Excel V Failure- Is there anything else I can do for the redness if the XLV didn’t work (laser, peel...?) (photo)

you likely need to try a combination of a 1064 (genesis or aerolase) plus VBeam or IPL.  Likely you will not get full improvement and need life long treatments given your skin type and "flushing."  Also i would suggest a hormonal workup.  Best, Dr. Emer.

I have to agree with Dr Emer and a hormonal workup should be done to make sure this is not a flushing. I would also consider a dermatitis from something in one or more of the products you are using .As for the excel v i am surprised, I use this system for facial redness and get nice results. I normally do not just use the 532 , I follow it up with a laser genesis which is a 1064 wavelength. Normally I will use the 532 on a monthly frequency . I space treatments out 2 weeks so day 1 is the 532 plus the geneses , 2 is genesis alone , 3 is 532 and genesis 4 genesis alone and finally if needed one more 532 and genesis. It seems the genesis helps resolve the redness as well

Looking at your photo, I’d first look carefully at more consistent use of sunscreen and whether the alpha Ret is bothering your skin. The redness looks very universal and skips areas like directly under your sunglasses and forehead so I’m sure sun is involved. Your cheeks also have a lot of sun spots in addition to redness. Halo and bbl combo treatment or a series of bbl would be a great approach to improving this. Bbl covers red and brown and shouldn’t swell you at all.