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Reshape Nose Without Surgery
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Question: I am noticing that the skin on my nose is beginning to look a little
irregular. I think it may be early rhinophyma. What can I do about
it? Is it reversible without surgery at this point?
Answer: True rosacea rhinophyma is hard to treat. Rhinophyma is caused by
several factors and usually requires a multifaceted approach....or
else your doctor will just wait until it is large enough to reshape
(I know...unacceptable).
The Pathophysiology:
The nose has the greatest density of sebaceous glands and blood
vessels.
1. Flushing brings androgen hormones to the sebaceous glands --
this increases the number and size of sebaceous glands. It also
increases sebaceous gland secretions.
2. There is then a contortion of the blood vessels around the
abnormal sebaceous glands -- this causes more fluid build up.
3. Sebaceous gland growth traps in bacteria, fungi and demodex
which all have an irritating action.
4. After a long time of intermittent swelling fibrosis sets in.
The treatment:
1. Low dose accutane is by far the best treatment
2. Laser therapy helps considerably
3. ORal spironolactone for females decreases androgen stimulation
of sebaceous glands; propecia and avodart decrease androgen
stimulation of sebaceous glands in men and has recently been
discussed in a rosacea review article.
4. If fibrosis is starting to set in then a dilute injection of
steroid and immunosuppressive directly into the center of the
fibrosing tissue.
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