ARTICLE Surgical Treatment of Rhinophyma Shaun Kilty ; and Peter Brownrigg Rationale: Rhinophyma is a slowly progressive, disfiguring disease of the nose. A variety of surgical techniques have been described for its management, which have had varying success. Objective: To describe the technique and results of the senior author (P.B.) using electrocautery decortication and/or CO 2 laser contouring in seven consecutive patients with rhinophyma by retrospective review. Design: A retrospective case series of seven consecutive adult patients treated from 1999 to 2005 inclusive. Methods: A retrospective chart review was conducted of the seven patients treated at the local tertiary care centre over a 6-year period. Results: In the seven consecutive patients who were operated on by the senior author, all had been previously diagnosed with acne rosacea. Five patients had moderate and two had major rhinophyma. Five patients (71%) had an excellent or very good result using the described technique. Conclusion: Electrocautery nasal decortication and/or CO 2 laser contouring in patients with rhinophyma is an effective technique that results in a satisfied patient with an aesthetically suitable nose. Caution should be exercised when vaporizing tissue in the nasal alar region with a CO 2 laser to prevent postoperative alar retraction. Key words: CO 2 laser, electrocautery, rhinophyma R hinophyma is a slowly progressive disfiguring disease of the nose. It is characterized by reddish to purple skin discoloration, a lobulated bulbous appearance, and comedones. It most commonly affects white men after the age of 30 years. 1 The etiology of rhinophyma is not well understood, although it may represent the end stage of acne rosacea. 2 Interestingly, rosacea is more common in women. 1 Treatment in the early stages of rosacea and rhinophyma is often attempted with medical therapy, mainly topical or systemic antibiotics. However, definitive treatment of the resultant nasal deformity is surgical. A range of surgical techniques have been described, including chemical peels and dermabrasion, blade excision with or without a skin graft, excision with a forehead flap, laser (CO 2 , erbium:yttrium- aluminum-garnet [YAG] or neodymium:YAG) vaporization, and the use of a microde ´brider. We describe both the senior author’s (P.B.) technique and the results of rhinophyma treatment using electrocautery decortication and/or CO 2 laser contouring in seven consecutive patients. Materials and Methods We performed a retrospective chart review of the seven consecutive patients who underwent nasal reduction surgery for rhinophyma with electrocautery decortication and/or CO 2 laser contouring from 1999 to 2005 inclusive. The severity of the nasal deformity was assessed using the grading system devised by El-Azhary and colleagues. 3 Patient skin type using the Fitzpatrick scale 4 was recorded, as was each patient’s level of alcohol consumption. Any occurrence of cancer was extracted from the final pathology report. The outcome of the treatment was assessed using the scale devised by Har-El and colleagues. 5 This scale incorporates the subjective response of the patient with the objective observations of the surgeon. The postoperative complications that were assessed in this study were hypertrophic scar, alar rim retraction, skin pigment changes, dilated follicles, bleeding, and infection. Revision procedures were performed on patient request with surgeon confirmation of rhinophymatous change that could be improved with further laser treatment. A minimum of 3 months was allowed to pass after any treatment prior to the assessment for revision surgery. All patients had surgery under a general anesthetic. After induction, 1% lidocaine with 1:100 000 epinephrine solution was injected into the nasal dorsum and nasal tip. Each patient received both intraoperative and postopera- The Journal of Otolaryngology JOT_2008_0056.3d 11/2/08 10:36:34 The Charlesworth Group, Wakefield +44(0)1924 369598 - Rev 7.51n/W (Jan 20 2003) Received Shaun Kilty and Peter Brownrigg: Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, Ontario. < Address reprint requests to: DOI 10.2310/7070.2008.0056 The Journal of Otolaryngology, Vol 37, No 3 (May/June), 2008: pp 000–000 1