Q: Dr. Eppley, I have rhinophyma. I do not have it nearly as severely as those Elephant-Man-images one sees on the net. However, my nose skin is so thick that it has defied two surgeries to correct it. I know that I need IPL for my roceaca but I went to see a new doctor and he recommended C02 laser for my nose. However, I also have lots of enlarged pores on that poor nose of mine. I need the dilated blood vessels improved by the IPL and I was nervously considering the CO2 also. But I read that CO2 can cause pore size to enlarge. My question is should I have both treatments? The CO2 for the thickness of skin and lesion buildup and than finally the IPL for the redness. I am wondering if you can tell me the order I should do them in or which I should or should not do at all. My dream is to do all them (if that is the correct thing to do) as soon as I can afford it. With all of the horrors that have taken place in the world and with all that are taking place at this moment, still, I am totally “tormented” by my nose. Thank you for your time, patience and kindness.
A: Rhinophyma, as you undoubtably know, is a challenging problem. You have mentioned two treatments, which are correct ones, but I would opt for a vascular laser as opposed to the IPL which is going to be more effective for shrinking of the larger blood vessels that you probably have over the nose. There are arguments both ways as to the order and I don’t think either of them is wrong. If the blood vessels are fairly big, I would first treat them with the vascular laser as they may cause signficant bleeding when doing the laser resurfacing. If they are just fine telangectasias then I would do the laser resurfacing first and treat the telangectasias 3 to 6 months later.
Dr. Barry Eppley