CO₂ Laser Resection of Giant Rhinophyma Under Local Anesthesia: A Case Report

Phymatous rosacea (PhR), also known as "rhinophyma", refers to a benign condition characterized by the excessive proliferation of sebaceous glands and fibrosis in the facial skin due to rosacea, leading to thickening and hardening of the nasal skin, ultimately developing into rhinophyma. This disease's pathophysiology remains unclear but is seen as an advanced stage of rosacea.

The patient is a 67-year-old male and has hypertrophy of nasal tip and an enlarged nodule measuring approximately 7 cm × 6.1 cm × 4.5 cm in size of dark red color, uneven surface, clear dilation of follicular orifices, presence of white pustules and yellowish-white comedone-like secretions on light touch. Compression causes deformity of the nostrils that influences the quality of life and breathing. A total excision of the rhinophyma under local anesthesia by means of the CO₂ laser surgery was agreed upon. The dressing changes were used to treat the wound after surgery and full healing took place after 30 days. The patient had satisfactory results, both in a functional and aesthetic sense, with the result having no recurrence in 1 year after surgery.

The CO₂ laser therapy with local anesthesia is an extension of traditional general anesthesia surgery when it comes to the removal of rhinophyma because it is easy to perform the surgery, with minimal trauma, bleeding, and no follow-up surgical operation, which leads to the development of a personal approach to the treatment. In our case, reconstructing the nasal area is complicated by the decision on anesthesia and management of nasal wound, which does not interfere with its functionality and beauty.

In this report, we emphasize the surgical value of local anesthesia with CO₂ laser for rhinophyma, reducing blood loss, operation time, and the need for secondary surgery. Follow-up for 1 year.