Disposable Hemi-Blade Decortication and Dermabrasion in the Management of Rhinophyma
Seance of wednesday 28 april 2021 (Communications libres)
DOI number : 10.26299/9c14-2a90/emem.2022.1.004
Abstract
Rhinophyma is a slow-growing and disfiguring disease of the nose, considered as the final stage of rosacea. It is characterized by sebaceous gland hyperplasia, telangiectasia and dermal fibrosis. It affects Caucasian male patients, the male-to-female sex ratio is 5 to 30:1. The role of alcohol intake has been debated for many years.
No medical treatment is effective. Many procedures can be proposed to the patients: surgical techniques, laser, cryosurgery, radiofrequency. There is no ideal one and the rhinophyma may recur.
We report a simple, safe, cost-effective surgical approach: the sculpting decortication and recontouring with a disposable hemi-blade followed by dermabrasion. We emphasize the use of the tumescent local anesthesia associated with a light sedation, which decreases the per-op bleeding allowing the procedure to patients with blood thinners. The key point for achieving good outcomes is to perform a tangential excision that reaches the pilosebaceous units from which the new epithelium will regenerate. A deeper penetration would result in scar formation. There is no thermal damage, the defect healing by secondary intention with alginate hemostatic pressure dressing for 3 to 4 days, changed every day, and then petrolatum ointment. The results are good: no achromia and pore enlargement are sparse compared to other techniques.
No medical treatment is effective. Many procedures can be proposed to the patients: surgical techniques, laser, cryosurgery, radiofrequency. There is no ideal one and the rhinophyma may recur.
We report a simple, safe, cost-effective surgical approach: the sculpting decortication and recontouring with a disposable hemi-blade followed by dermabrasion. We emphasize the use of the tumescent local anesthesia associated with a light sedation, which decreases the per-op bleeding allowing the procedure to patients with blood thinners. The key point for achieving good outcomes is to perform a tangential excision that reaches the pilosebaceous units from which the new epithelium will regenerate. A deeper penetration would result in scar formation. There is no thermal damage, the defect healing by secondary intention with alginate hemostatic pressure dressing for 3 to 4 days, changed every day, and then petrolatum ointment. The results are good: no achromia and pore enlargement are sparse compared to other techniques.