Erbium Yag or Fraxel for Rhinophyma?

I'm beginning to show signs of Rhinophyma. There are a few nodules on one side of nose and some thickening on tip of nose which I absolutely hate. Which of these two lasers, Erbium Yag or Fraxel, would improve my condition? These two seem, from what I have read, have less downtime than the CO2. Thank you for responding. I am on Tazorac and cream antiobiotic. It helps somewhat but my main concern is the thickening on end of nose.

Doctor Answers 7

Erbium Yag or Fraxel for Rhinophyma?

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Hi Barbara,

You should treat rhinophyma with CO2 ablative laser.  I have not been impressed by the results of Fraxel re:store or re:pair on rhinophyma.

Good luck and be well.

Dr. P

Encino Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

CO2 or erbium is preferred

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We have all 3 lasers that you have mentioned in your question, and my 1st choice would be the CO2 laser. The Fraxel is not designed to target individual nodules, so it is not ideal. The erbium could be used, but the downtime would be the same as the CO2. I just submitted some photos of a patient with the issue that you are concerned about to RealSelf, and I treated him with CO2 on the nose, and Fraxel Repair on the rest of the face. Look for them under my name of photos of Fraxel Repair...should be up in next 2 days. Take care, Dr. Groff

Fraxel and Erbium Laser For Rhinophyma

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Ablative lasers work well for rhinophyma, as this is a proliferative condition of the sebaceous glands of the nose.  In some cases, less invasive and simpler other modalities are used to treat rhinophyma such as CO2 laser, chemical peels, and surgery.

Rhinophyma treatment options

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It is best to have an in-person consultation to develop a the best individualized treatment for you.  That being said, I typically use electrosurgery to shave down the bigger nodules and reshape with the ablative laser. Both C02 and Erbium are ablative lasers and both work equally well. Sometimes in the early stages of Rhinophyma the fractional lasers can be used and can improve the more subtle early signs of the problem and prevent it from becoming worse. There is really a lot of improvement that can be made at all stages of rinophyma. 

Laser Treatment of Rhinophyma

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It all depends on the agressiveness of the treatment - settings of power, intensity, number of passes etc.
The Confluent CO2, Fraxel Re:pair, or Erbium in the right hands can all improve the appearance of a Rhinophyma.

Neither- CO2

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Rhinophyma is an uncommon form of rosacea seen mainly in men and is due to excessive fibrous tissue. If phyma is very mild, you can get away with Erbium Yag resurfacing (providing you have modulated coag such as Scition), but invariably you will have alot of tissue bleeding. Fraxel simply doesn't remove enough tissue for it to be effective. 

The answer is CO2 Laser, this ablates or vapourises tissue to an accurate depth, plus seals off the blood vessels. It reshapes, renews, and rejuvenates, and is an excellent tool to treat rhinophyma. 

Davin S Lim 
Consultant Laser Dermatolog

Rhinophyma Laser Treatments

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You are doing great to get a head start on the problem .  If you are developing nodules already then using any type of fractionated laser may not achieve your desired results.  I use the erbium yag laser in full ablation mode for most of my rhinophyma patients and can balance the downtime with results by fine tuning the depth of the treatments.  With this laser we can achieve dramatic results and it has been shown to heal quickly and carry less risks of scarring and discoloration.  But just remember all lasers in the wrong hands can scar so be sure to have someone experienced doing your treatments for this condition.

Shawn Allen, MD
Boulder Dermatologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.