Dr. Sam Lam Plastic Surgery Forum

Hello Dr Lam, as my name suggests i am from the uk and hope its ok to as you a few questions about my nose. i was diagnosed with rosacea a few years back and have had various treatments since to keep it under control the last being IPL to the nose and face area. my first question is my nose can on occasion feel quite swollen in the upper cartillage area especially in the morning, and other times doesnt look as bad but when it does swell you can feel it around half way down either side of it, does all this make sense!?? dont laugh but ive even taken to clipping a drying line peg on it at night in the hope it will squeeze it back to shape!!sad i know but thats how desperate i am to have my old nose back! do you know what causes this swelling? and is there a surgical treatment to reduce the slight layer of thickened skin that has formed over the same area, if i could narrow it slightly where the extra skin has formed it would look ok, and also under the tip of it the the cartilliage needs lifting is this common with rhinophyma patients!?? please help

hi,
i literally wrote the book on surgical rhinophyma correction: Comprehensive Facial Rejuvenation. I don't know of another book that has both a text on how to treat rhinophyma and a video showing it.

that being said, i usually have experience with advanced endstage disease, as you can see the correction on my website under rhinoplasty. i have also repaired disasters by other surgeons. one bad rhinophyma surgeon created so much scarring that I had to rebuild the entire nose with forehead tissue and both ears.

okay, now that i have your attention: it is very important not to use hot laser or cautery on the nose especially around the nostrils. this is where i see the most problems. fortunately, not in my own patients but in 2 to 3 that i have had to seriously correct from others. cold knife treatment, dermabrasion, and slight cautery is the way to go.

however, rhinophyma and rosacea are ongoing diseases that need to be controlled and managed and not cured. in addition, as i said, i don't have experience with mild cases only severe ones. those are some tips if you are going to find a surgeon in the UK.
best,
sml

thanks for the helpful advice Dr lam, i will now and try and find a surgeon in the UK, you dont have a surgery over here do you?? just wanted to clarify what you told me is should i stop IPL treatments on my nose? the first 2 seesions i recieved helped reducing the volume of my nose but after a few years it has returned to looking swollen again!? the last time i went for IPL a few weeks back i did think the doctor was a little reluctant to treat the nose area as intensely as she did previously!! my nose size increasing is it due to the sebacous glands or the skin thickning? can i reduce the volume any other way apart from taking roccutane! a lot of questions i know but im pretty depressed when i look in the mirror every morning! would you consider looking at a emailed picture of it!??
thanks again Dr lam

hi,
no, i am not saying to stop IPL. i think everything your derm is doing is probably good to control the disease process medically. what i am talking about is using excessive heat during a surgical treatment. that can lead to scarring. i know that is a fine point but it is a big one. send me a photo link in PM if you would like.
sml