ABSTRACT
Rhinophymas are characterized by slowly progressive enlargement of the nasal skin
that will not resolve spontaneously. The usual indication for treatment has plastic
cosmetic and functional reasons, above all in advanced cases with an obstruction of
the nasal respiration or reduction of the visual field. Treatment of rhinophyma consists
of surgical removal of the hyperplastic alterations. It should always be carried out
by an experienced rhinosurgeon, because of possible complications and injury to the
more deeply situated nasal structures. Different surgical procedures have been described,
such as excision with primary suture or extirpation with plastic covering of the defect
by free transplants, subcutaneous rhinophyma resection, as well as decortication with
peeling off the proliferations, dermal abrasion, or dermal shaving. In addition, there
are various abrasion procedures with abrasive cylinders, burrs, or wire brushes. The
methods of exfoliation and abrasive polishing can be effectively combined. Care should
be taken to preserve follicular epidermal islets from the more deeply situated layers
of the skin. The follicular epithelium left behind is the point of departure for re-epithelization
of the wound surface. If decortication is too deep, injuries to the perichondrium
or the nasal cartilage may arise, leading to cosmetically unattractive scar formations
and necessitate plastic surgery. The author's own method, which involves a combined
procedure with peeling or dermal abrasion, remodeling with abrasive cylinders, as
well as preoperative injection into the nasal tumor masses and a subsequent covering
of the wound area with fibrin glue, is shown with reference to several examples of
more than 60 cases. The cosmetic and long-term results are excellent.
KEY WORDS
Rhinophyma surgery - dermabrasion - dermashaving - fibrin glue
