Rhinophyma/Nose Scarring - what treatments can help with these two concerns? (Photo)

Question

I am a 25 year old dark skinned female (Fitzpatrick IV?) I was officially diagnosed with rhinophyma in 2021 but have been dealing with it since 2009. I would like to get laser surgery for my condition. None of the dermatologist recommended creams have worked. I am aware of the risks of lasers on my skin type but I am not concerned about hypo/hyperpigmentation. I am mainly concerned with the ridiculous shape and texture. What treatments can help with these two concerns?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Thanks for your questions and photos. CO2 laser resurfacing works very well for rhinophyma but there is a risk in higher Fitz patients of pigmentation issues. It sounds like you are not concerned with that, though, so it may be a good option. Cold-steel techniques, which involves shaving the skin to a new shape, can also be employed. I would visit with a facial plastic surgeon to see what option may be the best. Hope that helps!

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