Rhinophyma Treatment with Blue Laser

Case Report Iranian Journal of Otorhinolaryngology, Vol.37(4), Serial No.141, Jul-2025 Rhinophyma Treatment with Blue Laser Estefanía Miranda1,3, *Ithzel-María Villarreal1,2, Oscar Arenas1,3, Guillermo Plaza1,3 Abstract Introduction: Rhinophyma is a chronic skin pathology that mainly affects the nose. It is featured by thickening of the skin and soft tissue of the nose. Treatment options include topical medication, systemic drugs, electrocautery, cryosurgery, laser therapy, dermabrasion, and in some cases, surgical procedures like rhinoplasty. The aim of this report is to demonstrate the usefulness of the blue laser and its efficacy in the treatment of rhinophyma. Case Report: We report two cases of patients diagnosed with rhinophyma who underwent blue laser treatment. Conclusions: The use of blue laser to treat rhinophyma has shown to be an effective and safe procedure with very promising results. Keywords: Blue laser, Rhinophyma, Rosacea, laser therapy Received date: 20 Nov 2024 Accepted date: 02 Feb 2025 *Please cite this article; Miranda E, Villarreal IM, Arenas O, Plaza G. Rhinophyma Treatment with Blue Laser. Iran J Otorhinolaryngol. 2025:37(4):227-231. Doi: 10.22038/ijorl.2025.83754.3818 1Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos. Madrid, Spain. 2Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hospital Universitario Nstra Sra del Rosario, Madrid, Spain. 3Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hospital Universitario Sanitas La Zarzuela. Madrid, Spain. *Corresponding author: Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Hospital Universitario Nstra Sra del Rosario, Madrid, Spain. E-mail: Copyright©2025 Mashhad University of Medical Sciences. This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/deed.en 227 Miranda E, et al Introduction Rhinophyma is a chronic skin pathology that mainly affects the nose. It presents by a progressive thickening of the skin and soft tissues of the nose resulting in changes that may lead to nasal airway obstruction marked by external nasal valve collapse and consequently a loss of support of the lower two-thirds of the nose. In most cases, bone and cartilage structures are not affected (1,2). Treatment of rhinophyma includes topical medication, systemic drugs and may also include different procedures such as electrocautery, cryosurgery, laser therapy, dermabrasion and in more advanced cases, rhinoplasty. Technique The proper selection of patients is paramount. Our aim was to take advantage of the great affinity of the 450 nm wavelength of this type of laser to red structures, hence we selected patients whose condition already involved the presence of telangiectasias. A consent form was signed by each patient prior to the procedure. Rhinophyma treatment with blue laser can be performed under general anesthesia or local anesthesia (video 1) (video 2), in case of local anesthesia, topical anesthesia was applied at the office before injection (EMLA: lidocaine and prilocaine). Prior to the procedure, aseptic techniques were performed with aqueous chlorhexidine. The patient and all the operating personnel were given protective eyewear specific for the 450 nm wavelength. The blue laser parameters are selected with a manually controlled surgical handpiece (Figure 1) set at 6W power with 50 mS window and 5mS pause. The fiber used measured 600 nm diameter. The number of sessions may vary for each patient. Results should be evaluated by a medical professional at each visit. Video 1. In office procedure with local anesthesia. Video 2: Procedure with general anesthesia. Fig 1: Blue laser surgical handpiece Post-treatment pain was minimal. Our patients required only Acetaminophen. Reepithelialization takes 2 to 3 weeks, but erythema may persist for a month. Both of our patients demonstrated significant improvement in skin texture and aesthetic appearance of their noses following the first session. Case Report Case 1: A 73-year-old patient presented with bilateral nasal respiratory insufficiency. Physical examination revealed severe left septal deviation, bilateral external valve collapse leading to a severe loss of support in the lower third of the nose and rhinophyma. We decided to perform a functional septorhinoplasty with an external blue laser approach to treat the rhinophyma. During septorhinoplasty under general anesthesia the cartilaginous deviation was corrected, ANSA banner and alar rim grafts were placed. Afterwards rhinophyma treatment was performed with blue laser. One month after surgery patient reported significant functional and aesthetic improvement. A new blue laser session was performed in office under local anesthesia without complications and with adequate pain control. Four weeks after the last session, there was evidence of improvement in the telangiectasias, thickness and texture of the skin of the nose (Figure.2). 228 Iranian Journal of Otorhinolaryngology, Vol.37(4), Serial No.141, Jul-2025 Rhinophyma Treatment with Blue Laser Discussion Fig 2: Preoperative and 4-week postoperative images Case 2: A 53-year-old patient with a history of rosacea presents with skin thickening and increase in the size of the nose. Physical examination revealed no septal deviation and no valvular collapse. Nevertheless, telangiectasias, thick skin was observed. Blue laser treatment of his rhinophyma was proposed. Blue laser treatment was performed in office under topical anesthesia. The patient was evaluated one week later showing evidence of scab formed all over the lower two-thirds of the nose (Figure.3). Three weeks later resolution of the healing process was observed and no scabs or erythema were shown. Adequate pain control was assessed. Patient´s satisfaction with the improvement of the external appearance of his skin was documented. Fig 3: One week after blue laser treatment Rhinophyma is regarded as a severe stage of rosacea. It is a disfiguring affection characterized by progressive increased in size and distortion of the external nasal tissue. This condition can lead to various concerns, including functional impairments, aesthetic challenges, and psychosocial issues for affected individuals. The prevalence of rosacea is 5.46% affecting women more than men. Unlike rosacea, rhinophyma is more frequent in men, and is thought to be caused by increased androgenic activity in males (1,2). Rhinophyma affects most frequently Caucasian males in their fifth to seventh decade of life and is uncommon in the AfricanAmerican and Asian population (1-4). Our patients were both male, one in his fifth and the other one in his seventh decade. Various treatment modalities have been employed to manage rhinophyma. Among them is laser treatment. (...truncated)