Objective To explore the effect of intense pulsed light combined with type A botulinum toxin on treatment effect and aesthetics in patients with rosacea. Methods A total of 90 patients with rosacea admitted to Changsha Peng Ai Medical Aesthetic Hospital from February 2022 to April 2024 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 45 patients in each group. The control group was treated with intense pulsed light, and the observation group was treated with intense pulsed light combined with type A botulinum toxin. The treatment effect, facial symptom scores, aesthetics scores and adverse reactions were compared between the two groups. Results The total effective rate of teratment in the observation group was 97.78%, which was higher than 82.22% in the control group (P <0.05). The scores of erythema, papulopustule, telangiectasia and pruritus in the observation group were lower than those in the control group (P <0.05). The aesthetics scores in the observation group at 2 and 4 weeks after treatment were lower than those in the control group (P <0.05). The incidence of adverse reactions in the observation group was 6.67%, which was lower than 22.22% in the control group (P <0.05). Conclusion Intense pulsed light combined with type A botulinum toxin treatment can effectively improve the facial symptoms of patients with rosacea, enhance the aesthetics, and reduce the incidence of adverse reactions, with a higher safety.