Management of Rhinophyma: Outcomes Study of the Subunit Method

Rhinophyma causes a nasal deformity and functional airway obstruction. Partial excision (eg, tangential) with secondary healing commonly removes hypertrophic soft tissues but does not improve nasal support. The subunit method for rhinophyma uses 6 nasal flaps to provide exposure for removal of rhinophymatous tissue and enhance structure. The purpose of this study was to evaluate outcomes of subunit method.

Medical records of patients with rhinophyma treated with the subunit method between 2013 and 2016 were analyzed. The technique comprises degloving the distal half of the nose by elevating 6 subunit-based flaps; debulking phymatous tissues to perichondrium; enhancing nasal support with sutures/cartilage grafts; trimming excess skin; and redraping the soft tissues. Patient age, gender, need for cartilage grafts or skin grafts, revisions, and follow-up were assessed.

The study comprised 8 patients (6 male). Mean age was 63 years (range 34-72). All individuals had interdomal sutures for tip enhancement and 4 patients underwent cartilage grafts (alar batten) to correct external valve collapse. One patient had 2 subunits (alar) replaced with skin graft. Average follow-up was 1.6 years (range 0.2-3.7). Six patients underwent revisional procedures primarily to modify the scar between the dorsum and tip subunits.

The subunit method addresses the 3 fundamental problems of the rhinophymatous nose: hypertrophic sebaceous tissues, excess skin, and destruction of support. Most patients may benefit from a minor revisional procedure to optimize the result. Individuals should be counseled that operation will likely require 2 stages.