Surgical treatment of rhinophyma: a case series

Funding: None
Conflict of interest: None
Submitted on: December 23, 2025
Final decision: August 20, 2026
How to cite this article: Ishikawa GM, Motizuki AK, Morikawa NM, Brito JAGSM, Okajima RMO. Surgical treatment of rhinophyma: a case series Surg Cosmet Dermatol. 2026;18(3):e20260543.

Abstract

Rosacea is an inflammatory disease characterized by 4 clinical stages, with phymatous rosacea representing the final stage of progression. Its insidious and chronic course may result in exuberant rhinophyma associated with functional impairment, including nasal obstruction. This study reports a series of 5 cases of exuberant rhinophyma treated with electrosurgery, with satisfactory outcomes achieved after up to four treatment sessions.

Keywords: Rhinophyma; Electrosurgery; Rosacea

INTRODUCTION

Rosacea is a chronic inflammatory disease characterized by 4 clinical stages, with phymatous rosacea representing the final stage of progression.¹ This condition is characterized by hyperplasia of the sebaceous glands and connective tissue, resulting in marked skin hypertrophy; when it affects the nasal region, it is referred to as rhinophyma.² Rhinophyma is relatively uncommon and occurs more frequently in men aged > 50 years.³

Its insidious and chronic progression may result in exuberant disease associated with functional impairment, including nasal obstruction, as well as substantial aesthetic, social, and psychological effects.³ There is no established gold-standard treatment for rhinophyma. Therapeutic approaches reported in the literature include surgical techniques, carbon dioxide (CO₂) laser therapy, trichloroacetic acid peel, and systemic treatment with retinoids and antibiotics. However, surgical treatment has been described as a more definitive approach for extensive disease.⁴

Therefore, this study aimed to report a series of 5 cases of exuberant rhinophyma treated with electrosurgery, with satisfactory outcomes.

CASE REPORT

Five patients with rhinophyma followed at the dermatology department underwent electrosurgery. The surgical procedure was performed in all patients as follows:

Local antisepsis with 2% chlorhexidine digluconate.

Anesthetic block with 2% lidocaine with epinephrine administered bilaterally in the infraorbital nerve region, combined with local infiltration over the nasal dorsum.

A low-frequency monopolar electrosurgical unit (Wavetronic^® 120 Nano) was used in cut mode at a power setting of 20 W. A straight loop electrode, 3–5 mm in diameter, was used to remove the phymatous tissue, and a 3–5-mm ball electrode was used for hemostasis and contouring of the nose.

Immediately after the procedure, restoration of the nasal contour was observed, with preservation of the nasal architecture and a uniform raw surface without areas of carbonization or active bleeding, indicating adequate hemostasis (Figure 1).

An occlusive petrolatum dressing was then applied, and the wound was allowed to heal by secondary intention. In addition, oral cephalexin 500 mg every 6 hours for 7 days was prescribed to prevent secondary infection, along with collagenase/chloramphenicol ointment (0.6 U/g + 0.01 g/g) once daily until tissue re-epithelialization.

Case 1: A 60-year-old man with no comorbidities had a 16-year history of rhinophyma that had progressed to nasal obstruction. He underwent 4 sessions of electrosurgery at intervals of 3–4 months, resulting in satisfactory aesthetic and functional outcomes of the nasal dorsum (Figure 2).

Case 2: A 71-year-old man with no comorbidities and a 3-year history of rhinophyma underwent 2 sessions of electrosurgery 3 months apart, with a favorable outcome (Figure 3).

Case 3: A 67-year-old man with a 6-year history of phymatous rosacea underwent 2 surgical treatment sessions and achieved an excellent outcome (Figure 4).

Case 4: A 63-year-old man with hypertension and a 5-year history of rhinophyma underwent 2 sessions of electrosurgery involving the nasal ala, with an interval of 5 months between procedures, and achieved a satisfactory outcome (Figure 5).

DISCUSSION

Rosacea is a chronic inflammatory skin disease with a multifactorial pathogenesis. The condition involves both immune system changes and neurovascular dysfunction and frequently impairs patients' quality of life.^3-6 Epidemiologically, rosacea affects approximately 5% of the global population, predominantly individuals with lighter skin phototypes (Fitzpatrick I and II), and is more common in women.^5,6 Rhinophyma, however, has a distinct epidemiologic profile, occurring primarily in White men aged > 50 years, with reported male-to-female ratios ranging from approximately 5:1 to 30:1. Cases in men of Asian or African American ancestry have been reported but are uncommon.^5-7

Rhinophyma is considered pathognomonic of rosacea and may clinically present as skin thickening associated with erythema, edema, and telangiectasia. As the condition progresses, proliferation of fibrous tissue and sebaceous glands occurs, accompanied by accentuation of follicular openings and other structures of the nasal region.^5-8

Several therapeutic approaches for rhinophyma have been described in the literature, including laser therapy and oral isotretinoin; however, surgical excision remains a mainstay of treatment.^5,6,8 In this respect, electrosurgery represents an effective treatment option for rhinophyma because of its low cost, favorable safety profile, and relatively limited tissue trauma.^6,9,10 Moreover, this modality meets the objectives and procedural steps of excisional treatment of rhinophyma described by Oliveira et al., including removal of excess phymatous tissue, refinement of the nasal contour, achievement of hemostasis, and provision of appropriate postoperative wound care, supporting electrosurgery as one of the main treatment modalities for this condition.⁵

Major complications documented with this therapeutic modality include thermal injury to the surrounding tissue and the risk of aesthetically unfavorable scarring. Nevertheless, reported benefits include reduced tissue trauma, greater postoperative satisfaction, and improvements in functional outcomes and quality of life.^6,7,10 The cases described in this series are consistent with the literature, demonstrating excellent aesthetic and functional outcomes, as well as low treatment costs and high patient satisfaction. These findings are consistent with the favorable outcomes of similar surgical treatments reported in the medical literature.^2,4,7,10

CONCLUSION

Electrosurgery is an effective treatment option for rhinophyma, particularly in exuberant cases, such as those described in this series, and can provide high levels of patient satisfaction with both aesthetic and functional outcomes.

Case 5: A 68-year-old man with hypertension and a 5-year history of rhinophyma underwent 3 surgical sessions at 4-month intervals and showed a favorable clinical response (Figure 6).

AUTHOR'S CONTRIBUTION:

Geovanna Mourão Ishikawa
ORCID: 0000-0001-6404-6938
Approval of the final version of the manuscript, Preparation and writing of the manuscript, Acquisition, analysis and interpretation of data, Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied, Critical review of the literature, Critical revision of the manuscript.
Airton Kenji Motizuki
ORCID:
ORCID: 0009-0002-7188-0984
Approval of the final version of the manuscript, Preparation and writing of the manuscript, Critical revision of the manuscript.
Natalia Megumi Morikawa
ORCID: 0000-0001-9533-3307
Approval of the final version of the manuscript, Preparation and writing of the manuscript, Critical revision of the manuscript.
João Augusto Gomes de Souza Monteiro de Brito
ORCID: 0000-0001-7286-7066
Approval of the final version of the manuscript, Preparation and writing of the manuscript, Critical review of the literature.
Renata Mie Oyama Okajima
ORCID: 0000-0003-2168-5515
Approval of the final version of the manuscript, Conception and design of the study, Preparation and writing of the manuscript, Effective participation in the conduct of the study, Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied, Critical review of the literature, Critical revision of the manuscript.

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