Deep excision

Even if total excision techniques have been used less in the past few years, a combination of deep excision and single-step replacement of epidermal–dermal components with a dermal substitute covered by split‑thickness autologous skin graft was described. This surgical option, owing to the deep excision that facilitates complete removal of diseased tissue, may ultimately avoid the recurrence of rhinophyma and contribute to a full skin repair leading to satisfactory functional and aesthetic outcome33.


Patients with rhinophyma usually seek assistance because of cosmetic disfigurement and nasal obstruction. The ‘ideal’ treatment should be characterised by minimal bleeding, allowing accurate removal of the diseased tissue to the desired depth, without risk of exposure of any underlying osteocartilagineous structures, in case of excessive and/or defective removal, or risk of recurrence27. The need for histologic evaluation of excised tissue is generally accepted, because of the risk of malignancies associated with rhinophyma16.

Although many treatment options have been described, there is no agreement on the ideal treatment for rhinophyma. However, it is generally accepted that surgery offers the only chance of cure by removing the hypertrophied tissue. Most of the described techniques demonstrated specific advantages and disadvantages, and no single method seems to be free of complications, with all carrying a degree of morbidity. Many authors have described a combination of treatment methods that work complementarily, decreasing complication rates, and improving cosmetic and functional outcomes.

In the authors’ experience, the use of combined techniques represents the right choice among the wide spectrum of available surgical options for rhinophyma management. This is particularly valid in case of severe rhinophyma, which requires the excision of a large amount of diseased tissue with higher risk of recurrence, higher intraoperative and postoperative complication rates (bleeding, pain, unpleasant scars), and difficult shape contouring for preserving the aesthetic unit of
the nose.

The technique currently preferred by the authors is decortication through a combined use of cold scalpel (which allows an accurate removal of rhinophymatous tissue) and electrocautery (which is really useful to control the bleeding). From their clinical experience it seems to be a reliable, safe, and quick method for rhinophyma correction.