From the * Division of Plastic Surgery, Baylor College of Medicine, Houston, Tex.
Find articles by Daniel K. Chang† Dallas Plastic Surgery Institute, Dallas, Tex.
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Find articles by Yash J. AvashiaFrom the * Division of Plastic Surgery, Baylor College of Medicine, Houston, Tex.
† Dallas Plastic Surgery Institute, Dallas, Tex.
Find articles by Rod. J. Rohrich From the * Division of Plastic Surgery, Baylor College of Medicine, Houston, Tex. † Dallas Plastic Surgery Institute, Dallas, Tex. Corresponding author.Daniel K. Chang, MD, Division of Plastic Surgery, Baylor College of Medicine, 1977 Butler Blvd., Suite E6.100, Houston, TX 77030, E-mail: moc.liamg@dmgnahcleinad
Received 2019 Oct 18; Accepted 2019 Oct 31.Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
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Characterized by telangiectasias, sebaceous hyperplasia, and erythematous hypertrophied skin of the nose, rhinophyma is a deforming and debilitating condition. The term rhinophyma appropriately originates from the Greek rhis and phyma, meaning nose and growth.
First described in 1845 by Hebra, this condition is now understood as the final stage of acne rosacea. In 1851, von Langenbeck recognized the potential for treatment with partial excision and spontaneous re-epithelialization. Nevertheless, early treatment methods, up to the 1970s, often involved aggressive resection, which would lead to scarring or otherwise would require a reconstruction with skin grafts or even forehead flaps. 1,2
More recent treatment algorithms emphasize early medical management and the use of multiple treatment modalities for operative candidates. 3–5 The senior author (R.J.R.) combines these multiple modalities in 5 steps to achieve safe, effective, and consistent results in the modern treatment of rhinophyma.
A fine motorized diamond burr is used for dermabrasion. Performing dermabrasion as the initial step helps create a rough surface on which dermaplaning can be more effectively performed. Dermabrasion can also be repeated after subsequent steps to smooth out any irregular contours. To avoid discrete treatment borders, dermabrasion should be feathered onto the adjacent skin of the cheeks and alar bases. (See Video 1 [online], which displays the 5-step technique for rhinophyma.)
Pre-operative wound management. Video from “The Safe Modern Treatment of Rhinophyma: The Five-Step Technique”