If your rosacea has caused unsightly redness, enlarged blood vessels, and rhinophyma (bulbous nose), then procedures such as laser surgery, cryosurgery, electrosurgery, radiofrequency ablation, or dermabrasion may be treatment options to consider. Laser surgery may result in improved skin appearance with little scarring or damage. If you have rhinophyma, laser and other surgical methods may help reduce the size of the nose and improve your appearance. Since rosacea cannot be cured, further surgical treatment may be required at a later time.
After medical therapy removes the redness, bumps, and pimples, small red blood vessels (telangiectasia) may become more visible. In most cases, a surgical device called a pulse dye laser can be used to erase these visible blood vessels without pain or discomfort. Heat from the laser’s energy causes the blood vessels to disintegrate. The short pulses ensure that only the abnormal blood vessels are targeted, thus reducing or eliminating the chance of damage to surrounding facial tissue. Other lasers (such as KTP, long-pulsed alexandrite laser, long-pulse Nd:YAG laser, or an intense-pulse light device) may also be used.
A study of laser therapy for rosacea found that the procedure substantially reduced visible blood vessels and helped reduce redness and flushing after an average of three treatments. After the procedure, you may experience redness, swelling, and soreness within the first 12 to 24 hours. You may also have some peeling, similar to that of sunburn, and some bruising under the skin that lasts from 5 to 10 days. Visible blood vessels disappear in one to three weeks.
Rhinophyma, the unsightly overgrowth of tissue on the nose, can also be corrected with pulse dye laser. If necessary, a CO 2 or Erbium:YAG laser can be used as a bloodless scalpel to recontour the nose. Early treatment often shrinks the nose and helps prevent further development of the condition.
Electrosurgery may be used to treat small red blood vessels. In this procedure, an electrical "spark" is applied through a tiny needle electrode to coagulate each tiny vessel from its center. This procedure is quick and only mildly painful. It is a good method if you have only one or very few small red vessels. A small crusting sore follows and heals quickly with good results.
Dermabrasion is a surgical procedure that is used to treat the bulbous nose (rhinophyma) that is seen in severe cases of rosacea. It sculpts the nose back down to a more normal shape. It involves “sanding” the upper layers of skin. During healing, a new and smoother layer of skin replaces the abraded skin. This procedure requires only local anesthesia. Most people heal within one to two weeks. If you undergo dermabrasion, you should wear sunscreen of SPF 15 or higher to protect the new skin.
Medical therapy for rosacea. National Rosacea Society website. Available at: https://www.rosacea.org/patients/managementoptions/medicaltherapy.php. Accessed December 27, 2017.
Rosacea. DermNet New Zealand website. Available at: https://www.dermnetnz.org/topics/rosacea. Updated June 2014. Accessed December 22, 2017.
Rosacea. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116224/Rosacea . June 8, 2017. Accessed December 22, 2017.
Rosacea: Diagnosis and treatment. American Academy of Dermatology website. Available at: https://www.aad.org/public/diseases/acne-and-rosacea/rosacea#treatment. Accessed December 27, 2017.
Rosacea: How is it treated? National Institute of Arthritis and Musculoskeletal and Skin Disorders website. Available at: https://www.niams.nih.gov/health-topics/rosacea#tab-treatment. Accessed December 27, 2017.
Last reviewed November 2018 by
EBSCO Medical Review Board
Michael Woods, MD, FAAP
Last Updated: 12/20/2014