Rhinophyma is a progressive skin condition that predominantly affects the nasal skin, although other areas such as the chin may be affected. Those with untreated rosacea (a condition that affects the skin glands) are at a higher risk of developing the condition. It is not related to excessive alcohol intake as has been generally perceived and is not hereditary. The skin of the nose swells with over growth of sebaceous glands resulting in an unsightly look.
WHY CONSIDER REMOVAL
Not only is rhinophyma unsightly, but can often cause nasal blockage, alter its shape and very rarely may harbour cancer cells. Removal of the rhinophyma addresses all these issues, with an excellent cosmetic outcome. The psychological aspects of having a nose deformed with rhinophyma are significant, therefore treatment is recommended.
AM I A SUITABLE CANDIDATE FOR REMOVAL
Anyone with the condition should consider treatment.
BENEFITS OF THE PROCEDURE
The procedure helps to restore the aesthetics and function of the nose. Additionally, if cancer is a concern, treatment addresses the issue. Recurrence is uncommon.
LIMITATIONS OF THE PROCEDURE
Removal of existing lesion does not guarantee the chance of recurrence. Not all the affected areas can be surgically removed hence ongoing treatment for rosacea is an important part of follow up.
CONSULTATION FOR THE PROCEDURE
During the consultation the nose is examined carefully. This includes both external and internal examination including the nasal airway. The diagnosis is usually made from the appearance of the skin on the nose and the previous history of rosacea. If the diagnosis is unclear, a small skin biopsy under a local anaesthetic is obtained for diagnosis under a microscope. All treatment options which include simple scalpel removal, use of lasers or dermabrasion will be discussed, with the pros and cons of each procedure.
Skin conditions such as rosacea should be treated adequately. Occasionally rhinophyma on a weak nasal skeleton (weak cartilage) can cause sever nasal blockage. This may require other nasal surgical procedures such cartilage augmentation.
HOW IS THE SURGERY PERFORMED?
The procedure may be performed either under local anaesthetic with or without sedation (twilight) or general anaesthesia. Local anaesthetic is generally well tolerated by most patients. However, a general anaesthetic may be preferred because of considerable bleeding that occurs during surgery.
Depending on the severity and extent of the rhinophyma the following procedures are considered.
Non-surgical: These include oral isotretinoin, a retinoid commonly used for the treatment of acne, works by reducing redness and the growth of the sebaceous glands.
Surgical: 3 main types of treatments are considered:-
CO2 laser is the preferred and most common method of treating rhinophyma. Laser is used to either shave or evaporate smaller lumps of tissue and achieve a smooth surface. Bleeding with laser tends to be minimal however, heating of tissues of the nose, burning smell during the procedure and occasionally poorly healed scarred skin can be troublesome.
Scalpel or razor blade removal is the ideal option but does carry the risk of bleeding which can be uncomfortable during the procedure.
A combination of laser and scalpel excision tends to be the preferred treatment option in our practice as we often treat large rhinophyma.
Other methods include dermabrasion and electrosurgery. These are all aimed at removal of excess tissue, and are rarely used.
WHAT TO EXPECT POST-OPERATIVELY
Mild swelling, tenderness, or bruising is common. These side effects are temporary and subside within a few days. The area treated is usually covered with an antibiotic ointment and occlusive non-adhesive dressing which is removed in four to six days. Further dressings are applied after this until the operated area regains the normal skin. Sun avoidance is very important during the first six months to avoid a reddish tinge to the nasal skin. Patients are advised not pick the scabs, which fall off naturally as the skin heals over a period of approximately three weeks.
POTENTIAL COMPLICATIONS OF THE PROCEDURE
Complications are rare and include but not limited to bleeding, infection, unfavourable skin tethering, altered sensation, lumpiness, change in skin colour, and cosmetic irregularities. However, these are rare.
Please ask all questions you may have, and ascertain that your questions and concerns have been addressed to your satisfaction before you proceed to surgery. Understand that this may not be an essential procedure depending on your situation.
|Procedure time:||1 hour|
|Anaesthetic:||Local with sedation or General anaesthetic|
|Hospital stay:||Outpatient procedure|
|Time off work:||3 weeks|
|Restricted routine:||1 week|
|Back to full normal activity:||2 - 3 weeks|