Rhinophyma

Author: Dr. Bryce J Cowan BSc MSc MD PhD FRCS(C)
Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver, BC

Rhinophyma is a condition where the sebaceous glands of the nose become enlarged, and is a very common condition of advanced Rosacea. Rosacea is a chronic acneform disorder that often affects those with lighter color skin. Although women are more commonly affected by Rosacea, men tend to suffer from rhinophyma more often.
Rosacea tends to affect Celtic people and those from Southern Italians, both which have very fair skin types. Individuals with brown or black skin are affected much less commonly. Patients are typically 30 to 50 years old, at the onset of Rosacea.

Patients may describe sensitivities to extremes of temperature, hot liquids, alcohol, spicy foods or working in the direct sunlight. Typically these symptoms of aggravation are more typical in the female rosacea patient than in the male with rhinophyma. Although alcohol may be a precipitating factor or trigger for rosacea, the stigmata that all patients with the large overgrown nose seen in rhinophyma are in fact alcoholics or "boozers" is absolutely wrong.

The sebaceous glands that are overgrown in rhinophyma are regular glands that occur everywhere on the human skin except the palms and soles. These glands produce an oily substance called sebum, a composition of fat and debris from dead fat-producing cells. The product is designed to lubricate skin in non-hair bearing skin and the hair shaft itself in hair bearing skin. The sebum is brought to the surface of the skin through ducts. Excess sebum production can occur in response to poor hygiene, diets rich in fat, in conditions of accelerated glandular activity (like rosacea/rhinophyma) and naturally during adolescence.

Treatment of rhinophyma may include avoiding the many triggers for rosacea and may combine a medical based therapy to control the existing rosacea but typically involves a surgical external nasal reshaping.

TYPES OF RHINOPHYMA

SPECIAL LESIONS

Less commonly people can suffer from metophyma (an enlarged cushion-like swelling of the forehead), blepharophyma (similar swelling of the eyelids) related to marked sebaceous gland hyperplasia, otophyma (cauliflower-like swelling of the earlobes), or gnathophyma (swelling of the chin).

PREPARATION

Prior to any surgical procedure, it is important to take appropriate preparations to increase safety, and maximize the benefits of the procedure. First, patients should not take anti-inflammatory drugs such as Aspirin®, Motrin®, Ibuprophen, or Advil®, due to their effects on the body's blood clotting, for at least two weeks prior to surgery. Tylenol ES®, is a painkiller that can be used for those who suffer from chronic pain. Any use of herbal supplements or other alternative medicine should be discussed with your surgeon. Finally, alcohol should be avoided for at least a week prior to the surgery date.

Additionally, any medical condition or medications that are used must be disclosed to your surgeon prior to the procedure. Conditions such as running nose, allergies, prior nasal injury and use of nasal sprays are important factors and should be reported. If you have been placed on a blood thinner, or have high blood pressure, these factors should be reported to your family physician.

Smoking is a very important factor in surgery. Chemicals from smoking can cause vasoconstriction of blood vessels, which restricts the blood supply to the newly re-draped and transferred tissues. Smoking must be stopped at least 2 to 3 months prior to surgery in order to eliminate the risk of further tissue loss. It is important to understand that all smokers, regardless of quantity, are at an increased risk of tissue death following surgery.

THE PROCEDURE

Nasal reshaping involves shaving away the excess nasal glandular overgrowth to achieve an aesthetically pleasing nasal shape. The wound surface is then allowed to re-heal by a process termed re-epithelialization. Careful attention is made to leave enough skin adnexal structures available at the wound base to allow for proper re-healing. Scalpel, dermabrasion, electrocautery, laser or a combination of these methods can be used for nasal reshaping. All methods produce similar results.

At the completion of the procedure, bleeding vessels are controlled and an ointment based dressing is applied to the wound.

THE RECOVERY

The typical convalescence following rhinophyma surgery is approximately 3-4 weeks. Ointment and bandage dressings are used for the first 2-3 weeks. Pain is controlled with prescription medications for the first few days. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure.

EXPECTATIONS

Several weeks must pass post-surgery before a final look can be assessed. In the meantime, it is essential that sun protection using high SPF sunscreens is adhered to, and this should be lept up to 18 months after surgery in order to prevent a darkening of the wounds. Despite these inconveniences, patient satisfaction for this procedure is very high.

COMPLICATIONS

Although surgical complications with this procedure are rare, it is still possible, and important that you understand the possible complications that can occur. A discussion with the surgeon regarding risk is always important. Listed below are the most common complications that can occur, divided into early and late complications:

EARLY	LATE
Bleeding Infection Bruising Wound healing problems (increased risk in smokers) Numbness	Asymmetry Unacceptable scars Hyperpigmentation (darker skin colour) Minor edge deformity (at the junction of the treated and untreated skin)

For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.

COST

The cost of rhinophyma surgery is covered under the Canadian Medical Plan, and is considered a medical procedure as well as an insured service. In certain select cases, or circumstances, the procedure may be considered cosmetic, in which case the fee for correction will be at the discretion of the surgeon that performs the procedure.

DISCLAIMER

This website does not cover all of the medical knowledge related to rhinophyma surgery nor does it deal with all possible risks and complications of surgery on the nose. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure.