Rhinophyma: a new approach to hemostasis

Fractionated ablative carbon dioxide laser for the treatment of rhinophyma

BACKGROUND

Rhinophyma is a progressive and disfiguring proliferative disorder of the nose, which is related to chronic rosacea. Many different treatment modalities have been utilized both alone and in combination including: loop cautery, CO2 laser, argon laser, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel. CO2 resurfacing has been considered first line therapy but is often associated with a shiny, scarred appearance, with patulous pores, and with loss of pigmentation. We report a technique using aggressive parameters with the fractionated ablative CO2 laser, resulting in improvement of appearance with very few complications.

MATERIALS AND METHODS

Five patients who presented with rhinophyma of varying degrees were treated with a series of fractional ablative CO2 laser treatments (Fraxel re:Pair, Solta Medical, Hayward, CA). These patients were treated with settings of up to 70 mJ, 70% density and 16-18 passes. All patients received HSV prophylaxis using either acyclovir 400 mg TID or valacyclovir 500 mg BID. Patients were rendered anesthetic by 1% lidocaine and epinephrine regional perinasal nerve block.

RESULTS

All of the patients tolerated the procedure well with reepithelialization at days 4-7 and self-limited edema and erythema. Patients with relatively early to moderate signs of rhinophyma proved optimal candidates for this treatment. There were no adverse events. Patients and physicians noted significant improvement and reduction in the rhinophyma without the typical scarring noted with most other treatments.

CONCLUSION

Rhinophyma treated with fractionated ablative CO2 laser using relatively aggressive parameters achieved good cosmetic outcomes in this group of early to moderate cases of rhinophyma, while still retaining the benefits of a fractionated treatment such as faster healing times and fewer adverse events.

[CO2 laser treatment of rhinophyma]

Treatment of the advanced form of rhinophyma causing severe nasal deformity and nasal breathing impairment is reserved mainly for surgical methods. Laser techniques among them play particular role. The aim of the study was to present short series of patients suffering from severe form of rhinophyma, who were treated with CO2 laser, emphasizing the advantages and disadvantages of the method used.

MATERIAL AND METHOD

Three male patients, aged 51-69, with advanced form of rhinophyma were treated in our clinic with CO2 laser. The total removal of pathologic tissue was performed during 2-3 sessions of laser therapy with an interval 4-8 weeks in-between.

RESULTS

The follow-up ranged from 4-12 months. Satisfactory cosmetic and functional result was achieved in all patients. Full reepithelization of the wound took place within 4-6 weeks. Intensive bleeding from dilated vessels during the procedure that required bipolar electrocautery occurred in two cases. There were no postoperative complication in the studied group.

CONCLUSIONS

The CO2 laser is relatively save and precise surgical tool for rhinophyma ablation. If the resection is not to aggressive, healing process is quick and without excessive scaring. Unfortunately the "dry field" conditions are not always possible to achieve during operation, due to limited coagulative properties of the CO2 laser towards dilated blood vessels. In advanced stages of rhinophyma to increase safety of the procedure, several sessions of the laser therapy might be necessary to remove all the hypertrophic tissue.

Use of a Dual-Mode Erbium:YAG Laser for the Surgical Correction of Rhinophyma

Rhinophyma is a cosmetically deforming disorder characterized by nodular hypertrophy of the nasal soft tissue. Treatment of rhinophyma usually consists of laser ablation or surgical excision for correction of the associated tissue deformity. We describe 6 patients with mild to severe rhinophyma who were treated with a dual-mode erbium:YAG (Er:YAG) laser, which provides the advantages of controlled ablative energy for tissue reduction and excellent intraoperative hemostasis. Outcome measures included patient satisfaction, clinician observer ratings, and an assessment of complications, including scarring, pigment abnormalities, and postoperative bleeding. All patients were satisfied with their outcomes, and no complications were detected during follow-up. All treatment outcomes were rated as very good to excellent at a 3-month follow-up visit. The flexibility of the dual-mode Er:YAG laser provides both controlled ablation and hemostasis, making it an ideal laser for the surgical treatment of rhinophyma.

Laser treatment of rosacea

Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques. Laser studies on rosacea-associated telangiectasia and erythema are limited. Copper-bromide, krypton and KTP lasers have been used with good to excellent results. However, the most commonly applied system is the flash lamp-pumped pulsed dye laser. Rhinophyma can be treated with a variety of different surgical methods, including laser resurfacing. CO(2) lasers are the most widely used lasers, others are the Er:YAG and Nd:YAG lasers. Cosmetic end results are comparable to partial excision with a scalpel or electrosurgery. There does not appear to be an increased risk of infection or scarring, but the conventional surgical methods are quicker to perform and more cost effective.

Excision of rhinophyma with the carbon dioxide laser: a ten-year experience

Rhinophyma is a disfiguring disease of the nasal skin, primarily affecting white men in the fifth to seventh decades of life. Hypertrophy of the sebaceous apparatus leads to an enlarged, erythematous nasal tip with comedones. Modalities of treatment include dermabrasion, freehand scalpel shave, cryosurgery, electrocautery, excision and closure with local flaps, and laser resection. A retrospective review of 18 patients treated with carbon dioxide laser excision of rhinophyma from 1983 to 1993 is presented. Discussion includes technique, postoperative care, complications, recurrence, operative blood loss, length of follow-up, time to complete reepithelialization, and pathologic findings. The carbon dioxide laser is a relatively safe, cosmetically efficacious, and curative method of treating rhinophyma.

Rhinophyma: Treatment with CO2 Laser

Rhinophyma is an acne rosacea which primarily affects the midface of elderly men, and causes disfigurement as well as obstruction. There are numerous ways of treating this condition and, in our institution, a CO2 laser is the treatment of choice.