Large Rhinophyma Treated by Surgical Excision and Electrocautery

Abstract

Rhinophyma is a benign condition characterized by a large, bulbous nose with prominent pores. It is commonly associated with untreated cases of rosacea. The disease can carry a substantial psychological impact that causes patients to seek advice about how to improve their physical appearance. Many treatment options are available for rhinophyma, but there is no standard treatment protocol. Here, we describe the case of a 65-year-old man with a large rhinophyma that caused him cosmetic and psychosocial embarrassment. The condition was treated by surgical excision and bipolar electrocautery. No complications occurred after the procedures, and healing was completed 2 weeks later by secondary intention and reepithelialization. A simple surgical removal using a scalpel to shave off the abnormal tissue with electrocauterization of the bleeding points can be considered as a good treatment option for rhinophyma, as it results in an excellent cosmetic outcome and has short recovery time.

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“…The treatment of rhinophyma can be very provocative and involves a combination of different options. As the oral medications are not usually effective in established rhinophyma, surgery is often necessary 7 . The extent of tissue growth and the severity of the condition can help to determine the preferred method of treatment 7 .…”

“…Laser therapies are successful methods since eradicating telangiectasias leads to decreased blood supply to the hypertrophic tissue and subsequent tissue reduction, they can carefully cut and vaporize skin while obliterating sebaceous glands and expression of sebum 1,9 . Laser treatment and dermabrasion have the advantages of precise hemostasis and contouring of an aesthetic nasal shape 7,10,11 . The main limitations of laser therapy are imprecise tissue removal, risk of scarring, dyspigmentation, and bleeding, which can obstruct visualization 1,10 .…”

“…Our aim was to obtain a reduction of the abnormal tissue, by debulking and fine contouring, followed by hemostasis and a very careful postoperative assistance 15 . The advantages of the procedure are that it is easy to perform, leads to a significant result and there are no complications such as scarring or hyperpigmentation 7 .…”

“…The functional reasons, such as obstruction of the nasal respiration and reduction of the visual field, as well as the plastic and cosmetic reasons are usual indications of the need of treatment. Many treatment options are available for rhinophyma, but there is no standard treatment protocol 7 . Usually, the treatment of rhinophyma consists of surgical removal of the hyperplastic alterations and it should always be performed by an experienced rhino surgeon.…”

“…Because, in the past, rhinophyma was considered a clinical sign of heavy alcohol consumption, the disease is associated with negative stigma, low self-esteem, reduction in the quality of life and colloquial terms for the rhynophyma include "whiskey nose", "gin blossom", and "potato nose" 1,2,5 . Surgery is indisputably the treatment of choice for rhinophyma, because it responds poorly to the medical treatment 6,7 .…”