Thickened skin
The skin of the tip and wings becomes thick, porous and greasy.
CONDITION / CARRY
Rhinophyma of the nose.
Rhinophyma is an overgrowth of the skin and sebaceous glands of the nose, due to which it becomes thick, bumpy and red. This is late stage rosacea; when the tissues have already compacted, they are removed surgically.
CONCEPTUAL VISUALIZATION- what is it
- Growth of soft tissues of the lower two-thirds of the nose — the tip and wings — associated with rosacea.
- To whom does it concern?
- Mostly men are 40-70 years old: they have rhinophyma 12-30 times more often than women.
- Is it treated?
- The early stage is treated with drugs prescribed by a dermatologist. Densified growths are removed surgically or with a laser.
- Who treats
- Dermatologist - at an early stage; a surgeon who works with the nose - when surgery is required.
01 / WHAT IS ITWhat is
What is
rhinophyma.
Rhinophyma is a benign growth of the skin, sebaceous glands and connective tissue of the nose. The nose gradually enlarges, becomes bumpy, with expanded pores and vascular networks. Mainly the tip and wings — the lower two-thirds of the nose — change.
It is considered the final stage of rosacea, a chronic inflammatory disease of the skin of the face. The exact cause is still unknown. The common opinion about the connection of rhinophyma with alcohol has not been proven.
Rhinophyma is not only a cosmetic problem. Large growths narrow the nostrils and make it difficult to breathe, and skin tumors are sometimes hidden under the bumpy skin, so the removed tissue must be examined under a microscope.
This is general information. After the examination, the doctor will tell you which method of treatment is suitable for you.
02 / SIGNSHow
How
rhinophyma manifests itself.
In the summary of data of 2720 patients, 58.9% were men, the average age was 62.9 years; 61% had severe rhinophyma.
Knots and humps
Over time, soft and then dense knots appear - the nose looks "onion".
Redness
Persistent redness and vascular reticulations, as in rosacea.
Enlarged tip
The tip of the nose hangs down and becomes heavier, the profile changes.
Difficulty breathing
Large growths narrow the nostrils and prevent breathing through the nose.
Ulcer or rapid growth
An ulcer, discharge or rapid growth of one area is a reason to check whether there is a tumor.
Precancerous skin changes03 / REASONSWhy
Why
rhinophyma occurs.
The mechanism has not been fully elucidated. It is known who has the highest risk.
Rosacea
Rhinophyma develops associated with rosacea, although not all of them were diagnosed with it in a summary of 2,720 patients.
Gender and age
The main factors are older age and male sex. Fair-skinned people aged 40–70 are most often affected.
Long run
Growths build up over the years; without treatment, the compacted tissue does not shrink on its own.
Not alcohol
The popular notion of a "drunkard's nose" has not been confirmed: a causal relationship with alcohol has not been proven.
04 / SEEK MEDICAL ADVICE
When is it time to see the doctor?
Rhinophyma develops slowly and usually does not require emergency care. But some changes on the skin of the nose should be shown to the doctor as soon as possible: basal cell carcinoma and squamous cell skin cancer are described under rhinophyma.
103 immediately if:
- heavy bleeding from the node that does not stop after 15 minutes of pressure.
See a doctor in the coming days if:
A non-healing ulcer, a discharge, or a rapidly growing area appeared on the nose. If the nose is gradually increasing, reddening or obstructing breathing, make an appointment for a scheduled consultation: the earlier the stage, the less will have to be removed.
05 / DIAGNOSTICSHow to determine
How to determine
stage.
- Skin examination
The doctor assesses how widespread the growths are and whether they are still soft or already fibrous.
- Degree of severity
From the early inflammatory stage to large nodes that distort the shape of the nose; the choice of treatment depends on the degree.
- Breathing
They check whether the nostrils are not narrowed and whether the nose breathes freely.
- Suspicious areas
Ulcers or fast-growing nodules are examined separately so as not to miss a skin tumor.
06 / TREATMENTHow to treat
How to treat
rhinophyma.
There are no randomized trials on surgical treatment of rhinophyma, so the choice is based on cohort series and surgeon experience. The main rule is treatment by stage.
01
Early stage
While the tissues are inflamed, but not yet compacted.
- Treatment of rosacea
- Drugs prescribed by a dermatologist help mainly in the early, inflammatory stage. They do not remove compacted growths.
02
Compacted growths
In the later stages, surgery is usually required.
- Decortication with a scalpel
- The most frequent method: in the summary of data it was used in 49.0% of cases. Excess tissue is removed in thin layers and at the same time the shape of the nose is modeled.
- CO2 or Er:YAG laser
- CO2 laser is the second most frequent method (37.4%). Er:YAG heats tissues less, so healing is faster; scars and light spots are more likely to remain after CO2.
- Electrosurgery
- Another option; according to the results of the scalpel, CO2 laser and electrocoagulation are comparable.
03
Outcome and risks
- satisfaction
- In a meta-analysis, 88% of patients were satisfied with the result, 94% improved the appearance and condition of the skin.
- Layers, not complete excision
- Complete excision of the tissue up to the cartilage threatens with scarring, so the tissue is partially removed, preserving the deep structures from which the skin regenerates.
- Regrowth
- Rhinophyma can return: in a German cohort of 70 patients, a recurrence was found in 38% over an average follow-up period of 54 months.
07 / AT THE VALIKHNOVSKY CLINIC
How do we
How do we
treat it.
Rhinophyma at Dr. Valikhnovsky's Institute of Surgery is treated in the "New Nose" direction: the surgeon removes growths and at the same time restores the shape of the tip and wings.
DIRECTION TO THE CLINIC
A new nose
Shape, support and breathing of the nose: septum, concha, sinuses, consequences of injuries, failed operations and removal of tumors.
Go to direction
What do we do in this condition
- Layer-by-layer removal of rhinophyma — growths are removed in layers and the tip and wings of the nose are modeled at the same time.
- Histology of removed tissue — the entire tissue is examined under a microscope so as not to miss a skin tumor.
Rostislav Valikhnovsky
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovsky Institute of Surgery.
How is the treatment in us
- Photo onlineSend a photo of the nose from several angles - the doctor will pre-evaluate the stage.
- ConsultationExamination of the skin and breathing, evaluation of the degree of rhinophyma.
- PlanHow much tissue to remove and how to maintain the shape of the nose; with a rosacea dermatologist as needed.
- OperationLayer-by-layer removal of growths with modeling of the tip and wings. All removed tissue is sent for histology.
- RecoveryThe wound on the surface of the nose heals for several weeks; redness passes gradually. Next, follow up with a dermatologist about rosacea.
08 / QUESTIONS AND ANSWERSFrequently asked
Frequently asked
questions.
Short answers. What is right for you, the doctor will tell you during the consultation.
Rhinophyma — is it from alcohol?
No. Despite popular belief, the causal relationship between rhinophyma and alcohol has not been proven. It is considered a late stage of rosacea.
Can rhinophyma be cured without surgery?
Treatment of rosacea, which is prescribed by a dermatologist, helps in the early, inflammatory stage. Densified growths cannot be removed with medication - surgery or a laser is required.
Which is better: scalpel or laser?
The results of scalpel, CO2 laser and electrosurgery are comparable. Scalpel gives fewer complications after surgery, but bleeds more during it; The Er:YAG laser heats the tissues less. The method is chosen by stage and zone.
Can rhinophyma return?
Yes. In a cohort of 70 patients, over an average follow-up period of 54 months, relapse was found in 38%. Therefore, after the operation, you should continue to see a doctor.
Why examine removed tissue?
Skin tumors are sometimes hidden under rhinophyma - basal cell carcinoma or squamous cell carcinoma. In the review of the described cases, half of the tumors were found by chance during this type of examination.
Will scars remain?
There is a risk: among the 67 operated on, 6 had minor complications — scars or light spots. It is reduced by layer-by-layer removal while preserving the deep structures of the skin.
Sources
9 sources · reviews, guidelines and studiesShowCollapse
- Rhinophyma: a systematic review and meta-analysis of its epidemiology, associations, and treatment outcomesEuropean Archives of Oto-Rhino-Laryngology, 2026doi:10.1007/s00405-026-10087-1 ↗
- A systematic review and current recommendation for treatment of rhinophymaLaryngo-Rhino-Otologie, 2020doi:10.1055/a-1208-5284 ↗
- Rhinophyma: Prevalence, Severity, Impact and ManagementClinical, Cosmetic and Investigational Dermatology, 2020doi:10.2147/CCID.S201290 ↗
- Procedural management of rhinophyma: A comprehensive reviewJournal of Cosmetic Dermatology, 2018doi:10.1111/jocd.12770 ↗
- From CO2 to Er:YAG: A Comprehensive Review of Laser Treatments for RhinophymaJournal of Drugs in Dermatology, 2024doi:10.36849/JDD.8199 ↗
- Evidence-based management of rhinophyma according to disease severity and clinical gradeJournal of Laryngology and Otology, 2026doi:10.1017/S0022215126105362 ↗
- Surgical treatment of rhinophyma: experience from a German cohort of 70 patientsEuropean Journal of Dermatology, 2017doi:10.1684/ejd.2017.2987 ↗
- Surgical correction of rhinophyma: comparison of two methods in a 15-year-long experienceJournal of Cranio-Maxillofacial Surgery, 2013doi:10.1016/j.jcms.2012.11.009 ↗
- Malignancies within rhinophyma: report of three new cases and review of the literatureAesthetic Plastic Surgery, 2012doi:10.1007/s00266-011-9802-0 ↗
The figures on the page are from these sources.
Show us
your case.
Send a photo of the nose and describe how long it has been changing. The doctor will tell you what stage you are at and whether surgery is necessary.