Which Co2 Laser is Best for Rhinophyma

Rhinophyma is currently thought to be a severe form of acne rosacea. There is bulbous enlargement of the nose with a ruddy complexion & numerous pits along the surface. The sebaceous glands of the nose increase in size & number with each surface pit being the mouth of a gland. Although the disease is benign superficial skin infections are characteristic with drainage of foul smelling material.

In the early stages accutane may help shrink the sebaceous glands but could adversely effect future surgical treatment of the disease. For more marked disease the treatment is full thickness excision with skin grafting or tangential (partial thickness) excision allowing the skin to heal without grafting. Some surgeons prefer laser excision citing less bleeding among other reasons. Having seen & tried various modalities I think tangential excision with a scalpel under local anesthesia is best. The nature of laser excision makes this technically more  difficult with laser which works from the surface downward rather than tangentially. The nose heals within a week or 2 as the surface is repopulated by cells from the depths of all those pits. After it heals over the nose will be red for some months. This redness resolves on its own but its resolution can be quickened with the use of a flashlamp laser or covered in the interim with makeup.

Since the disease is not curable control in the early stages or after surgical excision & healing is of paramount importance to prevent recurrence. This involves continued use of oral tetracycline antibiotics at least a few times a week or topical application of metrogel antibiotics & meticulous skin cleansing. This prevents recurrence but is of no use in treating or decreasing the size of a rhinophyma.

I have just uploaded a before and after photo from aaronstonemd.com/rhinophyma.shtm to the realself website.

Rhinophyma is a form or dramatic sebaceous gland overgrowth, leading to lobulated growths on the nasal dorsum and tip (ie WC Fields).  There are a number of ways to address this problem surgically, which can include excision and cautery, cautery loop, Dermabrasion, and CO2 laser.  I personally prefer to use a combination of excision, cautery and Dermabrasion.  Both the Ultrapulse and Fraxel are very good lasers; the Ultrapulse is a totally ablative CO2 laser and the Fraxel repair is a fractionated CO2 laser.  Rhinophyma requires fairly aggressive treatment, with appropriately high settings on either laser. What is most important is the Surgeon performing the procedure and not the brand of laser.

The brand does not matter, but the skill set and the method does. See video for more on rhinophyma laser and how it is done. I usually combine several lasers, even surgery to help sculpt the nose of rhinophyma patients. All the bestDr Davin LimLaser DermatologistBrisbane, Australia.