This study aimed to evaluate the efficacy of advanced optimal pulse technology (AOPT) combined with collagen dressings on facial flushing and skin barrier function in patients with rosacea. A total of 150 patients with rosacea were prospectively enrolled and randomised into the control group (n = 75, received AOPT treatment alone) and observation group (n = 75, additionally used recombinant human type III collagen dressing). Clinical improvement, erythema and lesion features were recorded before and 12 weeks after therapy. Patient quality of life was measured using the Acne-QOL scale. Skin barrier function was evaluated by transepidermal water loss (TEWL), sebum output and epidermal hydration. Serum inflammatory markers were analysed, and adverse reactions and recurrence were also tracked. Following 12 weeks of treatment, compared to the control group, the observation group showed higher overall effectiveness, greater reduction in erythema, lesion severity and pain scores, higher Acne-QOL scores across all dimensions (self-perception, emotional well-being, symptom burden and social function), lower TEWL and sebum secretion, higher hydration and lower levels of TNF-α, hs-CRP and PCT (all p < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (2.67% vs. 6.67%, p = 0.246), but the observation group had a lower recurrence rate (2.67% vs. 14.67%, p = 0.009). The combination of AOPT with collagen dressing offers superior benefits over AOPT alone, alleviating facial flushing, strengthening the skin barrier, decreasing systemic inflammation and reducing relapse, highlighting its clinical value in rosacea management.