Radiofrequency electrosurgery of severe, extensive rhinophyma: A case series

Dear Editor, Rhinophyma is a severe form of acne rosacea that affects the nasal soft tissues.1-3 This dermatological condition most commonly Northern European males in their fifties to seventies.3 presents clinically with sebaceous gland hypertrophy erythematous changes and potential telangiectasias.2 In cases, patients can develop scars, fissures, pits, distortion, secondary airway obstruction.1, 2 Other associated complications include psychosocial morbidity, chronic infection, neoplasm development advanced nodular disease.4, 5 The exact etiology pathophysiology rhinophyma are unclear, but smoking, alcohol, hot beverages, mental stress, ultraviolet light, Helicobacter pylori Demodex Folliculorum infection may play role.1 Though benign, its stigmatization functional limitations highlight need for early detection aesthetic treatment.4 has low likelihood spontaneous regression.6 Nonsurgical interventions radiation oral topical therapy, effects limited.6 Surgical treatment accepted modality established aims excise hypertrophied tissue, recontour affected control intraoperative bleeding, minimize postoperative complications.7 laser scalpel excisions, electrosurgery.7 There no gold-standard treatment.7 Surgeons perform procedures based on preference considerations operative time, tissue sample preservation, scarring, achieving hemostasis.8-10 Herein, we describe three cases radiofrequency electrosurgical excision extensive under local anesthesia. Due lack consensus preferred treatment, seek review literature outline benefits drawbacks this technique compared current modalities rhinophyma. Three male were referred plastic surgery identified (Table 1).11 On physical exam, all received grade 3 or 4 severity index had attempted conservative medical minimal success (Figures 1-3). All given bilateral infraorbital nerve blocks followed by field block diluted Xylocaine 1% epinephrine. entire mid face was prepped Betadine draped sterile fashion. Elman Surgitron model FFPF loop hand piece used electrodesiccation serial shave excisions. Hemostasis achieved standard electrocautery unit. procedure lasted 60 min, tolerated well (Figure 4). recovered without use analgesics returned work normal activities within weeks. One patient encountered mild which required cauterization bleeding well-controlled did not recur. Pathology analysis specimens confirmed benign Postoperative follow-ups ranged from 40 100 days 5-7). satisfied outcome experience recurrence post-operative at latest follow up. case series documents cost-effective electrosurgery anesthesia excellent results. significant impacts does respond therapies.6 Multiple surgical approaches have been described, there mainstay management condition.6, 8-10 Our advocates using as approach rhinophyma, it quick precise method effective hemostasis.6, 9 Ellman light portable device suitable an outpatient setting.9 Aferzon Millman reported treated general good recovery.9 However, age multiple comorbidities, such type diabetes obstructive sleep apnea, increased risk adverse during anesthesia.12, 13 Performing would provide analgesia improved side-effect profile, reduce costs, allow flexible scheduling.14 Electrosurgery several advantages over widely CO2 laser.6, 8 ablation, highly reliant clinical experience, yield biopsy specimen.8 lower scarring hypopigmentation yields specimen rule out malignancy.1 also uncontrolled unfavorable occur excisional approaches.6 main disadvantage lateral heat accumulation adjacent tissues thermal injury.11 minimizes outputting frequency 3.8–4 MHz, optimal producing less supports performed affecting nose cheeks. From our patients’ satisfactory, effective, efficient, cost, require operating room. report adds limited body evidence follow-up various time points comprehensively displays painless recovery. third case, experienced warranted reoperation culprit vessel. While due his history hypertension, importance hemorrhage Surgitron's coagulation mode electrocautery, pressure dressings, education should be emphasized future procedures.15 Following re-operation, additional complications. senior author numerous technique, outcomes satisfaction rates. As series, findings generalizable different severities histories. Future studies needed determine definitive stages research specific grant any funding agency public, commercial, not-for-profit sectors. authors declare conflict interest. Consent publication photographs information provided letter submission journal stating gave consent published print online understanding publicly available. Data sharing applicable article new data created analyzed study.