Procedural management of rhinophyma: A comprehensive review

Abstract

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.

Dermabrasion for Scars and Wire Loop Electrocautery for Rhinophyma

“…20,21 It is important to note that the underlying bony cartilaginous framework to the nose is not affected. 22 Some of the rhinophyma tissue should be sent to pathology to rule out the presence of occult basal cell carcinoma (3-10% risk). 23 Multiple techniques are described in the literature for addressing rhinophyma, but no randomized controlled trials recommend one specific approach as being ideal.…”

“…23 Multiple techniques are described in the literature for addressing rhinophyma, but no randomized controlled trials recommend one specific approach as being ideal. 19,22 The techniques in managing rhinophyma is, first, to remove the bulk of the disease and, second, to recontour and smooth the nose to reestablish the nasal subunits. It is imperative to keep the remaining deeper dermal adnexa intact, which is the key stem cell source to replenish the regenerating epithelium.…”

“…It is imperative to keep the remaining deeper dermal adnexa intact, which is the key stem cell source to replenish the regenerating epithelium. 18,22 The approaches to manage rhinophyma include cold knife, hot knife, electrocautery, coblation, laser (CO 2 or erbium yttrium aluminum garnet), mechanical dermabrasion (wire brush or diamond fraise), and VERSAJET (Smith & Nephew). The senior author (D.H.) prefers the use of wired loop electrocautery (►Fig.…”

“…6). Wire loop electrocautery is used both to debulk the rhinophyma and to redefine the nasal contours and nasal subunits 18,22,24 (►Fig. 7).…”

“…The advantage of using wire loop electrocautery is that it is a simple, low-cost method to sculpture the nose by removing slivers of tissue with minimal intraoperative bleeding. One disadvantage is that if it is performed too deep by not leaving enough overlying pilosebaceous units over cartilage, then the risk of scarring is increased compared with other approaches 22 (►Fig. 8).…”