Fractionated ablative carbon dioxide laser for the treatment of rhinophyma

Rhinophyma is a progressive and disfiguring proliferative disorder of the nose, which is related to chronic rosacea. Many different treatment modalities have been utilized both alone and in combination including: loop cautery, CO2 laser, argon laser, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel. CO2 resurfacing has been considered first line therapy but is often associated with a shiny, scarred appearance, with patulous pores, and with loss of pigmentation. We report a technique using aggressive parameters with the fractionated ablative CO2 laser, resulting in improvement of appearance with very few complications.

Five patients who presented with rhinophyma of varying degrees were treated with a series of fractional ablative CO2 laser treatments (Fraxel re:Pair, Solta Medical, Hayward, CA). These patients were treated with settings of up to 70 mJ, 70% density and 16-18 passes. All patients received HSV prophylaxis using either acyclovir 400 mg TID or valacyclovir 500 mg BID. Patients were rendered anesthetic by 1% lidocaine and epinephrine regional perinasal nerve block.

All of the patients tolerated the procedure well with reepithelialization at days 4-7 and self-limited edema and erythema. Patients with relatively early to moderate signs of rhinophyma proved optimal candidates for this treatment. There were no adverse events. Patients and physicians noted significant improvement and reduction in the rhinophyma without the typical scarring noted with most other treatments.

Rhinophyma treated with fractionated ablative CO2 laser using relatively aggressive parameters achieved good cosmetic outcomes in this group of early to moderate cases of rhinophyma, while still retaining the benefits of a fractionated treatment such as faster healing times and fewer adverse events.