Management of severe rhinophyma with electrocautery dermabrasion - A case report

Rhinophyma is benign hypertrophic thickening of the skin and edema of the nasal pyramid. The affected tissue enlarges slowly before reaching its permanent size. The lobulated skin surface with hundreds of pores can become cosmetically embarrassing and cause significant psychosocial stress, anxiety, and depression for patients. In addition, extensive alar thickening can obstruct the external nasal valves making treatment necessary to alleviate respiratory issues. No consensus has been reached regarding management of rhinophyma and many surgeons follow the "to each his own technique" mindset. Our objective was to present a case report to support the use of electrocautery and dermabrasion as the mainstay of treatment.

Here we describe the case of a 62-year-old Caucasian male with a long-standing history of acne rosacea who developed severe rhinophyma overtime which lead to nasal obstruction and major cosmetic deformity. Electrocautery and dermabrasion in the operating room were utilized to obtain an outstanding cosmetic result and respiratory function improvement. Loop and Colorado cautery tips were used with cutting current to remove the hypertrophic skin and create a smooth contour. The patient tolerated the procedure well without any complications. The patient's skin was scab-free with normal pigmentation by four weeks post-op. He was satisfied with the cosmetic outcome and reported substantial improvement in his breathing.

There have been several case reports published which describe using different surgical methods to treat rhinophyma including lasers, electrocautery dermabrasion, surgical blade, cryosurgery, and radio excision. The main limitations of laser therapy are imprecise tissue removal, risk of scarring, dyspigmentation, and bleeding. Other therapies such as surgical excision and skin grafts may require multiple procedures before obtaining a satisfactory cosmetic outcome.

This case report supports electrocautery dermabrasion as the mainstay of treatment as it is a management technique which allows for smooth contouring, efficient hemostasis, more control in the operating room, and does not require multiple procedures.