Tangential excision of rhinophyma with electrocautery and healing by secondary intention: A case report

Rhinophyma is a benign, slowly progressive, disfiguring condition of the nose characterized by sebaceous gland hypertrophy, fibrosis, and follicular plugging, generally regarded as the end stage of phymatous rosacea. It predominantly affects middle-aged to elderly men and can cause significant cosmetic and psychosocial morbidity and, in advanced cases, nasal airway obstruction. We report a 71-year-old hypertensive man who presented with progressive, painless nasal enlargement involving the nasal tip and alar crests bilaterally. Incisional biopsy confirmed rhinophyma, showing sebaceous hyperplasia with cystic dilatation of the follicular infundibula and keratinous plugging. He underwent tangential excision using a cold blade combined with monopolar electrocautery, with hemostasis achieved by monopolar diathermy, and the wound was left to heal by secondary intention under a silver-based dressing. Healing was uneventful, with complete re-epithelialization and a satisfactory cosmetic outcome. This case supports tangential excision with monopolar electrocautery as a simple, effective, and reproducible technique for rhinophyma. Beyond the outcome itself, this report documents the intraoperative depth-control and symmetry cues used, the technical difficulties encountered during subunit contouring, and a staged postoperative wound-care protocol, so that an established but often summarily described technique can be reproduced in centres without access to laser or hydrosurgical platforms. A single case cannot establish superiority over alternative modalities, and comparative studies using standardized aesthetic outcome measures remain needed.