Melt 2 tbsp butter in a skillet over medium heat. Add onions and cook 10–12 minutes, stirring occasionally, until deeply caramelized. Remove and set aside.
Pat livers dry and toss lightly with almond flour, smoked paprika, salt, and pepper.
Add remaining butter to the skillet and sear livers 2–3 minutes per side, until browned outside but still slightly pink inside.
Return onions to the skillet and toss to combine.
Finish with a few dashes of hot sauce and serve hot.