Treating Rhinophyma (large swollen nose) with ER:YAG Laser

Written by on December 3, 2008 in Rhinophyma, swelling with 0 Comments

rhinophyma-er-yag Did you know that the first known rhinophyma surgery was performed by Daniel Sennert in 1629 ? Were you also aware that the proven link between rosacea and rhinophyma was established in 1846 ? Rhinophyma and rosacea sure have been with us for a long time.

Rhinophyma that is severe enough to require surgery is rare. Knowing that it is rare should firstly put you as ease. This means that most like you will never require surgery.

Before you get too far along this route, and see too many grotesque pictures on the internet, can I suggest that you read – How to cure a red swollen nose. This article offers some good non-surgical options that you can consider along with your doctor.

Should you find yourself in the situation where you do require surgery, then suddenly how it works becomes much more interesting.

For sure this sort of surgery requires careful research into the methods available from your treating surgeon.

Going back in the archives we find this 2001 paper which was published in the respected journal Lasers in Surgery and Medicine. You can also find more recent papers featuring the combined erbium:yttrium-aluminium-garnet (YAG)/CO2 laser – for eg. see the 2004 paper The Gold Standard for Decortication of Rhinophyma: Combined Erbium-YAG/CO2.

So here is the abstract for the 2001 paper;

Treatment of rhinophyma with Er:YAG laser, Lasers Surg Med. 2001;29(3):230-5. Orenstein A, Haik J, Tamir J, Winkler E, Frand J, Zilinsky I, Kaplan H.

Rhinophyma is a benign, disfiguring disorder of the nose which presents the end stage of acne rosacea, and can also occasionally result in nasal airway obstruction. We describe the first series of patients treated with Erbium laser.

Study design/Materials and Methods: Severe-to-moderate rhinophyma in six patients were treated at our institution between 1995 and 1996, using the Erbium:YAG (Erb:YAG) laser.

Results: All patients achieved marked cosmetic improvement, with no complications. Post-operative healing time was seven to fourteen days-signicantly shorter than similar other modalities.

Conclusions: The Erbium laser provides very accurate tissue ablation and allows the sculpturing of the hypertrophied areas, offering good cosmetic results, with a very short healing period as shown in our study

The laser was used in a 5mm beam diameter and a power of 1.2J, a pulse frequency of 10Hz, with up to 10 passes on the prominent lobules and 3 passes between the lobules.

The paper tells us that the post-operative redness subsided after 1 month and none of the patients required re-treatment in the following 2 years. Further “The surgical results were good to excellent. A good result was defined as an acceptable nasal contour with minimal scar formation and an excellent result was defined as normal nasal contour without clinical scarring. All patients were satisfied with their results. No post operative complications were encountered”. The patients ranged in age from 46 to 84, and their cosmetic results are listed as either good or excellent.

A gauze with diluted adrenaline was used to control bleeding, the paper also refers to the usage of a meshed Omniderm sheath. The Er:YAG offers minimal thermal damage to the neighbouring tissue.

The final conclusion of the paper was “the Er:YAG laser ideal for removal of superficial skin layers with maximum sparing of adjacent structures, short healing process and minimal and short-term redness.”

You may also like to read about a new surgical technique for rhinophyma using a microdebrider + floseal. For some more background reading see treating rhinophyma with accutane.

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About the Author

About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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