Rhinophama: Rhinophyma is a progressive, disfiguring disease of the nose which represents an end stage of rosacea. This cosmetically annoying condition almost exclusively affects white men. The rhinophyma pattern presents as an erythematous lobulated nasal tip with a seborrheic discharge and multiple large vessels, primarily involving the lower two-thirds of the nose.

Therapy:
There are many techniques available to treat and reduce rhinophyma; however, the UltraPulse CO2 laser used in the collimated beam mode is the treatment of choice. I have used various laser treatments since 1979 for treating rosacea. The current method the last few years has created excellent results with a high patient satisfaction.

Past treatment techniques have included:

• Excision with or without grafting
• Heating scalpel excision (Shaw scalpel)
• Ultrasonic scalpel
• Electro cautery excision
• Dermabrasion Cryosurgery
• Chemical peels
• Combination of any of the above

Current treatment technique:

1. Patient is sedated and prepared with antibiotics and anti-virals orally.
2. Block anesthetic is used to completely anesthetize the nose so the patient has no discomfort while the laser treatment is proceeding.
3. First step is to eliminate any of the larger vessels with the Vasculight & long-pulsed YAG laser.
4. Second step is a combination of UltraPulse CO2 laser in a collimated beam mode feathered with Erbium YAG laser.

Goals of rhinophyma therapy:

1. To remove all the excessive rhinophyma tissue creating an even contour to the nose.
2. Create one color , texture and tone to the lower 2/3 of the nose that is involved.
3. Feathering and blending the edges so that the transition zone is not detectable once the healing has taken place.
4. Pre-existing active rosacea lesions are easier to manage and control after the rhinophyma laser surgery.

SKIN CARE FOR ULTRAPULSE LASER RHINOPHYMA

1. Leave dressing in place for 3 days. If dressing falls off start soaking phase early.
2. The end of your nose will not be covered with a dressing. You should keep this resurfaced skin moist at all times using the prescribed antibiotic ointment. (Do not use Polysporin, Bactroban, Fucidin etc.)
3. On day 3 get in shower and soak your dressing off. Do not rip them off. It will fall off or gently lift it off. Your nose will be red!

Now the soaking phase starts. You will have to soak your nose every 3-4 hours for about 5-10 minutes at a time. To soak:

1. Fill a large mixing bowl with warm tap water and add a "splash" of white vinegar. Approximate proportions (1cup:1 tsp).
2. Submerge a thin face cloth in vinegar and water solution and soak and gently rub your new skin being careful to get old skin off. Do not rub so hard that you bleed. Although with the nose some bleeding is normal; just hold pressure on it until it stops.
3. Blot area dry with a clean towel and apply a thin layer of the prescription antibiotic ointment.

You do not have to soak over night but keep your nose moist at all times even if it means using your ointment 20 times daily. This is the routine you will follow until we see you again at one week. Then we will assess you and discuss a new routine for you to follow.

SUMMARY

1. Leave dressing on for 3 days.
2. Keep tip of nose moist with ointment prescribed.
3. Remember you will "ooze" under your dressing. The edges of your dressing will turn yellowish and drainage may run down chin or cheeks. This is normal and part of the healing process. Again even small amounts of blood is normal.
4. Stay positive and think of your end results!