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Rhinophyma

Introduction

Rhinophyma is a condition in which the nose gradually enlarges, becomes bulbous and red, and has prominent oil glands. It is commonly associated with rosecea (an inflammatory condition of the facial skin). It is a condition that can be very distressing for patients, on occasion causing them to become socially withdrawn, not least because of the false perception that it is due to excess alcohol intake. Some patients will have associated malarphyma, a related condition in which the skin over the upper cheeks takes on a similar appearance to the affected nose.

RHINOPHYMA

  • Type of anaesthetic
    Local or general anaesthetic
    Length of surgery
    30-60 minutes
    Nights in hospital
    0 nights (day case)
    Scars
    Nose

  • Recovery
    1-3 weeks off work
    2 weeks gentle exercise
    4-6 weeks strenuous exercise
    Follow-up
    5-7 days (dressing clinic)
    2 weeks
    6 weeks
    6 months

My approach

There are a number of surgical approaches to this condition. Traditionally, excess tissue was cut away, and in some cases a skin graft placed on the resultant raw surface. A newer approach is to use a carbon dioxide laser to pare down the bulk of the tissue, and allowing the skin the regrow over the treated area (re-epithelialise). This approach is associated with far less bleeding than the traditional method, which makes it particularly useful in patients who are on blood thinners such as warfarin. It also allows “sculpting” of the shape of the nose, restoring the normal curvatures around the nostrils, etc.. I became familiar with this technique during the course of my fellowship training in medical lasers, and am delighted to be able to offer what I believe to be a superior form of treatment to my patients.

The surgery

Laser treatment is performed under local or general anaesthesia, depending on the extent of the problem. Where there is a very large rhinophyma, some surgical excision combined with laser treatment may be necessary. An overnight stay is unnecessary. Where a surgical excision alone, with or without a skin graft is being performed, an overnight stay may be necessary, depending on what medications you take, and other medical conditions you may have.

Following laser treatment, the nose will be covered with a dark brown to black coloured scab. No dressing is necessary, but you will be prescribed an antibiotic ointment for regular use during the healing process. Healing takes up to three weeks, during which time the scab will gradually lift to reveal fresh, pink, new skin underneath. This new skin will be vulnerable to sun burn and it is important that it is protected from sunlight.

If a surgical excision is performed, a dressing that adheres to the raw area will be applied at the end of the operation. This will gradually lift off in the following days to weeks, revealing new skin, similar to the situation after laser treatment. If a graft is performed, a dressing will be stitched in place, and removed a week later. Sun protection is also important following surgical treatment, in order to protect the new skin.

Consequences and limitations

Unfortunately, neither laser nor surgical treatment can offer a permanent cure for this condition. It is likely that it will gradually recur over time, and further treatment may become necessary. It is a very slowly progressive condition, however, and most patients are very happy to undergo treatment in the knowledge that they may need further intervention a number of years later. Both laser and surgical treatments can be repeated.

Both types of treatment rely on your body’s ability to regenerate skin cells. For this reason, any condition that impacts on your healing ability (such as diabetes or some medications) may slow your healing response after surgery. Smoking will also negatively impact healing. The fact that we rely on the skin cells to regenerate may also limit the amount of tissue that can be removed.

Following both types of treatment, the new skin that forms will be vulnerable to sunburn, and protection in the form of daily sunblock plus a wide-brimmed hat is advised. The colour of the new skin may never match that on the rest of the face, and particularly with laser treatment, hypopigmentation (skin that is permanently paler) may be an issue.

As with any laser treatment, you need to be aware of the tiny risk of damage to the eyes during this operation. All necessary precautions will be taken, including the wearing of a protective eye-shield (metal goggles) by you, during the operation to reduce this risk to an absolute minimum.