Rhinophyma Repair

Rhinophyma Repair – Information for Patients

Introduction

Rhinophyma is the end stage of rosacea, affecting almost exclusively male patients, characterized by a progressive deformity in nasal shape. Depending on the extent of the deformity, rhinophyma may distort the appearance of those affected and patients may become psychosocially disabled. No consistent causative factor has been identified to date. Men are 12 times more likely to have this problem than women. Symptoms include overgrowth of the sebaceous (oil making) skin glands, vessel and tissue growth in the deeper layers of the skin, and a thickening of the outer layer of the skin. This can make for a very obvious and prominent nose.


Surgical Approaches to Rhinophyma

A variety of treatments have been used for reshaping the nose in rhinophyma. Among these are surgical excision with skin grafting, CO2 laser resurfacing, dermaplaning, dermabrasion and Radiosurgery.

Radiosurgery is used at St Mellion Clinic to remove the excess nasal skin and sebaceous gland tissue. Following debulking of this excess tissue, the electrical current is used to stop any bleeding and to smooth the skin surface. The pores of the skin go very deep in this condition. Regrowth of skin comes from these deeper skin elements.

Radiosurgery is performed under local anesthesia as an outpatient. The entire nose is numbed with a few injections of Xylocaine, a local anesthetic that is commonly used by physicians and dentists. Once the numbing is complete, you are unlikely to feel any discomfort during the operative procedure. The time required to remove the excess skin tissue will vary, depending on the amount present, but usually the actual reshaping of the nose takes about an hour to perform. Some smoke is generated during Radiosurgery and this is removed using a vacuum device called a “smoke evacuator”.

The raw skin after surgery needs careful wound care with antibiotic ointment and dressings applied every day by patients or their helpers.

Weeping occurs as healing proceeds and is absorbed by the bandage, which should be changed twice daily for the first week or two while drainage is at its greatest. When the drainage slows down (or stops) dressing changes are performed only once daily. The speed of healing depends on many factors such as the depth of surgery and your own healing tendencies. Usually this is complete in about four weeks.


Preparing for Surgery

1. You may eat a light breakfast and/or lunch on the day of surgery since you will be awake for the entire procedure.
2. NO ASPIRIN, IBUPROFEN, OR VITAMIN E SHOULD BE TAKEN FOR TWO WEEKS PRIOR TO SURGERY since this can thin your blood and cause excessive bleeding during and after surgery. You should take any other medications as usual.
3. Wear a buttoned shirt or blouse to the office so that no clothing has to be pulled over your head following surgery.
4. Arrange for someone to take you home following surgery. You should plan to be in the office for a total of two to two and one half hours.
5. You and/or your caregiver will be instructed on how to apply bandages prior to your departure.

Post-Operative Instructions

1. You should plan to “take it easy” for the first week following surgery. This means no heavy exercise, lifting, or straining (since this could cause bleeding to occur).
2. You may shower, bathe, wash your hair, etc. beginning on the day following surgery. Leave the dressing in place until after you come out of the shower.
3. Dressing changes:
a. Remove the old dressing and dispose of it.
b. Cleanse the treated area with cotton-tipped applicators (Q-tips) soaked in Hydrogen Peroxide solution. Use some dry applicators to remove the bubbles that remain.
c. Apply a thin layer of Fucidin ointment (prescription).
d. Cut telfa dressing to size and tape in place with Micropore Paper tape.
e. If bleeding occurs at any time, apply firm pressure to the bleeding site with gauze or a tissue for 30 minutes (no peeking). If this does not stop in thirty minutes contact our office or go to the nearest emergency room for treatment.