Ben Talei, MD
DIRECTOR
Board Certified.
Dual Fellowship Trained.
Facial Plastic Surgeon.

Rosacea Treatment

Rosacea can be a very troubling issue for many patients visiting our office. Many patients present to us a hopelessness and concern that nothing can be done, having had multiple failed prior attempts at treatment. Fortunately, there are many non-surgical and non-invasive options available to help improve and soften the appearance of rosacea.

Rosacea may present in many forms, some chronic and some causing more short-lived exacerbations. There are 2 main subtypes of rosacea commonly noted:

Subtype 1: Ertyhematotelangiectatic (ETR) rosacea - smooth and red

Subtype 2: Papulopustular rosacea - bumpy and red

Two less common forms are:

Subtype 3: Phymatous rosacea - thickened, bumpy and possibly red

Subtype 4: Ocular rosacea - red and irritated eyes

Can My Rosacea Be Treated?

In most cases, the answer is yes. However, the treatments are not typically curative or permanent. For some patients, exacerbations can be prevented by avoiding sun, spicy food, alcohol or straining. Sunscreen is always recommended with a SPF of 50, if possible. For many patients with papulopustular rosacea, standard acne treatments work best.

Topical Medical Treatments

The following treatments have been used with variable success depending on the skin type:

Azelaic acid gel or cream (15-20%) – azelaic acid (Finacea) has classically been used for papulopustular rosacea and acne. It works mainly by providing an acidic environment on the face, which makes the skin a hostile environment for bacteria and fungi to grow on. This may make your face red initially, but it eventually calms down. This can be combined with other creams and even brimonidine eye drops to blanch the face for special occasions.

Metronidazole topical (0.75-1%) – The 1% formulation has shown great success for papulopustular rosacea and sometimes for ETR.

Tetracylclines – These medications may cause photosensitivity but have been a mainstay of treatment for all types of rosacea and acne, along with other topical antibiotics.

Sirolimus (0.2%) – Sirolimus (Rapamycin) is more of an investigational drug used to prevent the regrowth of vessels in more resistant cases. This is not typically recommended for the more common cases, as periodic blood testing needs to be done to ensure safety.

Ivermectin (1%) – Ivermectin cream (Soolantra) is now available for inflammatory forms of rosacea as this medication has anti-inflammatory and anti-parasitic activity. There is no evidence at this point proving its mechanism against demodex mites, but many patients have shown great promise with this once daily medication.

Oxymetazoline – Typically used as an intranasal medication, this has been mixed off-label and placed on the face by some patients with or without moisturizer. We do not recommend this or Visine, as it may cause rebound redness or blotchiness.

Brimonidine (0.15-0.33%) – Brimonidine is now available as an eye drop (Alphagan) or a gel (Mirvaso). This is the most promising topical medication to date for patients seeking resolution of redness prior to an event. The effects may last 12 to 24 hours for most patients, but should not be used for more than 4 days in a row. Mirvaso is a wonderful medication but can be quite costly. Many patients have had great success using a single drop of brimonidine 0.2% mixed into a moisturizer, although this is an off-label use.

What are the Good And Bad Laser Treatments for Rosacea?

Almost any type of laser treatment has the potential to worsen the rosacea temporarily or permanently when not used correctly. Ablative lasers such as fractionated CO2 and fractionated Erb:YAG have been known to cause temporary or permanent exacerbations of ETR. This is NOT a contraindication to laser resurfacing, but you should be aware that resurfacing could cause a flare up temporarily. Sublative lasers (1440-1540nm) and radiofrequency (RF) devices used for skin tightening have much less potential of flare-ups than their ablative counterparts mentioned.

Pulsed-Dye Laser

A pulsed-dye laser (575-595nm) has long been the gold standard in treatment of vascular lesions, including rosacea. It has shown the greatest efficacy, with the lowest amount of complications for most skin types. The best pulsed-dye laser on the market is the newer Vbeam Perfecta, which has an increased depth of penetration as well as cryogen cooling spray for patient comfort. This treatment is typically repeated once or twice a year.

Intense Pulsed Light

Most forms of intense pulsed light (IPL) can actually worsen rosacea and discolor the overlying skin. IPL differs from lasers by dispersing a broad band, high intensity light rather than a single wavelength like a laser would. This means that more colors absorb the energy of IPL. Palomar ICON Max G can be used for rosacea however, since the hand pieces on this IPL filter out the unwanted wavelengths. This enables the laser to target and coagulate vessels while preserving the normal surrounding skin.

Yellow, Red, and Green Lasers

There are a large variety of other lasers, which may also target rosacea. Some are more effective than others, depending on the skin type and the machine used. The 532nm KTP and diode lasers are good for targeting very small lesions. The 577nm yellow lasers are equally effective. Dual band diode lasers with 532nm and 1064nm combined have also shown good efficacy for mixed blue and red lesions.

No matter what type of rosacea you have, the specialists at the Beverly Hills Center for Plastic & Laser Surgery can guide you. Contact us today to schedule a consultation to learn more about advanced rosacea treatments.

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Peter S.
Literally one of the best facial plastic surgeons in the world. You will NOT regret being treated by this highly skilled professional. He's a mensch, too.
darci t.
I am absolutely ecstatic about my results!!!!!! I am a model and actress as well as an occasional TV host. I have been performing upkeep for my face and lips in Beverly Hills for years and I was convinced I was with the most talented and famous surgeons and dermatologists, but boy was I wrong! One visit with Dr. Talei and my life has changed. He clearly and quickly explained the slow imbalance which had happened in my lips and face over time and we planned for a lip lift procedure. I did this under local anesthesia with no pain at all! He's the ONLY surgeon who can do this with NO scarring. All other doctors I reviewed had scars on at least half their patients. Now all of my friends in plastic surgery and fashion compliment me much more and they have no idea what I had done. This man is AMAZING!!!!
Jennette C.
I went to Dr Talei for under eye filler using Restylane. Dr Talei was very thorough with each step in the process and made me feel very comfortable. The procedure was quick and painless! My under eyes have always been an insecurity for me and when I looked in the mirror after he was done I was beyond impressed with his work. I felt more confident and beautiful. I was able to leave his office and go right back to work! I highly recommend Dr Talei. He's friendly, has a lovely staff and truly cares about making his patients happy.
Lauren F.
My experience with Dr. Ben Talei was very positive. He answered all my questions prior to the procedure and made me feel very comfortable. Before meeting him, I had heard all the rave about his work, and I am so glad I went through with the visit. I was very insecure with my "eleven" deep wrinkles in between my eyebrows, he was very fast and clean with this procedure and I couldn't be more grateful for this minor adjustment that has brought me a major confidence boost. Thank you Dr. Talei
Bryan B.
Ben is a skilled professional. I would have no hesitation recommending Ben and his team to my friends or family. He is passionate about his work and this passion shows in the exceptionally high standard of care that he provides to his patients (both in his practice and in his humanitarian work). You’re in good hands with Ben and his staff!
Danielle B.
I used to see Dr Ben in New York and now I fly to LA to see him. I have no room for error and he is absolutely the only plastic surgeon I trust. Everyone else seems to be out for money. Every time I'm in his waiting room all I hear is praises and how he's the greatest. I completely agree. He's the most talented surgeon I've ever seen. It's worth the flight
Kelly H.
I have worked in health care in Los Angeles for over 20 years and have always hesitated in referring plastic surgeons to my clients. Dr. Ben Talei, MD is in a class of his own. I am so pleased to be able to refer to Dr. Talei without hesitation, and consistently receive outstanding feedback on him. Dr. Talei brings a wealth of experience and exceptional skill, along with cutting edge techniques to his practice. Not only does Dr. Talei excel in every facet of care, but he has also cultivated a warm, kind and patient bedside manner that is second to none. Dr. Talei's office is a dynamic patient focused environment, I urge you to visit him!
Holly K.
Ben is amazing! Was my first time getting botox and it was virtually painless. Marks were gone in minutes. Thanks Ben you're the best!!!