A few years ago, I did an instagram live with Andy Millward (Facialist extraordinaire) where we answered all of your questions about the best rosacea treatments – at home and in the salon. The video was so popular that (even years later) I was still directing people to it at least once a week, so I thought it was time to do a proper post about it. I’m so grateful to Andy for answering all of my questions below, I hope you find it useful.
If you would like to watch our original chat, you can find it HERE – Andy has so much knowledge but explains things in such an accessible way, it’s a really great chat.
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Table of Contents
What *is* a facialist? Is it different to an aesthetician?
They’re generally interchangeable words. Aesthetician is typically more common in the US and Facialist is more common in the UK. However, aesthetician may also include other beauty/aesthetic treatments aside from skin treatments (such as hair removal for example), a Facialist is a skin therapist who typically specialises in facials and skin treatments only.
How to find a good facialist? What training should I be looking for when searching for a facialist?
In terms of how to find a good Facialist, it will mostly come down to research and word of mouth unfortunately, as in the UK the level of training is not standardised across the industry. Unlike medical professionals such as a dermatologist for example, Facialist is not a protected term nor do we have a professional register. So unfortunately anyone who has done a short course, could call themselves a Facialist compared to someone like myself who has completed several OFQUAL recognised qualifications. As a minimum, a Facialist should have at least completed their Level 2 & 3 in anatomy & physiology, facials and facials electrics to show a certain level of competence, as well as CPD training with skincare and machine providers. For a more advanced Facialist, you may also want to look for someone who is CIBTAC or VTCT Level 4 in aesthetic treatments such as microneedling, chemical peels, laser & IPL (however the courses themselves are very expensive to complete, so I wouldn’t rule someone out if they haven’t completed their level 4 as you may be overlooking a very experienced therapist).
What are the green/red flags when finding a facialist?
The best way to find a facialist you need confident in is to go for consultation and skin assessment with them first (this is likely a chargeable service with a good practitioner, as it’s an hour of education not simply a 10 minute ‘free consultation’, which is more about assessing suitability for treatment and an opportunity to sell). During consultation you’ll be able to assess their experience and understanding of working with rosacea clients.
Can I have facials with rosacea?
Yes absolutely you can have facials if you have rosacea. It’s important to clarify though: there is a difference between a facial and a skin treatment specifically to address a skin concern. So, for example, if you have rosacea and you’re on a spa day and want a therapeutic facial, providing you’re not in an active flare, I would absolutely have the facial but do your homework on the brand and ask the therapist if they are suitable for sensitive and reactive skins.
Are there particular facials that are best for rosacea?
If you want a skin treatment specifically to treat the rosacea, then I’d opt for something light therapy based primarily, whether it’s LED light therapy or IPL / laser based treatments. My go-to’s in clinic are either my Byonik Pulse-Triggered Laser (not to be confused with Pulse Dye Laser, they are very different), Venus IPL or Dermalux LED. Not a laser, but I have also recently introduced a Cold Atmospheric Plasma treatment, which is anti-microbial and promotes skin healing, which is excellent specifically for rosacea subtype-2.
Can I have exfoliation with a rosacea facial?
Exfoliation is something that needs to be considered carefully and will vary depending on the individual. As rosacea is fundamentally a skin barrier disorder, exfoliating the skin too aggressively is counterproductive. Enzymes are best for subtype 1 and ingredients like salicylic can be used for subtype 2, but this is only following skin assessment for suitability.
Can I have steam/extraction with rosacea?
I would avoid steam and extractions on a rosacea skin, they are likely unnecessary (typically extractions are performed on comedones, which are more associated with acne and less common in rosacea) and also the steam will likely over-stimulate the skin.
Can I have facial massage with rosacea?
Gentle facial massage, nothing too stimulating, can be performed, but again it will depend on the individual and how active the rosacea is.
What is a facial’s downtime? How long do results last? How often should I have a facial?
This really depends on the type of facial/skin treatment being performed and also the severity of the condition being treated so this is difficult to answer at a general level. This is always something that should be discussed at an individual level during consultation.
Are there any facials that you *wouldn’t* recommend for rosacea?
In terms of facials I wouldn’t recommend for rosacea, bearing in mind rosacea is a chronic skin barrier disorder, then anything that is too harsh or detrimental to the skin barrier including microdermabrasion, hydro-dermabrasion, dermaplaning and overly relying on chemical peels.
How to handle the upselling at the end of a facial?
In terms of how to handle the upselling at the end of a facial, I think this also depends on the reasons you went for the treatment in the beginning. If you’ve gone for a relaxing facial as a treat, and the products recommended aren’t necessarily something you’d be using, then just politely decline and advise you’re happy with your current regime. If however, you’ve gone to a specialist Facialist/aesthetician specifically for help with your skin, then I’d encourage you to be open to their suggestions, as they will be recommending something they genuinely believe is going to help you based on their experience of treating other rosacea clients. If you view it purely as an “upsell” there is an element of distrust there, which could be limiting your progress and if you don’t trust your Facialist, I’d question why you’re having treatment with them at all. To avoid feeling pressured on the day however, politely advise that you’re not in a position to purchase them today, but ask them to email the recommendations to you for future reference. This way you can do your research about the product and have it for future consideration.
Can people with rosacea have microneedling? What is microneedling?
Yes microneedling is not only suitable, but can be beneficial for rosacea. Microneedling works by creating tiny controlled micro-injuries to the skin using a mechanical pen or dermaroller device with lots of needles. These micro-injuries, or micro-channels that are created, signal to the skin to repair itself. During this process there is a release of growth factors and other proteins and cell mediators, that help to improve cell-to-cell communication (cells need to speak to each to repair the damage) as well as improving angiogenesis (cells need oxygen and nutrients to repair the damage). Some people may think this is a bad thing, as surely an increase in blood vessels (angiogenesis) is the last thing someone with rosacea would want. However, capillaries are being generated and broken down all the time and in case of an acute inflammatory response in the skin (following treatment for example), the weak and damaged capillaries are broken down and replaced with stronger ones. From experience, I wouldn’t say microneedling is as effective as IPL for reducing capillaries but it’s certainly beneficial for strengthening the extra cellular matrix (dermal tissue) surrounding the capillaries and helping to thicken the tissue up, making them less visible. It’s worth mentioning that microneedling is a broad term and can be used superficially (from 0.25mm) to deep (up to 1.5mm on the face) and they both have different indications and outcomes. For rosacea, superficial skin needling is best so 0.25-0.5mm needling at most.
What is the downtime for microneedling?
Downtime wise there is usually 24-48 hours’ worth of redness, but this could be longer in someone with rosacea.
Can I use my usual skincare products after microneedling?
Normal skincare can be used prior to treatment but nothing should be applied for around 24 hours following a clinical treatment, other than what the practitioner has provided because the micro-channels can stay open for up to 18-24 hours. Skincare is designed for topical use only, unless its sterile or mesotherapy quality, it is not designed for trans-dermal infusion.
Can I do microneedling at home?
This can be a controversial topical but providing it’s done properly, it can be beneficial and even help to prep your skin for clinical treatment but I would advise against using anything deeper than a 0.25mm at home.
Do you recommend light therapy for rosacea?
Yes I absolutely love light therapy for rosacea and have been using light therapy in treatment for over 10 years, as well as recommending home devices to client to use between treatments.
NOTE FROM LEX: As I know people will ask, Andy personally uses and recommends the Facelite mask for at-home treatment.
Are there different kinds, what do the different colours do?
Quality varies greatly though, as do results. The most proven wavelengths are red (at 633nm), near-infrared (at 830nm) and blue (at 415nm), although blue isn’t typically use for rosacea and is most beneficial for acne. There are some LED masks who have yellow, purple, green etc but this is appealing to the idea that “more is better”. There is little to no evidence that these other wavelengths have any benefit to the skin, and they will likely have compromised on bulb quality to fit more wavelengths into the device.
Is there a difference between salon light therapy and at-home light therapy?
The main difference between salon light therapy and at-home light therapy is of course the salon devices are much stronger so you’ll see results faster. Home devices can still get a good result though so if in-salon treatments are not an option, then it’s worth considering a good quality at home device. Just remember it will be a slower process and will require more frequent usage. In salon, devices are also more sophisticated in the fact that on some devices we can actually alter the strength of different wavelengths to adapt to our clients’ needs. For example, for someone with particularly inflamed rosacea, I may choose to turn down the red (633nnm) dosage and keep the NIR (830nm) higher initially, as red is more stimulating and NIR is immune-modulating. As their condition improves, I’d then increase the red light to boost collagen and energy levels in the skin, to help with repair of tissues. With home devices, you typically don’t get this option, which may explain why some people with rosacea rave about LED masks and get great results, where others find it causing them to flare more (presuming they’re using the same quality masks of course, it may just be the mask they’ve used doesn’t omit the correct wavelengths that are stated as, depending on the quality of the bulbs, they can be +/- 10nm off).
Does a Facialist need training to do LED therapy? What do I need to ask to ensure I’m safe/getting the best treatment for my skin? What is the downtime? How often should I have it done? How long do the results last?
In terms of training for salons, providing they’ve got a decent LED device from one of the main providers, then yes of course training is providing. Dermalux are considered the gold standard in clinical LED and their training is really good. There typically isn’t any downtimes with LED, but someone with rosacea may be a little flushed (as it can be get a little warm under the LED) but this is temporary. For best results you’d have 2 treatments a week for 6 weeks and then once a month as maintenance (but this is where using a home LED mask could also be beneficial to help maintain the results in between for longer).
NOTE FROM LEX: I would really recommend watching the video I did with Andy if you want a little more information on this, you can find it HERE and if you click on the white bar at the very bottom of the screen, hold and drag it to about 49mins in you can access the bit about LED masks at home and what to look out for.
Can people with rosacea use microcurrent devices?
Yes microcurrent is suitable for people with rosacea and may also be beneficial. Similar to light therapy, one of the positive effects from micocurrent is an increase in ATP (cellular energy) so helps cells and tissues to repair. It will increase microcirculation so the skin may appear flushed temporarily but this isn’t necessarily something that should put people off, as over time as the tissue health improves the flushing should get less and less.
Are the at-home microcurrent devices as good as the salon versions?
Similar to the LED Masks, of course the salon versions are stronger and will get better results but the at-home devices can still have a place, but will require more commitment and more frequent usage. Personally I am more of a fan of LED than I am of microcurrent for at-home use.
Can microcurrent devices cause flare ups?
With microcurrent you also need a conductive gel, which could irritate the skin more, especially because you’ll need to be using it daily initially. Also the physical action of moving the device around the skin [can be irritating to reactive skin].
When you see a new client, what do you cover in your (fantastically extensive and thorough!) consultation chat? Why do you think this is important?
I personally spend a full hour during consultation going through everything that could be relevant to identify possible triggers and also any potential gut health issues that could be contributing to the condition. I review medical history (past and present), family medical history (genetics), diet, lifestyle, stress, sleep, environmental factors etc as well as of course topical skincare. I am also in the process of training to be a naturopathic nutritionist with a focus on functional medicine, so will be able to offer various functional health tests once I’m qualified to help me piece more of the full picture together to get the best outcome for my client, not only from a topical skincare and treatment perspective but also from a nutritional and gut health perspective. It’s worth noting thought, this is my approach and not necessarily reflective of all Facialists. As mentioned previously there isn’t necessarily a standardised approach or training so some people may work differently.
If people can’t afford treatments, what do you recommend they do at home to promote/maintain healthy skin? (e.g. skincare routine, lifestyle, etc)
This is really hard to answer on a general level, as the whole point of consultation is to identify and implement a personal approach on an individual level. What may be triggering one person’s rosacea could be completely different to another person’s. However, what’s probably beneficial in all cases is focusing on barrier supportive skincare at all times and also supporting the digestive system (even if you don’t have any obvious digestive issues), particularly supporting optimal stomach acid. Also practising mindfulness / meditation and other stress management techniques, as often stress is one of the biggest drivers of rosacea flares, it also has negative downstream effects on stomach acid production and can cause the barrier to breakdown.
If I’m preparing for a big event (e.g. wedding), what would you recommend? How much lead time do I need? How to set realistic expectations?
If you’re planning on having professional treatments then start at least 3, ideally 6, months prior to the big event. It takes time to treat most conditions but especially rosacea. Especially because there are often many other internal factors at play that are out of your Facialist’s control. 6 months however gives a decent time to implement a plan and do IPL treatments for example. If you’ve left it later than that though, then I’d recommend keeping it gentle and focusing on LED or Byonik type treatments. Try not to make too many radical changes to your skincare and stick with what you know (if it’s working well). The main thing would be to really know your triggers! So for example, if you know stress is a big trigger and you’re getting stressed leading up to the event, there really is only so much the treatment can help with. It has to be a holistic approach so alongside treatments, really implement some boundaries so not to take on too much stress (easier said than done I know).
And that’s your lot! So much information crammed into one blog post – you lucky ducks. Thank you again to Andy for his expertise and help with this blog post. If you want to follow him, you can find him on instagram HERE.
Lex
NEXT STEPS
- Follow me on INSTAGRAM for lots of rosacea updates.
- Get more information on rosacea and my journey so far in my ROSACEA FAQ POST.
- Join my private rosacea FACEBOOK GROUP for support and information.
- I’ve designed some FREE digital downloads to help you get to grips with your rosacea: grab the Rosacea Trigger Checklist, the Rosacea Flare Up Diary, and the How To Speak To Your Doctor form.
- If you’re a Pinterest user, I share all my rosacea posts (and some interesting posts by others) on this board: Rosacea Articles, Reviews, And Infographics.
So much good info! Something I’ll definitely refer back to from time to time.