Cosmetic Surgery Tips

Co2 Laser For Bulbous Nose

If you have a bulbous nose, you are aware of how tough it is to keep warm on your face. If you want to avoid looking like a mummy, you can wrap your scarf around your face numerous times. But what do you do if you don’t want to?

We do have some good news for you, though. The CO2 laser for bulbous noses is a new laser procedure that may be of assistance. Your nose will look less bulbous and more appealing after receiving this treatment, which helps remove extra skin from the tip of your nose. The best thing is that it only takes a short amount of time and doesn’t include any painkillers or post-operative recovery (though we do encourage taking some time off work).

Check out what the CO2 laser for bulbous noses has to offer today if you’re interested in permanently getting rid of those extra-large nostrils!

This post also talks about rhinophyma laser treatment cost and co2 laser nose pores.

Co2 Laser For Bulbous Nose

Rhinophyma, a severe form of chronic rosacea, is a benign proliferative disorder of the nose almost exclusively affecting Caucasian men [1]. Although its pathogenesis is still not completely understood, clinical manifestations include erythema and enlargement of the nose with tumour-like growths due to sebaceous and connective tissue hypertrophy [1].

The subsequent deformity can not only result in nasal obstruction but also has psychosocial implications due to its unsightly appearance and perceived association with alcohol abuse, resulting in negative effects on quality of life [2,3]. Numerous different treatment methods have been outlined including dermabrasion and surgical excision, however, more recently the use of a CO2 laser has been described [1,4,5].

This ablative laser works by targeting intracellular water resulting in cell vaporisation and subsequent tissue destruction. In this article we describe our technique and experience of treating rhinophymas with a CO2 laser at the Welsh Centre for Burns and Plastic Surgery, Swansea, United Kingdom.

Figure 1: Schematic representation of the clinical severity of rhinophyma according to
The Welsh Centre for Plastic Surgery criteria for severity assessment and laser treatment of rhinophyma.

Technique

We perform the procedure under local anaesthetic in an outpatient setting. The nose is prepared with an antiseptic solution and the anaesthesia administered. All necessary safety precautions are undertaken, including eye protection for both staff and the patient prior to the commencement of the treatment. The UltraPulse® CO2 laser, aided by use of the plume evacuator, is then used to ablate the main bulk of the rhinophyma.

This is achieved by selecting a 2mm ‘TrueSpot’ hand piece on continuous wave settings. This may start at 12 watts, or be increased as high as 30 watts, depending on the size of the area to be reduced. A ‘layer-by-layer’ technique is used. The high settings ensure vaporisation of the tissue and usually there is no requirement to wipe away the eschar. Early signs of adequate ablation include visible expression of the contents of the dilated glands, coined the ‘gopher sign’ by the senior author [6].

As the bulk is reduced it is important to progressively lower the energy to maintain control and minimise the potential of over-reduction and scarring. This usually follows a pattern of 8 watts, 6 watts and 3 Watts until a satisfactory end point is achieved (Table 1). Finally, the CO2 laser is changed to the UltraPulse® mode. Using a 2mm hand piece and settings of 125-175 Jcm2 and 10-15 Hz, finer shaping, ‘feathering in’ and blending of treated areas into normal surrounding tissue is achieved. The patient is given a mirror prior to concluding the treatment to ensure the outcome of the ablation is satisfactory.

An antibacterial ointment is applied to the area following treatment, which remains covered with a brown eschar that gradually separates over a period of three weeks. Written instructions for aftercare are also given and discussed with the patient.

Co2 Laser Nose Before and After

Figure 2: An 89-year-old gentleman who was referred to our service with moderate rhinophyma.
The patient had involvement of at least three nasal subunits with no overhang of tissue.

Figure 3: Three months post a single treatment session with the CO2 laser.

Case 1

Figure 2 illustrates the appearance of an 89-year-old gentleman who presented with a rhinophyma. The patient had a history of nasal obstruction and was unhappy with his appearance. He had undergone no previous treatments for his rhinophyma, which was classified as moderate as per our protocol, with significant proliferation of tissue over both nasal alae. The patient underwent a single CO2 laser treatment using continuous wave and UltraPulse® modes. The laser power was progressively reduced to precisely sculpt the aesthetic units of the nose (Table 2). The patient achieved excellent improvements in the shape, texture and size of the nose and was very happy with the outcome of his treatment (Figure 3).

Figure 4: A 60-year-old gentleman who was referred to our service with severe rhinophyma.
The patient had previously trialled various topical agents without success.
The patient had obliteration of nasal aesthetic subunits with a tissue overhang.

Case 2

A 60-year-old gentleman with a known history of rosacea presented with a progressively enlarging rhinophyma (Figure 4). He was self-conscious regarding his appearance and had undergone numerous medical treatments for his rhinophyma in the past. Clinically, the patient had a bulbous and nodular overhanging rhinophyma primarily affecting the tip of the nose causing obstruction of his right nostril. There was also moderate involvement of both alae and therefore the rhinophyma was classified as severe. The patient was treated with a continuous wave mode of CO2 laser using the settings shown in Table 2. The overhanging rhinophyma was amputated using the laser before sculpting the nasal aesthetic subunits.

Figure 5: Immediate post-treatment appearance illustrating complete
haemostatic control with no requirement for wound dressings.

Figure 6: Appearance three months post a single treatment session with the CO2 laser.

Figure 5 represents the immediate post-treatment appearance of the nose demonstrating haemostatic control of the treated area. At three months the treated area had healed completely with no scarring or residual oedema (Figure 6). There was, however, some hyperpigmentation noted although it did not affect the patient and no further treatment was undertaken.

Figure 7: An 81-year-old gentleman who was referred to our service with severe rhinophyma.
The large polypoid growth extending from the nasal tip was making it extremely difficult for him to drink.

Case 3

An 81-year-old gentleman with a one-year history of severe rhinophyma presented to our outpatient clinic (Figure 7). The patient always found his rhinophyma to be unsightly, however, he was now finding it increasingly difficult to drink, which subsequently prompted his referral to our unit. He had a large polypoid growth affecting the nasal tip, which extended to the dorsum of the nose superiorly and the nasal alae bilaterally. The weight of the growth was also causing mechanical collapse of the nostrils.

Figure 8: Appearance three months post a single treatment session with the CO2 laser.

The patient was treated with a continuous wave mode of CO2 laser and the overhanging rhinophyma was amputated before sculpting the nasal aesthetic subunits (Table 2). At three months the wounds were completely healed, and a good nasal contour and shape was achieved with no scarring (Figure 8).

Discussion

Rhinophyma is a progressive proliferative disorder with an incompletely understood aetiology that can lead to significant deformity of the nose. Despite the common belief that it is associated with alcohol excess, none of our cohort demonstrated a history of this. This finding is supported by existing literature outlining that little evidence exists confirming this association [7,8]. Various different modalities exist for its management, including topical medications, however, it is widely accepted that for severe cases surgical intervention is required [4,9].

Techniques including electrosurgery, cryosurgery and scalpel excision have all been described, although more recently the use of CO2 ablative lasers have been utilised. Both fractionated and non-fractionated lasers can be used, with fractionated devices delivering the laser energy as interspacing columns creating areas of tissue that remain unaffected [4]. For this reason the amount of debulking may be less, resulting in more modest outcomes if used alone. Serowka et al. [4] advocated its use in early to moderate cases of rhinophyma due to previous concerns regarding the side-effect profile of non-fractionated ablative lasers, including prolonged oedema, permanent pigmentary changes and scarring.

In our experience, the CO2 laser’s continuous wave mode for tissue ablation followed by UltraPulse® mode for feathering and finer sculpting produces excellent results. In the first few cases treated by our laser service, alar notching was observed following treatment due to overtreatment of the areas. This was corrected by adjusting the continuous wave mode settings and following a careful ‘layer-by-layer’ approach. In some cases pigmentary changes were also noted. Hyperpigmentation was usually self-limiting and settled by three months.

Such changes were further reduced by advocating the use of sunscreen in the post-treatment period. Hypopigmentation was also observed and was more obvious within a background of persistent rosacea. If needed, this redness could be addressed with a vascular laser, however, none of our patients requested further treatment. We found that the majority of complications encountered are minor and widely acceptable to patients, with the cohort reported in this study being universally pleased with the outcome following treatment. This is, albeit, user dependent and experience is paramount, along with a sound knowledge of the nasal aesthetic subunits.

The main advantages that we find to using a CO2 laser is the immediate haemostasis and precision that can be obtained with regards to the depth and area of tissue destruction when compared to other surgical treatment methods. Van Gemert et al. demonstrated this through histological analysis and found vaporisation of tissue with a CO2 laser occurs within a 0.5mm error in the desired treatment area [12]. Because the treated area formed a dry eschar requiring only antibacterial or paraffin-based ointment, no wound dressings were necessary and minimal hospital visits for wound care were required, resulting in reduced healthcare costs

Rhinophyma Laser Treatment Cost

The cost of the surgical removal of rhinophyma is dependent on the complexity of your case. You will receive a firm quote once you have had your complimentary consultation with one of our surgeons.

When it comes to the surgical removal of rhinophyma, the cost can vary depending on the complexity of your case. This condition, characterized by a large, bulbous, and red nose, is often associated with severe cases of rosacea. If left untreated, rhinophyma can cause disfigurement and impact a person’s quality of life. Surgical removal is often recommended to address the physical and emotional effects of this condition.Before undergoing surgery for rhinophyma, it is important to consult with a qualified surgeon to discuss your individual case and determine the best course of treatment. At our clinic, we offer complimentary consultations with our experienced surgeons, who will assess your condition and provide you with a firm quote for the procedure.During the consultation, the surgeon will evaluate the severity of your rhinophyma and the extent of the surgical intervention required. Factors that may impact the cost of the procedure include:

  • The size and shape of the enlarged nose tissue
  • The presence of any accompanying skin lesions
  • The overall complexity of the surgical technique needed
  • The need for additional procedures, such as skin resurfacing or scar revision

Based on these factors, the surgeon will provide you with a detailed breakdown of the costs involved in the surgical removal of your rhinophyma. It is important to note that health insurance may not cover the cost of rhinophyma surgery, as it is often considered a cosmetic procedure. However, some insurance plans may provide coverage if the condition is causing significant functional impairment.

Co2 Laser Nose Pores

When it comes to cosmetic treatments for the skin, the Fractional CO2 laser has become a popular choice for addressing issues such as large pores, brown spots, wrinkles, and skin tightening. While this treatment can effectively improve the appearance of the nose by shrinking pores and reducing imperfections, it is important to understand that the results may not be permanent.It is true that the heat from the Fractional CO2 laser can initially shrink pores and make them appear smaller, giving the skin a smoother and more refined look. However, over time, the pores may return to their original size. This is because pore size is primarily determined by genetics and oil production within the skin, factors that are beyond the control of laser treatments.Despite the temporary nature of pore reduction with Fractional CO2 laser treatment, there are several other benefits to this procedure for the nose. The laser can effectively tighten the skin, minimize the appearance of brown spots and sun spots, and reduce the depth of wrinkles. These effects can give the nose a more youthful and rejuvenated appearance.It is important to consult with a qualified dermatologist or cosmetic surgeon before undergoing Fractional CO2 laser treatment on the nose. They can assess your skin type, specific concerns, and overall goals to determine if this treatment is the best option for you. Additionally, they can provide guidance on how to maintain the results of the treatment and address any potential side effects.

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