|Anesthesia||Local, Heavy Sedation or General|
|Duration of Surgery||1 hour|
|Final Results||6-12 months|
|Return to regular activity||1 week|
|Resume Exercise||4 weeks|
Rhinophyma or the red, bulbous nose features commonly seen in older men is an imminently treatable medical condition. This condition, which is caused by an overgrowth of the sebaceous or oily glands of the nose, is an end result of the common skin condition Rosacea. Rosacea affects approximately 14 million Americans and is characterized by diffuse redness and capillaries of the central zone of the face including the forehead, nose, eyelids, cheeks and chin. Bacteria and overactive sebaceous glands also contribute to pustule and nodule formation. Over a period of time, untreated Rosacea leads to overgrowth of the sebaceous glands primarily of the nose leading to the characteristic condition Rhinophyma.
Optimal treatment of this condition always starts with prevention. Retinoid creams as well as topical antibiotics like Metrogel® are the most commonly prescribed medications. Occasionally oral antibiotics are prescribed during acute breakouts. Additional preventive measures include wearing sunscreen, topical Vitamin C, and avoiding exacerbating foods, alcohol, extreme weather conditions, and stress. The “old wives” tale that excess alcohol consumption caused Rhinophyma comes from the flushing of the overactive blood vessels of the face and nose characteristic of alcohol use. Treatment of the redness and ruddy appearance of the skin is typically treated by a series of non-ablative Intense Pulsed Light (IPL) treatments or several different wavelengths of lasers that target the red blood cell components in the skin.
Correction of the bulbous appearance of the nose involves a series of different resurfacing procedures. Dermabrasion, electro-surgery and laser resurfacing are the most commonly used procedures to smooth the texture of the nose back to its normal state. These procedures are typically done under local anesthesia or IV sedation, or general anesthesia as an outpatient. Recovery occurs in stages. The nose heals in about a week, is red for several more weeks, and then returns to its normal state in a much improved form. Final Results are seen at 6-12 months after surgery.
An initial consultation is set-up where we discuss the various options available to treat Rhinophyma, and whether you are a good candidate for the surgery. Alternatives may be discussed as well. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge. You will need several products for post-procedure care and a shopping list will be provided. Alternatively, procedure kits can be purchased in the office.
For the right patient, Rhinophyma reduction can be an extremely gratifying operation. The advantages are natural looking results; long-term skin enhancement with what is usually a difficult problem to address, and no scarring from the procedure itself. This procedure takes about one hour to complete.
The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this procedure, is given antibiotics, and anesthetized in the operating room or in the office. The nose and surrounding skin is injected with local anesthetic to decrease bleeding and for postoperative comfort. Next, the chosen device is used peel of the skin and to shape the nose into its final form. The initial result appears as though that area has been ‘sandpapered”. An occlusive dressing placed on the raw surface area, and used for about a week until new skin regenerates. The skin is pink for a few weeks, and gradually starts looking natural and vibrant. Patients are cautioned to stay out of the first few weeks after this procedure, as new skin is forming, which is fragile. Maintenance of the result involves the use of the topical rosacea treatments such as retinoids, antibiotic gels and IPL treatments to manage the re-growth of capillaries.
Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.
To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach him after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.
At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.
There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.
We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr. Bitar is committed to continuing education, honing their skills and introducing new techniques always with the aim of improving safety and surgical results.
We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.
Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for our patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.
For more information, call our office at 703-206-0506.
Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.