Treatment to improve texture reactive rosacea skin (rhinophyma but subtype 1 and 2 also): Fraxel repair? Or any other? Accutane?

Question

I have rosacea (both rhinophyma, early stage but obvious, and erythema and p&p) “orange peel” skin, fibrous papules etc. For redness and capillaries I’m trying PDL, RF Pelleve (both help a little but not much). Derm suggested Fraxel repair for texture, pores etc but my skin is very reactive, gets redder easily for a long time, but would Fraxel work? Does it shrink pores? Would it make rosacea worse? Other tx? Accutane helps with texture/pores? With Acc. skin appears redder (closer to surface)?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Maggie Chen, MD · Answer

I have seen really great results with Cynosure (Palomar)'s Icon platform.  It is a quick 10-15 mins treatment, very tolerable, and results can be seen with just 2 to 3 treatments.  Hope this helps.

Jason Emer, MD · Answer

For rosacea, I like a combination approach, using lasers (ProYellow, Pulsed Dye/Vbeam, Excel V, Clear + Brilliant), peels and botox to the cheeks. This makes dramatic changes in color and symptoms. See an expert. Best, Dr. Emer

Bruce E. Katz, MD · Answer

Thank you for your question. Treating Rosacea depends on the type of Rosacea you have.
The following are subtypes of Rosacea: 
  
Subtype 1 – flushed, red facial skin, facial spider veins, sensitivity, and dry skin
  
Subtype 2 – acne breakouts, very red skin, oily skin, sensitive skin
  
Subtype 3 – rare type of rosacea with bumpy portions of skin, especially on the nose, and oily skin
  
Subtype 4 – affects the eyes causing burning, stinging, blurry vision, and dryness
  
There are a variety of methods used to treat Rosacea including photodynamic therapy and the Cynergy pulsed dye laser. This laser is FDA-approved and revolutionary at removing redness and scars from your skin. For more information, I recommend getting a in person consultation with a board-certified dermatologist.

Treatment to improve texture reactive rosacea skin (rhinophyma but subtype 1 and 2 also): Fraxel repair? Or any other? Accutane?

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