and skin flushing. It is a safe procedure that can be used at varying depths to help treat micro blood vessels in the skin. We also use it in our office for facial skin inflammation, keloids, and hypertrophic scarring. It is an important part of scar therapy. Vbeam can be combined with chemical peels and other lasers, but experience with the treatment is essential. The Vbeam laser does not affect deeper tissue. Schedule a consultation with an expert in Vbeam and you will find it to be an excellent modality for many skin types.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Steroid-induced rosacea can be a very
hard problem to overcome. A critical component is to discontinue the
corticosteroids, usually with a tapered use of topical steroids. After doing
so, it is important to address the acne in a similar way that we combat normal
acne or acne rosacea.

I would recommend to slowly taper
those steroids and initiate stronger therapies for acne/acne rosacea - even
though this seems to be steroid-induced. Those include conventional agents,
such as higher dose oral antibiotics to turn steroid-induced acne around.

Generally I expect patients to obtain about a 20-30% improvement with each pulsed-dye laser treatment, with most patients needing about 3-4 treatment sessions.  Flushing is the slowest aspect to respond, but you should typically see improvement after 2 treatments.  Often a higher Fluence (the 9.5 and 10.5 sounds like the fluence, or energy, setting) is not needed, but a shortened pulsed duration, for the blush/flush of Rosacea.Be sure to consult with a Board Certified Physician with specialty in aesthetic medicine, such as Dermatology, who is a recognized local expert to get your best results.