combination surgical excision and fractional carbon dioxide laser for treatment of rhinophyma

rhinophyma is a severe late complication of rosacea, which is characterized by progressive hyperplasia of sebaceous glands and connective tissue involving the lower two-thirds of the nose. it can be an emotionally devastating disorder, and serve as a medium for occult cancers and other health problems. many surgical treatments have been advocated, as well as dermabrasion and laser therapy. in light of the problems faced with these individual therapy modalities, we advocate a combination therapy of surgical debulking and fractionated carbon dioxide laser therapy. by excising the tissue first, we not only decreased the amount of time needed for the procedure, we were also able to preserve a histopathologic specimen that can be examined for occult cancers. after debulking, the fractionated carbon dioxide laser is then used to blend. by using fractionated carbon dioxide, we avoided the complications associated with non-fractionated carbon dioxide lasers, such as delayed healing times, hypopigmentation, hyperpigmentation, scarring, and persistent redness. we report our experience in two patients with rhinophyma who underwent a combination of surgical excision and fractional co2 laser therapy for treatment. pre- and postoperative protocols and treatment parameters are discussed. both patients had excellent cosmetic and functional results and were followed for at least one year.