Rhinophyma Rosacea

Laser surgery can sculpt the nose back to normal contours. We use the Ultrapulse CO2 laser for most cases. Mild forms of rhinophyma are treated with fractional laser resurfacing.

Once treated, rhinophyma rarely recurs. Knowing how to perform lymphatic massage of the area will reduce future inflammation & swelling. In severe cases, dermatologists will initiate low dose vitamin A tablets to prevent recurrence.

Rhinophyma is progressive. It’s much easier to treat & prevent early disease. A good way to see the progression is to compare old photos. 

Early cases of rhinophyma can be reversed with massage, vitamin A tablets & simple fractional lasers. More established cases required ablative CO2 lasers & or surgery. 

Treatment time takes between 15 to 40 minutes, depending on the severity of rhinophyma. 

This painless surgery is conducted under conscious sedation & nerve blocks in our accredited laser theatres at Cutis Dermatology in Taringa. 

No. This procedure is done under conscious sedation. We also apply nerve blocks to the treated area. Post procedure, there is no pain. 

Yes, we treat half a dozen women a year with rhinophyma. The ratio of male to females is about 10:1. 

Female rhinophyma management is harder, as the skin has less pilosebaceous units & is not as thick, hence overcorrection & scarring can be potentially more common in females. On this basis we under correct, not overcorrect. In mild cases, fractional CO2 is both effective and safe.

In over 95% of cases, only one rhinophyma surgical correction is required. Post-surgery steps will markedly reduce the chances of recurrence. 

Massage & anti-inflammatory medications are most effective at preventing recurrence. Avoidance of flare factors can help. 

Epic. Recovery is proportional to the depth. The process goes like this

• First seven days, dripping, crusting, oozing
• 7-10 days, skin starts to reform
• 1-15 days, skin fully reforms
• 15 to 90 days, skin colour changes include persistent redness
• 6 months plus, may have some lightening of the area

The bark is worse than the bite, though it looks dramatic, there is no pain post-surgery. 

As with all surgical procedures, risks are involved. The deeper the resurfacing, the higher the risks. They include-

• Scarring
• Persistent redness
• Hypopigmentation 
• Infection

Your dermatologists will discuss specific risks, based upon the proposed depth of the procedure. 

Early phymatous changes can be revered with low dose vitamin A tablets & daily massage, see below. Other methods we use to treat rhinophyma include-

• Surgical debulking, often prior to laser resurfacing. 
• Loop RF excision 
• Cold steel excision with cautery

Except for loop RF, lasers offer more precision & reduce blood loss, in comparison to freehand surgical procedures. 

Creams can give a marginal change. They are best served as preventive measures as they can reduce the signs & symptoms of rosacea. They include-

• Metronidazole or Rozex gel
• Soolantra or Ivermectin
• Topical erythromycin, clindamycin
• Sodium sulfacetamide 

Massage opens lymphatic drainage channels on the nose.  Believe it or not it can reverse early phymatous changes & can further improve the results you get from laser surgery. Here is a guide-

• Massage daily
• Start from the tip of the nose, work to the base
• Use a moisturizer to help 
• Apply firm to very firm pressure
• 40 to 50 seconds per set
• 2-3 sets per day
• Form a habit, & you won’t forget

This procedure is partially covered by Medicare.
The out-of-pocket cost will vary between consultant dermatologists.

No, it is unclear why some patients develop rhinophyma & others do not. It is related to-

• Gender. Males outnumber females 10-15:1
• Chronicity of inflammation: though to be end stage after many years of rosacea
• Genetics; more common in Anglo Saxon
• Age; most commonly seen after 55 years of age

There are other forms of phyma, including metophyma (forehead) & otophyma (ears).