Treating Rosacea in Twickenham: How the excel V+ Vascular Laser Calms Redness, Flushing and Thread Veins

If you live with rosacea, you already know it is about far more than “a bit of redness”.

Rosacea can mean flushing that appears suddenly, visible thread veins across the cheeks and nose, breakouts that behave nothing like ordinary acne, and skin that feels permanently reactive or on edge.

At Thames Skin Clinic in Twickenham, rosacea is one of the skin conditions we manage most often. It is also one of the most rewarding to treat well because the right combination of medical skincare, skin barrier repair and vascular laser treatment can help settle the visible signs and symptoms of rosacea over time.

Rosacea cannot be cured, but it can often be managed very effectively. The aim is to calm redness, reduce flushing, improve skin tolerance, reduce triggers and support the skin so flare-ups become less frequent, less intense and easier to control.

This article explains how we approach rosacea at Thames Skin Clinic and looks in detail at one of the key treatments within our vascular rosacea programme: the Cutera excel V+ laser.

Quick Answer: How Does excel V+ Help Rosacea?

The Cutera excel V+ is a vascular laser used to target the visible blood vessels that contribute to rosacea redness, flushing and thread veins.

It uses two laser wavelengths, 532 nm and 1064 nm, to treat different vessel depths and patterns. 

• The 532 nm wavelength is especially useful for superficial facial redness, diffuse redness and fine thread veins.
• The 1064 nm wavelength can reach deeper vessels and may be suitable for selected patients and skin types.

At Thames Skin Clinic, excel V+ is not used as a standalone quick fix. It is part of a doctor-led rosacea programme that may also include skin scan analysis, medical skincare, desensitisation, Exoie plant-based exosomes, HydraFacial, LED, Laser Genesis and long-term maintenance.

What Is Rosacea?

Rosacea is a long-term inflammatory skin condition that commonly affects the central face, especially the cheeks, nose, chin and forehead.

It is diagnosed through a combination of skin history and the pattern of signs and symptoms seen during examination. There is no single blood test or lab test for rosacea.

Common rosacea symptoms include:

• Persistent facial redness
• Flushing
• Visible thread veins
• Burning or stinging
• Skin sensitivity
• Dryness or flaking
• Swelling or inflammation
• Large pores
• Oiliness
• Congestion
• Spots, papules or pustules
• Thickened skin, particularly around the nose
• Eye irritation in some patients

Many people with rosacea feel frustrated because their skin can be unpredictable. It may appear calm for a while, then flare suddenly after heat, stress, sun exposure, alcohol, spicy food, hot drinks, hormonal changes or certain skincare products.

What Are the Main Types of Rosacea?

Most patients do not fit neatly into one category. Many have more than one rosacea pattern, which is why a proper consultation is important.

At Thames Skin Clinic, we commonly assess for the following rosacea subtypes.

Erythematotelangiectatic Rosacea

This type causes persistent redness, visible blood vessels, easy flushing, burning and stinging.

It is the pattern most closely linked with facial redness, thread veins and vascular laser treatment.

Papulopustular Rosacea

Papulopustular rosacea is sometimes called acne rosacea.

It causes redness alongside acne-like breakouts, bumps, pustules and inflammation. It can look like acne, but it behaves differently and needs a different treatment approach.

Phymatous Rosacea

This causes thickened, irregular skin texture, most commonly around the nose.

It can be associated with enlarged pores, thread veins and progressive skin thickening.

Ocular Rosacea

This affects the eyes and eyelids, causing dryness, grittiness, redness, irritation or swelling.

Significant eye symptoms should always be assessed by an appropriate eye specialist.

Mixed or Multitype Rosacea

Many patients have overlapping symptoms, such as redness, flushing, sensitivity, thread veins and breakouts.

These cases usually need a phased combination plan rather than one single treatment.

Why Does Rosacea Come Back?

Rosacea is a long-term condition. It cannot be cured, and symptoms can recur at different rates and intensities.

This does not mean treatment has failed. It means rosacea needs ongoing management.

A patient may have excellent improvement after skincare and laser treatment, then flare again months later after sun exposure, stress, heat, alcohol, illness, hormonal change or skin barrier disruption.

This is why our rosacea plans are built around long-term control, not one-off treatment.

At Thames Skin Clinic, the aim is to:

• Settle redness and inflammation
• Reduce visible thread veins
• Improve skin tolerance
• Support the skin barrier
• Reduce flushing intensity
• Identify and manage triggers
• Maintain results with a long-term plan

The Thames Skin Clinic Approach to Rosacea

Dr Anna Hemming designed Thames Skin Clinic around medical standards, natural skin restoration and long-term skin health.

Our rosacea care follows the THAMES philosophy.

T — Thorough

We take time to understand your skin history, symptoms, previous treatments, flare patterns, triggers, skincare and goals.

H — Holistic

We look beyond redness alone. Rosacea can involve inflammation, barrier disruption, vascular change, oiliness, congestion, lifestyle triggers, stress, hormones and skin sensitivity.

A — Assessment

Your consultation includes clinical examination and, where appropriate, skin scan analysis so you can see what we see in your skin. This helps identify redness, vascular activity, inflammation, congestion, pigmentation and barrier stress.

M — Medical

Rosacea is a medical skin condition, not simply a cosmetic redness concern. Your plan is led by diagnosis, skin physiology and safety.

E — Expectations

We explain what treatment can and cannot do. Rosacea cannot be cured, but the signs and symptoms can often be improved and managed.

S — Safety

Treatment is planned carefully around your skin type, sensitivity, medical history, pigmentation risk and vascular pattern within a CQC-registered clinic environment.

What Might a Thames Skin Clinic Rosacea Plan Include?

At Thames Skin Clinic in Twickenham, we put together personalised rosacea treatment plans that may include a combination of in-clinic treatments and medical skincare plans. We see the best results come from layering treatments carefully and gradually.

Depending on your assessment, your rosacea programme may include the following.

Desensitisation Skincare

Many patients with rosacea arrive with a damaged or reactive skin barrier. Their skin may sting, burn, flush or react to products very easily.

Before active treatment, we may need to desensitise the skin and improve its tolerance.

Once the skin is less reactive, medical-grade skincare can be introduced more confidently. Skincare for rosacea usually takes around six to eight months to treat and restore the skin once it has been desensitised.

ZO Skin Health

ZO Skin Health may be used as part of a structured rosacea plan to support barrier repair, reduce inflammation and improve long-term skin function.

Products are introduced carefully and adjusted according to your skin response.

Exoie Plant-Based Exosomes

Dr Anna Hemming is a key opinion leader for Exoie plant-based exosomes.

Exosome therapy may be used within rosacea care to support desensitisation, calm inflammation, help barrier repair and support skin health restoration.

Exosomes are not a cure for rosacea. They may be recommended as part of a wider plan when the skin is reactive, inflamed or struggling to recover.

HydraFacial, HydraRadiance and HydraShower

In-clinic facial treatments may be adapted for rosacea-prone skin to support hydration, reduce congestion, calm inflammation and improve skin comfort.

These treatments are not used aggressively. The aim is to support the skin without overstimulation.

Dermalux LED Phototherapy

Dermalux LED may be used to calm inflammation, reduce sensitivity and support recovery in reactive skin.

It can be helpful between more active treatments or during the desensitisation phase.

Laser Genesis

Laser Genesis is a gentle laser treatment that can support background redness, inflammation, skin quality and collagen stimulation.

It is often used alongside vascular laser treatment or as part of maintenance.

Cutera excel V+ Vascular Laser

The excel V+ is used to target the visible vascular component of rosacea: redness, flushing and thread veins.

It is one of the key technologies within our rosacea programme at Thames Skin Clinic.

Why Laser Is Needed for Rosacea Redness and Thread Veins

Skincare can support the skin barrier, reduce inflammation and improve tolerance.

Facials and LED can help calm the skin.

However, visible thread veins and persistent vascular redness are caused by blood vessels close to the surface of the skin. Skincare cannot close down an existing visible vessel.

This is where vascular laser treatment becomes important to manage rosacea.

The excel V+ laser targets unwanted blood vessels by delivering light energy that is absorbed by haemoglobin, the red pigment in blood. This heats the vessel wall, causing the vessel to close down gradually while the surrounding skin is protected.

How Does the excel V+ Laser Work?

The Cutera excel V+ combines two clinically used vascular wavelengths: 532 nm and 1064 nm.

These wavelengths allow treatment to be adapted to different vessel sizes, depths, colours and skin types.

532 nm Wavelength

The 532 nm wavelength is strongly absorbed by haemoglobin and is particularly useful for superficial facial redness, diffuse redness and fine thread veins.

This is often the pattern seen in erythematotelangiectatic rosacea and mixed rosacea.

Cutera describes excel V+ as using an LBO-generated 532 nm wavelength. This technology is designed to deliver stable energy and precision for superficial vascular treatment.

1064 nm Wavelength

The 1064 nm Nd:YAG wavelength penetrates more deeply and may be used for deeper, larger or bluer vessels.

It can also be useful in selected patients where deeper vascular targeting is needed.

Laser Genesis Handpiece

The excel V+ platform can also deliver Laser Genesis, a gentler treatment that uses micro-pulses of laser energy to support background redness, inflammation, skin quality and collagen stimulation.

At Thames Skin Clinic, Laser Genesis may be used as part of a rosacea programme, either alongside excel V+ vascular sessions or as maintenance between more targeted treatments.

What to Expect From excel V+ Treatment

Before any excel V+ treatment for rosacea, every patient has a consultation and suitability assessment.

A patch test is carried out at least two days before the first treatment to assess skin response and reduce risk.

A typical vascular rosacea course at Thames Skin Clinic is three sessions, spaced approximately one month apart.

Your clinician will explain:

• What the laser can treat
• What it cannot treat
• How many sessions may be needed
• What redness, swelling or sensitivity to expect
• How to prepare
• What aftercare is required
• When to avoid heat, sun exposure and active skincare

The exact plan depends on:

• The severity of redness
• The number and size of visible thread veins
• Skin sensitivity
• Skin type
• Previous treatment history
• Pigmentation risk
• How easily the skin flushes
• Whether acne-like rosacea is also present

Some patients need further treatment later because rosacea can flare again. Maintenance sessions may be recommended to manage new redness or thread veins as they appear.

What Does excel V+ Treatment Feel Like?

Most patients describe the excel V+ laser treatment as a short, hot snapping sensation on the skin. The excel V+ system uses cooling to help protect the skin and improve comfort during treatment.

The exact sensation depends on the settings used, the area treated and the number of visible vessels. Some redness, warmth or swelling can occur after treatment. This is usually temporary and will be explained during consultation.

Is There Downtime After excel V+ for Rosacea?

Downtime after excel V+ varies depending on the intensity of treatment and the vascular pattern being treated. Some patients have mild redness and warmth for a short time. Others may have swelling or a more obvious post-treatment response, particularly when stronger vascular settings are used.

Dr Hemming and the Thames Skin Clinic team will explain what to expect based on your individual treatment plan.

Because rosacea-prone skin is reactive, aftercare is important. Patients are advised to protect the skin from sun exposure, heat, saunas, steam, vigorous exercise, alcohol and active skincare for the period advised after treatment.

Who Is Suitable for excel V+ Rosacea Treatment?

Excel V+ rosacea treatment may be suitable for patients with:

• Persistent facial redness
• Flushing
• Visible thread veins
• Redness across the cheeks or nose
• Vascular rosacea
• Mixed rosacea with redness and breakouts
• Redness that has not improved enough with skincare alone

It may not be suitable for everyone. Suitability depends on your skin type, medical history, medication, tan status, pigmentation risk, recent treatments and the pattern of redness being treated.

This is why consultation and patch testing are essential.

Can excel V+ Treat Acne Rosacea?

Excel V+ can help treat the vascular redness and visible vessels that may be present in acne rosacea.

However, acne-like rosacea often also involves inflammation, congestion, oiliness, papules or pustules. These symptoms may need additional support, such as skincare, HydraFacial, LED, Laser Genesis, Exoie exosomes or AviClear, where appropriate.

At Thames Skin Clinic, we do not treat acne rosacea as “just redness” or “just acne”. We assess both the inflammatory and vascular components before planning treatment.

Real Results: An excel V+ Case Study From Thames Skin Clinic

This patient had spent much of his life living and working at altitude in the mountains, where prolonged sun, wind and environmental exposure can contribute to visible vascular change.

Combined with a family history of rosacea, he had developed dense, visible thread veins, known as telangiectasia, across his cheeks, nose and forehead, alongside persistent background redness.

He underwent a course of three excel V+ vascular laser treatments at Thames Skin Clinic.

Full Face Before and After Three excel V+ Treatments

After three treatments, there was a marked reduction in diffuse redness and visible vessels across both cheeks.

Alt text: Before and after three excel V+ laser treatments for rosacea redness and facial thread veins at Thames Skin Clinic Twickenham.

Cheek Close-Up Before and After Three excel V+ Treatments

The dense network of visible thread veins across the cheek was substantially reduced after treatment.

Alt text: Close-up before and after excel V+ treatment showing reduced cheek thread veins and facial redness.

Forehead and Temple Before and After Three excel V+ Treatments

The forehead and temple area showed a similar reduction in visible vessels after the course of treatment.

Alt text: Forehead and temple before and after excel V+ vascular laser treatment for visible facial veins.

This case illustrates why excel V+ can be helpful for exposure-related and hereditary vascular rosacea. The 532 nm wavelength is particularly suited to fine, widespread superficial telangiectasia, helping to reduce visible vessels while protecting the surrounding skin.

Results vary from patient to patient. The treatment plan and outcome shown are specific to this individual. Rosacea and vascular damage present differently in everyone, and your treatment plan will be designed around your own skin, triggers, medical history and goals following a full consultation.

Why Choose Thames Skin Clinic for Rosacea Laser Treatment?

Thames Skin Clinic is a CQC-registered medical skin clinic in Twickenham, South West London.

The clinic is led by Dr Anna Hemming, a medical doctor since 2002 and a specialist in acne, rosacea, pigmentation, natural skin health, wellness, longevity and restoration.

Dr Hemming has worked in medical aesthetics and skin health since 2008. She previously worked as a GP at Buckingham Palace and founded Thames Skin Clinic in 2019 to bring medical standards, careful assessment and natural skin restoration into aesthetic medicine.

She is a Cutera Key Opinion Leader, an AviClear ambassador and recipient of Cutera’s Lifetime Achievement Award.

Dr Hemming also manages rosacea personally, which shapes the way she treats patients: realistic, thorough, careful and focused on long-term skin health rather than quick fixes.

Patients visit Thames Skin Clinic from Twickenham, Richmond, Teddington, Kingston, Chiswick, Barnes and across London for doctor-led rosacea treatment, laser treatment for rosacea, facial redness treatment and thread vein treatment.

FAQs About excel V+ Laser for Rosacea

Can excel V+ cure rosacea?

No. excel V+ cannot cure rosacea, and no treatment can currently cure rosacea. excel V+ can help improve the vascular signs and symptoms of rosacea, including redness, flushing and visible thread veins. Long-term management usually also involves skincare, trigger reduction, sun protection and maintenance treatment.

Is excel V+ good for facial redness?

excel V+ can be very helpful for facial redness caused by visible or dilated blood vessels. At Thames Skin Clinic, we use it for suitable patients with rosacea-related redness, flushing and thread veins after consultation and patch testing.

Does excel V+ treat thread veins?

Yes. excel V+ is commonly used to treat visible facial thread veins, including those seen around the nose and cheeks in rosacea. The settings are adjusted depending on the vessel size, depth and skin type.

Will my redness come back after laser treatment?

Rosacea can flare again because it is a long-term condition. Laser treatments can reduce visible redness and thread veins, but maintenance may be needed because triggers such as sun exposure, heat, alcohol, stress, hormones and spicy food can continue to cause flare-ups.

Do I still need skincare if I have laser treatment?

Yes. Laser treats the vascular component of rosacea, but skincare supports the skin barrier, reduces sensitivity and helps maintain results. At Thames Skin Clinic, laser treatment is usually combined with a personalised skincare and maintenance plan.

Is excel V+ suitable for sensitive skin?

It may be suitable for sensitive skin, but this depends on the individual. Because rosacea-prone skin is often reactive, consultation and patch testing are important. Some patients need a desensitisation phase before starting laser treatment.

Can darker skin tones have excel V+?

Some vascular laser treatments can be used in selected darker skin tones, but suitability depends on the skin type, vessel pattern, pigmentation risk and treatment settings. Dr Hemming will assess this carefully during consultation and advise on the safest option.

What is the difference between Laser Genesis and excel V+?

Laser Genesis is a gentler laser treatment often used for background redness, inflammation, skin quality and maintenance. excel V+ vascular treatment is more targeted for visible thread veins, flushing and vascular redness. Some patients benefit from both as part of a combined rosacea programme.

Book a Rosacea Consultation in Twickenham

If flushing, facial redness or thread veins are affecting your confidence, you do not have to simply live with it.

A doctor-led rosacea consultation at Thames Skin Clinic can help you understand what is happening in your skin and whether excel V+, Laser Genesis, skincare, exosomes or a combined rosacea programme is right for you.

New patient consultations at Thames Skin Clinic are £249. As part of this consultation fee, £50 is placed on your account for one month following your appointment and can be used towards treatment or skincare purchased as part of your plan.

Thames Skin Clinic is located at 1–3 Baylis Mews, Twickenham TW1 3HQ, close to Twickenham station, with free on-site parking.

Contact our team today to find out more or book an appointment online.