Treatment of Rhinophyma Using CO2re Fractional Laser
The CO2re fractional laser is an effective treatment for rhinophyma, offering excellent cosmetic outcomes with fewer adverse events compared to traditional CO2 laser resurfacing. 1, 2
Treatment Approach
Patient Selection and Preparation
- Patients with early to moderate rhinophyma are optimal candidates for fractional CO2 laser treatment 1
- HSV prophylaxis should be administered prior to treatment using acyclovir 400 mg TID or valacyclovir 500 mg BID 1
- Anesthesia should be achieved with 1% lidocaine and epinephrine regional perinasal nerve block 1
Treatment Parameters for CO2re Fractional Laser
- Aggressive parameters can be used for optimal results: 70 mJ, 70% density with 16-18 passes 1
- For patients with darker skin types (Fitzpatrick IV-VI), fractional CO2 laser has been shown to be safe and effective, though parameters may need adjustment 2
- Multiple sessions may be required for optimal results, though some patients achieve satisfactory improvement with a single treatment 2, 3
Post-Treatment Care
- Patients typically experience reepithelialization within 4-7 days 1
- Self-limited edema and erythema are expected post-procedure 1
- Regular follow-up at 3 months post-treatment is recommended to assess results 3
Advantages of CO2re Fractional Laser for Rhinophyma
- Provides significant improvement without the typical scarring noted with traditional CO2 laser resurfacing 1
- Creates a dry surgical field that allows precise sculpting of hypertrophic areas 4
- Offers faster healing times and fewer adverse events compared to traditional ablative techniques 1, 2
- Demonstrates high patient satisfaction and acceptability 3
- Shows durable long-term results with low recurrence rates 3
Potential Complications and Management
- Pain associated with local anesthetic injection is the most common complaint 3
- Scarring and hypopigmentation may occur in approximately 3% of patients 3
- Open pores may persist in some patients 3
- For patients with significant erythema and telangiectasias post-treatment, adjunctive therapy with pulsed dye laser may be beneficial 4
Alternative Treatment Options
- For severe cases of rhinophyma that may not respond adequately to fractional treatment, traditional CO2 laser in continuous mode may be more appropriate 5, 3
- A combined approach using continuous mode CO2 laser for debulking larger rhinophymas followed by fractional mode for contouring can be effective 3
- Scanner-assisted carbon dioxide laser treatment under topical anesthesia has shown only 1.1% recurrence in long-term follow-up studies 6
Treatment Efficacy
- Long-term studies show good to excellent results in approximately 95% of patients treated with CO2 laser 3
- Patient satisfaction surveys demonstrate high levels of satisfaction following CO2 laser treatment 3
- The benefits of treatment are maintained long-term, with minimal recurrence when performed properly 5, 3
Special Considerations
- For patients with darker skin types, careful parameter selection is crucial to minimize post-inflammatory hyperpigmentation 2
- Early intervention is recommended to prevent progression to more severe forms of rhinophyma 2
- Patients should be counseled about expected downtime and the potential need for multiple treatments 1, 3