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 of very marked overgrowth (hyperplasia) of the sebaceous glands of the nose. The condition is part of the common skin disease rosacea. Rosacea is a chronic acneform disorder of the pilosebaceous units of the skin coupled with an increase in the reactivity of the local skin capillary beds to heat. Where women commonly suffer from one of three stages of rosacea, men more typically suffer the associated nasal overgrowth (rhinophyma). The sensitivity of the capillaries in women results in flushing and finally series of dilated small red veins visible at the surface of the skin.

Rosacea typically affects Celtic people and southern Italians, both with fair skin types. Individuals with brown or black skin are affected much less commonly. Patients are typically 30-50 years old at onset of the disease.

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 typically overgrown in rhinophyma are regular skin glands that occur in all area of our skin with the exception of the soles and palms. 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 plastic surgical procedures patients should avoid alcoholic beverages for one week prior to surgery. Anti-inflammatory drugs (Aspirin®, Motrin®, Ibuprophen, Advil®, etc.) should stopped two weeks prior to surgery due to their effects on the body's blood clotting system. Failure to do so may lead to increased bleeding during the operation, blood clots (hematomas) and post-operative bruising. If you require painkillers on a regular basis for arthritic pain or headaches, the use of Tylenol ES® will not affect blood clotting. The use of herbal supplements or traditional medicines should be discussed with your surgeon pre-operatively to see if they will affect your surgery.

All medical conditions and medications must be discussed with your surgeon pre-operatively. Nasal breathing problems, chronic running nose, allergies, prior nasal injury and regular use of nasal sprays should be disclosed. Medical conditions such as high blood pressure must be well controlled in procedures like facelifts where bleeding and hematomas are a risk. If you have been placed on a blood thinner, you may be asked to speak to your family physician to discuss the medical requirement for this medication and health impact of a short stoppage in the peri-operative period.

Smoking requires special mention as chemicals in smoke can cause vasoconstriction of blood vessels resulting in reduced blood supply to the redraped and re-positioned facial tissue. All smokers, regardless of quantity, are at an increased risk of tissue death (necrosis) following facelift procedures. Smoking should be stopped 2-3 months before the operation in order to eliminate the added risk of tissue loss due to smoking. Some surgeons will refuse to perform elective operations on smokers due to this risk.

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

With a gradual recovery, you will need to wait several weeks for a proper assessment of how you are going to look. The wound will take months before it can be assessed in its final form. For the first year, protection of the nose from the sun is essential. Although proper sun protection is essential on all exposed skin, high SPF sunscreens (SPF 55 or 60) is essential over the surgical field, for 12-18 months, to prevent permanent darkening of the wound. Patient satisfaction with this procedure is usually high.

COMPLICATIONS

A discussion of potential complications is essential with every discussion about a surgical procedure. It is important to know that although complications from surgery are possible they are not common. Some possible complications associated with a rhinophyma surgery are listed into both 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

Rhinophyma surgery is covered under the Canadian Medical Plan and is considered an insured service in Canada. In some select cases or in unique circumstances such procedures may be considered cosmetic and the fee for correction will be at the discretion of the surgeon performing 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.