The goal of this study is to review the current literature on severe rhinophyma requiring operative management for significant cosmetic deformity or nasal obstruction. We aim to provide a treatment algorithm for the various surgical techniques employed in the treatment of severe rhinophyma.
Methods:
Independent searches of the PubMed and MEDLINE databases were performed. Articles from the period of 2010 to 2020 were collected. All studies which described surgical treatment of severe rhinophyma using the Boolean method and relevant search term combinations, including “rhinophyma,” “severe,” “operative” and “surgery” were collected.
Results:
A total of 111 relevant unique articles met criteria for eligibility analysis. Of these, 85 articles were deemed inappropriate for the literature review due to exclusion criteria. The remaining 26 articles were included in the literature review. Due to variability in study design and outcome measures, formal synthesis of data in the form of a meta-analysis was not possible.
Conclusions:
Severe rhinophyma may present a reconstructive challenge to reestablish normal contour and patent nasal airway. Significant deformity necessitates surgical correction. The present article reviews the current literature and provides a summary and stepwise explanation of established surgical techniques for addressing the cosmetic and functional deficits these patients encounter.
KubanovAGallyamovaYKravchenkoA. Clinical picture, diagnosis and treatment of rosacea, complicated by Demodex mites. Dermatol Reports. 2019;11(1):7675.
6.
FisherWJ. Rhinophyma: its surgical treatment. Plast Reconstr Surg. 1970;45(5):466–470.
7.
MarksR. Concepts in the pathogenesis of rosacea. Br J Dermatol. 1968;80(3):170–177.
8.
LazzeriDLarcherLHuemerGM, et al.Surgical correction of rhinophyma: comparison of two methods in a 15-year-long experience. J Craniomaxillofac Surg. 2013;41(5):429–436.
9.
El-AzharyRARoenigkRKWangTD. Spectrum of results after treatment of rhinophyma with the carbon dioxide laser. Mayo Clin Proc. 1991;66(9):899–905.
10.
FurukawaMKanetouKHamadaT. Rhinophyma in Japan. Int J Dermatol. 1994;33(1):35–37.
11.
SchweinzerKKoflerLSpottC. et al.Surgical treatment of rhinophyma: experience from a German cohort of 70 patients. Eur J Dermatol. 2017;27(3):281–285.
12.
NewellRMarksI. Phobic nature of social difficulty in facially disfigured people. Br J Psychiatry. 2000;176:177–181.
13.
MacgregorFC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesthetic Plast Surg. 1990. 14(4):249–257.
14.
SadickHGoepelBBerschCGoesslerUHoermannKRiedelF. Rhinophyma: diagnosis and treatment options for a disfiguring tumor of the nose. Ann Plast Surg. 2008;61(1):114–120.
15.
MoherDLiberatiATetzlaffJAltmanDG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–1012.
16.
SomogyváriKBattyáNiZMóRiczPGerlingerI, et al.Radiosurgical excision of rhinophyma. Dermatol Surg. 2011;37(5):684–687.
17.
RørdamOMGuldbakkeK. Rhinophyma: big problem, simple solution. Acta Derm Venereol. 2011;91(2):188–189.
18.
MarcascianoMVaiaNRibuffoDTaralloMCiaschiS. Rhinophyma: “less is more” and “old is gold”. Aesthetic Plast Surg. 2017;41(1):232–233.
19.
PradoRFunkeABrownMMelletteJR. Treatment of severe rhinophyma using scalpel excision and wire loop tip electrosurgery. Dermatol Surg. 2013;39(5):807–810.
20.
Husein-ElAhmedHArmijo-LozanoR. Management of severe rhinophyma with sculpting surgical decortication. Aesthetic Plast Surg. 2013;37(3):572–575.
21.
GonzálezLFHerreraHMottaA. Electrosurgery for the treatment of moderate or severe rhinophyma. Actas Dermosifiliogr. 2018;109(4):e23–e26.
22.
GötkayFErfanGÇelikNS, et al.Early cosmetic results and midterm follow-up findings of rhinophyma patients treated with high-frequency electrosurgery and a discussion on the severity assessment of the disease. J Cutan Med Surg. 2017;21(3):221–226.
23.
GreaneyLSinghNPRobertsDN. Surgical management of rhinophyma. Clin Otolaryngol. 2010;35(2):158–159.
24.
LazzeriDAgostiniTSpinelliG. Optimizing cosmesis with conservative surgical excision in a giant rhinophyma. Aesthetic Plast Surg. 2013;37(1):125–127.
25.
LittleSCStuckerFJComptonAParkSS. Nuances in the management of rhinophyma. Facial Plast Surg. 2012;28(2):231–237.
26.
HofmannMALehmannP, Physical modalities for the treatment of rosacea. J Dtsch Dermatol Ges. 2016;14(Suppl 6):38–43.
27.
ClarósPSarrMCNyadaFBClarósA. Rhinophyma: our experience based on a series of 12 cases. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(1):17–20.
28.
ChellappanBCastroJ. Management of severe rhinophyma with electrocautery dermabrasion—a case report. Int J Surg Case Rep. 2020;72:511–514.
29.
HassaneinAHCatersonEJErdmann-SagerJPribazJJ. The subunit method: a novel excisional approach for rhinophyma. J Am Acad Dermatol. 2016;74(6):1276–1278.
30.
HassaneinAHVyasRMErdmann-SagerJCatersonEJPribazJJ. Management of rhinophyma: outcomes study of the subunit method. J Craniofac Surg. 2017;28(3):e247–e250.
31.
WolterAScholzTLiebauJ. Giant rhinophyma: a rare case of total nasal obstruction and restitutio ad integrum. Aesthetic Plast Surg. 2017;41(4):905–909.
32.
HomDBHarmonJ, Dermabrasion for scars and wire loop electrocautery for rhinophyma. Facial Plast Surg. 2019;35(3):267–273.
33.
FinkCLackeyJGrandeDJ. Rhinophyma: a treatment review. Dermatol Surg. 2018;44(2):275–282.
34.
WetzigTAverbeckMSimonJCKendlerM. New rhinophyma severity index and mid-term results following shave excision of rhinophyma. Dermatology. 2013;227(1):31–36.
35.
Al HamzawiN.KAl BaajSM. Large rhinophyma treated by surgical excision and electrocautery. Case Rep Surg. 2019;2019:2395619.
36.
WójcickaKZychowskaMYosefTSzepietowskiJ. Tangential excision followed by secondary intention healing as a treatment method for giant rhinophyma-simple, safe, and effective. Dermatol Surg. 2019;45(6):859–862.
37.
GuptaMSinghGGuptaM. Severe rhinophyma treated by shave excision and electrocautery. BMJ Case Rep. 2020; 13(1):e232973.
38.
SarifakiogluNSarifakiogluE. Simple, easy, and still effective treatment option in severe rhinophyma: shave and paste. Dermatol Ther. 2013;26(2):168–169.
39.
FerneiniEMBankiMPalettaFFerneiniCM. Surgical management of rhinophyma: a case report and review of literature. Conn Med. 2014;78(3):159–160.
40.
TortorellaRMoriERovestiM, et al.Huge rhinophyma in a complicated patient successfully treated with CO. Dermatol Ther. 2019;32(3):e12850.
41.
StewartMGWitsellDLSmithTLWeaverEMYuehBHannleyMT. Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130(2):157–163.
42.
FloydEMHoSPatelPRosenfeldRMGordinE. Systematic review and meta-analysis of studies evaluating functional rhinoplasty outcomes with the NOSE score. Otolaryngol Head Neck Surg. 2017;156(5):809–815.
43.
RheeJSSullivanCDFrankDOKimbellJSGarciaGJ. A systematic review of patient-reported nasal obstruction scores: defining normative and symptomatic ranges in surgical patients. JAMA Facial Plast Surg. 2014;16(3):219–225. quiz 232.
