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Chen J, Roushani J, Huq NS. Radiofrequency electrosurgery of severe, extensive rhinophyma: A case series. Skin Res Technol 2023; 29:e13409. [PMID: 37522510 PMCID: PMC10318419 DOI: 10.1111/srt.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Jeffrey Chen
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Jian Roushani
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
| | - Nasimul S. Huq
- Faculty of Health SciencesMcMaster UniversityHamiltonOntarioCanada
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Rhinophyma: Taking Care of the “WC Fields” Nose. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00409-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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3
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Chen CJ, Chan KC, Qing Y. Modified Rhinophymaplasty- incomplete resection with nasal contour reconstruction: A case report. Asian J Surg 2022; 45:1137-1138. [PMID: 35304052 DOI: 10.1016/j.asjsur.2022.01.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Chiao-Ju Chen
- Department of Burn and Plastic Surgery. Institute of West China Hospital Sichuan University, Chengdu, China.
| | - Kuong-Chak Chan
- Department of Dermatology, Institute of Centro Hospitalar Conde de São Januário, CHCSJ, Macau, China.
| | - Yong Qing
- Department of Burn and Plastic Surgery. Institute of West China Hospital Sichuan University, Chengdu, China.
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Benyo S, Saadi RA, Walen S, Lighthall JG. A Systematic Review of Surgical Techniques for Management of Severe Rhinophyma. Craniomaxillofac Trauma Reconstr 2021; 14:299-307. [PMID: 34707790 DOI: 10.1177/1943387520983117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Design Systematic review of the literature. Objective The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical techniques employed in the treatment of severe rhinophyma. Methods Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 2010 to 2020 were collected. All studies which described surgical treatment of severe rhinophyma using the Boolean method and relevant search term combinations, including "rhinophyma," "severe," "operative" and "surgery" were collected. Results A total of 111 relevant unique articles met criteria for eligibility analysis. Of these, 85 articles were deemed inappropriate for the literature review due to exclusion criteria. The remaining 26 articles were included in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible. Conclusions Severe rhinophyma may present a reconstructive challenge to reestablish normal contour and patent nasal airway. Significant deformity necessitates surgical correction. The present article reviews the current literature and provides a summary and stepwise explanation of established surgical techniques for addressing the cosmetic and functional deficits these patients encounter.
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Affiliation(s)
- Sarah Benyo
- The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Robert A Saadi
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Scott Walen
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jessyka G Lighthall
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Egorov VI, Sambulov VI, Magomedov MU, Mustafaev DM. [The rhinophyma through the prism of time]. Vestn Otorinolaringol 2021; 86:95-98. [PMID: 34499455 DOI: 10.17116/otorino20218604195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
One of the frequent causes of a significant increase in the external nose, forming a persistent deformity of the face, as well as leading to a non-standard clinical picture is rhinophyma disease. The article considers some historical data, epidemiology, peculiarities of pathogenesis, as well as the basics of surgical treatment tactics along with possible preventive measures against rhinophyma. At present, the treatment of this pathology presents great difficulties. Despite the many surgical methods, rhinophyma is poorly treatable, often relapses and leaves no less noticeable disfigurement of the face in the postoperative period. In this regard, there is a constant search for new surgical methods, which has not only medical but also important social significance.
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Affiliation(s)
- V I Egorov
- Moscow Regional Research and Clinical Institute M.F. Vladimirsky, Moscow, Russia
| | - V I Sambulov
- Moscow Regional Research and Clinical Institute M.F. Vladimirsky, Moscow, Russia
| | - M U Magomedov
- Moscow Regional Research and Clinical Institute M.F. Vladimirsky, Moscow, Russia
| | - D M Mustafaev
- Moscow Regional Research and Clinical Institute M.F. Vladimirsky, Moscow, Russia
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Chowdhary S, Alexander A. Giant rhinophyma. BMJ Case Rep 2021; 14:14/1/e239860. [PMID: 33431478 PMCID: PMC7802713 DOI: 10.1136/bcr-2020-239860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Stuti Chowdhary
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Arun Alexander
- ENT, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
Rosacea has an overall female predominance; however, rhinophyma, a feature attributed to advanced rosacea, is exceedingly rare in females. The impact of this condition on quality of life can be profound. Multiple treatment modalities have been described. However fully ablative carbon dioxide (CO2) laser for moderate-severe rhinophyma has been shown to be most effective with good cosmetic outcome and high patient satisfaction. We describe a series of 7 female patients presenting with rhinophyma to a tertiary NHS laser centre and a private dermatology clinic. A retrospective case review of rhinophyma management was performed, assessing presentation, treatments and outcomes. The mean age at presentation was 47 years (27-62 years). Three patients developed rhinophyma before the age of 30 years. One patient had severe, 2 patients had moderate and 4 patients had minor rhinophyma. Four patients underwent fractional CO2 laser treatment with a good cosmetic outcome. Two further patients developed scarring following fully ablative CO2 laser. Long-term low-dose oral isotretinoin was used in 3 patients following laser treatment, to prevent relapse. One patient solely received isotretinoin with a good outcome. In our experience, females suffering with rhinophyma presented for treatment at an early age and stage of severity. Fractional or fully ablative CO2 laser alone or in combination with oral isotretinoin is a very effective treatment modality.
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8
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Huseynov J, Mozet C. [A systematic review and current recommendation for treatment of rhinophyma]. Laryngorhinootologie 2020; 99:772-778. [PMID: 33111293 DOI: 10.1055/a-1208-5284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Rhinophyma is a benign disease involving the skin of the nose, which is characterized by skin thickening and hypertrophy of the sebaceous glands and connective tissue. It occurs predominantly by Caucasians in their fifth to seventh life decades and is 12-30 times more likely to affect males. The etiology and pathogenesis of Rhinophyma remains unclear, however it is generally stated to be the final stage of rosacea. A causative relationship between rhinophyma and alcohol consumption has not yet been proven. This review highlights the treatment options of rhinophyma. Surgery is gold standard for management of advanced rhinophyma. Each technique has pros and cons, but using surgical instruments with monopolar energy as loop and ball electrode seem to combine several goals best - first of all simultaneous removal and hemostasis followed by nasal contour refinement. Due to possible coincidence of skin cancer such as a basal- or squamous cell carcinoma, histopathological examination of all removed tissue is recommended.
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Affiliation(s)
- Jamal Huseynov
- HNO-Heilkunde, Kopf- und Halschirurgie, Schwarzwald-Baar-Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Germany
| | - Christian Mozet
- HNO, Schwarzwald-Baar-Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Germany
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Saad M, Matteucci P. A very severe case of rhinophyma requiring a three-stage reconstruction with a forehead flap. Ann R Coll Surg Engl 2020; 102:e219-e222. [PMID: 32808811 DOI: 10.1308/rcsann.2020.0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Rhinophyma is a skin condition that affects the nose. It is often characterised by a large, red, bulbous nose. It can have a physical, psychological and social impact on the patient. Management options include conservative medical therapy such as retinoids or surgical excision followed by reconstruction as required. The reconstruction options can range from a dermal substitute full-thickness skin graft to local flaps, depending on the wound bed. We present a severe case of rhinophyma that required a complex reconstruction with a three-stage forehead flap because of the mass effect and the wound that resulted from the surgical excision of an extremely large and troublesome rhinophyma.
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Affiliation(s)
- M Saad
- Castle Hill Hospital, Cottingham, UK
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10
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Chellappan B, Castro J. Management of severe rhinophyma with electrocautery dermabrasion - A case report. Int J Surg Case Rep 2020; 72:511-514. [PMID: 32698277 PMCID: PMC7317162 DOI: 10.1016/j.ijscr.2020.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Rhinophyma is benign hypertrophic thickening of the skin and edema of the nasal pyramid. The affected tissue enlarges slowly before reaching its permanent size. The lobulated skin surface with hundreds of pores can become cosmetically embarrassing and cause significant psychosocial stress, anxiety, and depression for patients. In addition, extensive alar thickening can obstruct the external nasal valves making treatment necessary to alleviate respiratory issues. No consensus has been reached regarding management of rhinophyma and many surgeons follow the "to each his own technique" mindset. Our objective was to present a case report to support the use of electrocautery and dermabrasion as the mainstay of treatment. PRESENTATION OF CASE Here we describe the case of a 62-year-old Caucasian male with a long-standing history of acne rosacea who developed severe rhinophyma overtime which lead to nasal obstruction and major cosmetic deformity. Electrocautery and dermabrasion in the operating room were utilized to obtain an outstanding cosmetic result and respiratory function improvement. Loop and Colorado cautery tips were used with cutting current to remove the hypertrophic skin and create a smooth contour. The patient tolerated the procedure well without any complications. The patient's skin was scab-free with normal pigmentation by four weeks post-op. He was satisfied with the cosmetic outcome and reported substantial improvement in his breathing. DISCUSSION There have been several case reports published which describe using different surgical methods to treat rhinophyma including lasers, electrocautery dermabrasion, surgical blade, cryosurgery, and radio excision. The main limitations of laser therapy are imprecise tissue removal, risk of scarring, dyspigmentation, and bleeding. Other therapies such as surgical excision and skin grafts may require multiple procedures before obtaining a satisfactory cosmetic outcome. CONCLUSION This case report supports electrocautery dermabrasion as the mainstay of treatment as it is a management technique which allows for smooth contouring, efficient hemostasis, more control in the operating room, and does not require multiple procedures.
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Affiliation(s)
- Brinda Chellappan
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, United States.
| | - Jose Castro
- Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, United States.
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Tambe SA, Nayak CS, Gala P, Zambare U, Nagargoje A. Management of Rhinophyma with Radio Frequency: Case Series of Three Patients. J Cutan Aesthet Surg 2019; 12:136-140. [PMID: 31413484 PMCID: PMC6676810 DOI: 10.4103/jcas.jcas_16_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Rhinophyma is the most common form of phymatous rosacea, typically seen in men. It may appear de novo (without preceding inflammatory changes) or occur in patients with preexisting papulopustular rosacea. It is characterized by slow, bulbous, reddish-purple, painless enlargement of lower two-third of nose with rugose peau d’orange surface resulting from the enlargement of the sebaceous glands and subcutaneous tissue, which does not resolve spontaneously. Though benign, it causes lot of cosmetic and psychological concern. Commonly used treatment modalities include debulking by surgical excision, electrosurgery, carbon dioxide laser ablation, cryosurgery, or dermabrasion. Here we report a case series of three patients with Grade 3 rosacea as per National Rosacea Society grading, treated by radio frequency with good improvement.
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Affiliation(s)
- Swagata A Tambe
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India
| | - Chitra S Nayak
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India
| | - Priyal Gala
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India
| | - Uddhao Zambare
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India
| | - Amol Nagargoje
- Department of Dermatology, Topiwala National Medical College and BYL Nair Hospital, Mumbai, India
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Krausz AE, Goldberg DJ, Ciocon DH, Tinklepaugh AJ. Procedural management of rhinophyma: A comprehensive review. J Cosmet Dermatol 2018; 17:960-967. [PMID: 30225926 DOI: 10.1111/jocd.12770] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rhinophyma is a cosmetically deforming disease characterized by nodular overgrowth of the lower 2/3 of the nose and is considered the end stage of acne rosacea. AIMS Review the spectrum of procedural techniques for treatment of rhinophyma with a focus on the advantages and disadvantages of each modality. METHODS A comprehensive literature search was conducted using the search terms "rhinophyma," "treatment," and "surgery" in PubMed. Case reports, case series, and small retrospective trials using procedural techniques for management of rhinophyma were included for review. Animal studies, non-English articles, and reports of medical treatment of rhinophyma were excluded. RESULTS There are currently no prospective, randomized controlled studies evaluating procedural management of rhinophyma. The most commonly employed treatments include scalpel excision, resection with heated knives, dermabrasion, electrosurgery and lasers, specifically carbon dioxide (CO2 ) and erbium:yttrium-aluminum-garnet (Er:YAG). The main complication associated with complete excision of rhinophymatous tissue is excessive scarring. To correct for this adverse effect, partial or tangential excision with preservation of underlying adnexal structures is now the accepted technique, irrespective of the chosen modality. CONCLUSION There is no accepted gold standard for management of rhinophyma, and each modality succeeds in maintaining hemostasis, reducing scarring and achieving satisfactory cosmesis to different degrees. There is a conflicting data on the theoretical risk of recurrence with partial excision due to incomplete removal of tissue. Further studies evaluating this risk and alternate methods of prevention are required.
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Affiliation(s)
- Aimee E Krausz
- Division of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - David J Goldberg
- Skin Laser & Surgery Specialists of NY and NJ, New York City, New York.,Division of Dermatology, Rutgers University New Jersey Medical School, Newark, New Jersey.,Department of Dermatology, Icahn School of Medicine at Mt. Sinai, New York City, New York
| | - David H Ciocon
- Division of Dermatology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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