Rhinophyma is considered to be the final stage of rosacea and has an unknown aetiology. We present two new surgical adjuncts for the treatment of this condition. The microdebrider is easy to use and allows precise contouring of the nose. It shares the same underlying principle as free-hand scalpel shaving but outperforms this method in key areas. We also describe a novel use for FloSeal®, a gelatin-thrombin co-mixture, utilizing its haemostatic properties to address bleeding from the re-shaped denuded nose.

Rhinophyma is a slowly progressive, disfiguring disorder of the nose which represents the end stage of acne rosacea. The cosmetic deformity is often the reason for patients to seek medical attention. Over the years many treatment modalities, including dermabrasion, electrocautery, excision and grafting, decortication and cryosurgery amongst others, have been described to treat this condition, but none of them are very satisfactory. Special concern about the droplet dispersion of blood in dermabrasion have made this method less acceptable as it poses a potential risk to health workers.

We describe a technique in which this proliferative disorder can be treated, using carbon dioxide laser excision and vaporization. This method provides a very dry surgical field which allows the sculpting of the hypertrophic areas to be very effective, giving a very satisfactory cosmetic result.