in London and Surrey
Rhinophyma is a skin condition that predominantly affects the nose. The skin of the nose becomes thickened and oil glands within the skin become enlarged (sebaceous hypertrophy). The skin may have a normal colour but often there can be blood vessels excess or enlargement within the skin that causes it to have a red appearance. Individual red or purple vessels may be visible. Usually the skin develops a bulbous and pitted appearance that can result in significant cosmetic deformity of the nose. In extreme cases the excess tissue can cause functional problems with breathing. Rhinophyma is a type of Rosacea – an inflammatory skin disorder.
Rhinophyma tends to affect the lower part of the nose. Typically the tip and sides of the nostrils are affected. It is a condition that is more prevalent in men.
The tool of choice for Rhinophyma treatment is the Carbon Dioxide (CO2) laser. It has revolutionised and simplified the treatment of Rhinophyma. The NHS used to offer rhinophyma treatment in some centres but now treatment is only reserved for such severe cases where functional problems develop. Problems such as collapse of the nasal cartilage and problems with breathing.
This is a simple daycase laser surgical procedure. The patient will typically be in clinic for no more than 3 hours.
A powerful short pulsed surgical grade CO2 laser should be used (Lumenis Ultrapulse CO2 is the most appropriate laser – it has the shortest possible pulse width and greatest power) and not a cosmetic grade fractional CO2 laser. Lower powered lasers can result in a greater risk of burn, scar and pigmentation loss due to overheating and insufficient vaporisation of the tissue.
The procedure is performed under local anaesthetic. The nose if completely numbed with a technique called nasal ring block. Dr Hussein also likes to prepare the nose with anaesthetic gel as well. Once the anaesthetic is applied the procedure is painless. Nothing will be felt when the CO2 laser is firing on the nose. As can be seen in the video the patient is awake, comfortable and still while having laser.
Dr Hussein will clean and prepare the nose and mark the affected areas prior to applying the anaesthetic gel. The anaesthetic gel will be left on for 40 minutes and then the patient will be transferred to the resurfacing suite. Here the gel will be removed and the nasal anaesthetic ring block injected.
Once the nose is completely numb Dr Hussein will begin work with the CO2 laser. Initially the excessive skin tissue will be debulked. Depending on how much excess tissue there is different methods can be used. If there is a large lump or nodule then this can be actually cut off with the laser. Usually the CO2 laser is used in high power output continuous wave mode to debulk and remove excess tissue. Once most of this tissue has been removed Dr Hussein will then use a pulsed mode to precisely sculpt and shape in order to return to the original shape of the nose. Finally the rest of the nose will be laser resurfaced with controlled full ablation to blend the skin and avoid any obvious demarcations.
Rhinophyma is usually treated in one sitting. For complex and larger rhinophyma occasionally a supplementary session is required fro any surviving bridges of excess tissue.
Following treatment aquaphor cream or vaseline are applied to form a protective barrier over the nose. This must be used for a period of at least fourteen days. The nose will be washed twice daily along with the rest of the face and the aquaphor/vaseline reapplied for fourteen days. Dr Hussein will regularly photo monitor the healing process. The skin of the nose will return to a functional and normal but red/pink appearance after 14 days. Full recovery with reduction of redness can take up to 3 months.
VIDEO & PHOTOS
Rhinophyma – Click to enlarge
OTHER VALID TECHNIQUES
CO2 laser has superceded all other surgical techniques and is now the gold standard in surgical management of rhinophyma. It really should not be managed in any other way as this would constitute suboptimal treatment.
- Mild Rhinophyma – £1575
- Complex Rhinophyma – £3000