While many individuals may fear the growth of excess tissue on the nose that often heralds subtype 3 rosacea (phymatous rosacea), a bulbous enlarged nose need not be permanent. Today, surgical methods such as electrocautery and laser surgery may be used to take away the distorted shape and bring back a normal appearance.
"The process is not so much a restoring of the exact nose shape before the disfiguring changes as a sculpting to remove the excess tissue," said Dr. Ronald Moy, associate clinical professor of dermatology at the University of California-Los Angeles and president-elect of the American Society for Dermatologic Surgeons.
"The result will depend on the thickness of the excess skin," said Dr. Moy. "I have people bring in a picture of what they looked like before. Although the finished nose may not look exactly like it did, it can look normal again and most patients are very pleased with the results."
Dr. Moy said he prefers to use the CO2 laser, which heats the tissue and seals off the blood vessels, making for a bloodless procedure. It is more precise than the electrocautery, a burning device that also may be used to resculpt the nose, he said. There is a small chance of scarring with both procedures depending on the depth of skin removed.
The laser procedure is performed under a local anesthetic, and the complete healing process may take up to several months, Dr. Moy said. In the first two weeks after surgery, the nose will appear very red and sore, although it looks worse than it feels and few patients report much pain.
He said there may still be redness after two weeks, but it will taper off and disappear over time. He cautioned that, depending on the depth of tissue to be removed, 1 to 2 percent of individuals may have some scarring.
Enlargement of the nose, known as rhinophyma, may develop when recurrent inflammation - the bumps and pimples of rosacea - leads to the growth of excess tissue. Though this may develop elsewhere on the face, it typically appears on the nose and occurs more frequently in men.
According to Dr. Moy, the best solution to the problem of rhinophyma is to avoid it in the first place if possible.
"Inflammation can make the nose get thick pretty easily," he said. "Though rhinophyma itself may not respond to oral antibiotics or topical therapy for rosacea, such treatment is effective against the inflammation and thus may prevent the excess tissue growth before it begins."
He advises patients with very mild rhinophyma to forgo surgery and instead rely on preventive treatment unless it becomes worse.