Rhinophyma Reduction (Nose Surgery)


By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons


Rhinophyma or the red, bulbous nose features commonly seen in older men is an imminently treatable medical condition.  This condition, which is caused by an overgrowth of the sebaceous or oily glands of the nose, is an end result of the common skin condition Rosacea.  Rosacea affects approximately 14 million Americans and is characterized by diffuse redness and capillaries of the central zone of the face including the forehead, nose, eyelids, cheeks and chin. Bacteria and overactive sebaceous glands also contribute to pustule and nodule formation.  Over a period of time, untreated Rosacea leads to overgrowth of the sebaceous glands primarily of the nose leading to the characteristic condition Rhinophyma.

Optimal treatment of this condition always starts with prevention.  Retinoid creams as well as topical antibiotics like Metrogel® are the most commonly prescribed medications. Occasionally oral antibiotics are prescribed during acute breakouts.  Additional preventive measures include wearing sunscreen, topical Vitamin C, and avoiding exacerbating foods, alcohol, extreme weather conditions, and stress.  The “old wives” tale that excess alcohol consumption caused Rhinophyma comes from the flushing of the overactive blood vessels of the face and nose characteristic of alcohol use.  Treatment of the redness and ruddy appearance of the skin is typically treated by a series of non-ablative Intense Pulsed Light (IPL) treatments or several different wavelengths of lasers that target the red blood cell components in the skin.

Correction of the bulbous appearance of the nose involves a series of different resurfacing procedures.   Dermabrasion, electro-surgery and laser resurfacing are the most commonly used procedures to smooth the texture of the nose back to its normal state.  These procedures are typically done under local anesthesia or IV sedation, or general anesthesia as an outpatient.  Recovery occurs in stages.  The nose heals in about a week, is red for several more weeks, and then returns to its normal state in a much improved form.  Final Results are seen at 6-12 months after surgery.

Preparing for Surgery

An initial consultation is set-up where we discuss the various options available to treat Rhinophyma, and whether you are a good candidate for the surgery. Alternatives may be discussed as well. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.  You will need several products for post-procedure care and a shopping list will be provided.  Alternatively, procedure kits can be purchased in the office.

The Rhinophyma Reduction Procedure

For the right patient, Rhinophyma reduction can be an extremely gratifying operation. The advantages are natural looking results; long-term skin enhancement with what is usually a difficult problem to address, and no scarring from the procedure itself. This procedure takes about one hour to complete.

The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this procedure, is given antibiotics, and anesthetized in the operating room or in the office. The nose and surrounding skin is injected with local anesthetic to decrease bleeding and for postoperative comfort. Next, the chosen device is used  peel of the skin and to shape the nose into its final form. The initial result appears as though that area has been ‘sandpapered”.   An occlusive dressing placed on the raw surface area, and used for about a week until new skin regenerates. The skin is pink for a few weeks, and gradually starts looking natural and vibrant. Patients are cautioned to stay out of the sun for the first few weeks after this procedure, as new skin is forming, which is fragile.  Maintenance of the result involves the use of the topical rosacea treatments such as retinoids, antibiotic gels and IPL treatments to manage the re-growth of capillaries.

Post-operative Care

Our office will provide you with a detailed post-operative instruction sheet and shopping list that will be individualized to your needs.  We usually see patients the day after surgery in one of our offices to make sure that you are recovering normally.  Multiple visits in the year after the procedure will ensure the best outcome possible.

For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.

Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.

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