Rhinophyma-surgery
Rhinophyma Surgery
Rhinophyma surgery treats thickened, bulbous, and red nasal skin caused by severe phymatous rosacea. At our London clinic, Centre for Surgery uses CO2 or erbium laser ablation to carefully reshape the nose and restore a more natural contour.
Correcting Rhinophyma with CO2 Laser Surgery
Rhinophyma is a progressive skin condition affecting the nose, most commonly seen in men over 50. It causes the skin of the nose to thicken, the sebaceous glands to enlarge, and the nose itself to become progressively bulbous, red, and distorted. In advanced cases, it can also obstruct breathing. Rhinophyma is a subtype of , specifically the severe phymatous form, although not everyone with rosacea develops it.
Rhinophyma surgery reshapes the nose by removing excess thickened tissue, restoring a more normal contour, and, where relevant, improving the nasal airway. At Centre for Surgery, CO2 laser or erbium laser ablation is used as the primary technique. This may be combined with careful scalpel excision for larger or more nodular areas. The procedure is performed as a day case under local anaesthetic, usually takes 1 to 2 hours, and can result in a significantly smoother, more natural-looking nose.
Most patients need only a single procedure. Occasionally, a second session may be required for residual areas of overgrowth in more severe cases. The link between rhinophyma and alcohol consumption is a long-standing myth. While it has been associated with alcohol in popular culture, the scientific evidence for any direct link is weak. Rhinophyma is fundamentally a dermatological condition driven by long-standing rosacea, not lifestyle.
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What is rhinophyma?
Rhinophyma is a dermatological condition that primarily affects the nose. It causes progressive enlargement, thickening, and distortion of the nasal skin — leading to a bulbous, reddened, bumpy appearance that develops gradually over years.
Rhinophyma is the end stage of untreated or inadequately managed phymatous rosacea — a severe subtype of rosacea characterised by thickening of skin and overgrowth of sebaceous glands. It typically evolves over many years, going through distinct stages before reaching the recognisable bulbous form:
Rhinophyma is significantly more common in men — possibly because testosterone influences sebaceous gland size — and most commonly appears in men over 50. It’s more frequent in people of Celtic and Scandinavian descent, consistent with the fair-skinned populations in which rosacea generally is more prevalent. It’s rare in women, and when it does occur in women it tends to be milder.
Beyond the obvious aesthetic impact, rhinophyma can have meaningful functional and psychological consequences. In advanced cases the nasal airway can be partially obstructed, causing breathing difficulty and snoring. Socially and psychologically, the visible appearance often leads to embarrassment, social withdrawal, and in some cases unfair assumptions about lifestyle (because of the longstanding but poorly-supported alcohol association). Addressing the condition surgically can be genuinely transformative.
Rhinophyma Surgery Before & After Photos
A selection of real rhinophyma surgery results from our specialists at Centre for Surgery. More cases are available to view at your consultation, and we only publish photos of patients who have given written consent for their images to be used.
Significant reduction in bulbous thickening with restoration of a smoother, more natural nasal contour using CO2 laser ablation.
Advanced rhinophyma with extensive nodular overgrowth treated in a single session — the reduction in volume and restoration of airway patency is typical of the procedure.
What causes rhinophyma?
The exact cause of rhinophyma isn’t fully understood, but it’s generally considered a complication of long-standing rosacea rather than a separate condition. Several factors contribute to who develops it.
is a chronic inflammatory skin condition affecting the face, characterised by facial redness, visible blood vessels, and small bumps resembling acne. A specific subtype called phymatous rosacea features thickening of facial skin and enlargement of sebaceous glands — over years, this can progress to rhinophyma on the nose. Not everyone with rosacea develops rhinophyma, but almost everyone with rhinophyma has had long-standing rosacea, often undiagnosed.
Rhinophyma has been popularly associated with heavy alcohol consumption for centuries — to the point where "drinker’s nose" entered common usage. The scientific evidence for a direct link is weak. Alcohol may trigger rosacea flares in some people, and there’s a broader association between rosacea severity and alcohol intake, but many patients with severe rhinophyma drink little or no alcohol. This association has caused real social harm to people with the condition, and we think it’s important to be clear that rhinophyma is fundamentally dermatological, not behavioural.
Effective treatment of rosacea in its earlier stages — with topical medications, oral antibiotics, or laser therapy — can reduce the risk of progression to rhinophyma. If you have persistent facial redness, flushing, or small bumps, a dermatology assessment is worthwhile. The earlier rosacea is managed, the less likely phymatous changes are to develop.
Symptoms of rhinophyma
Rhinophyma develops gradually, often over many years. Recognising the symptoms at different stages helps clarify whether you’re dealing with early phymatous change or established rhinophyma — and guides appropriate treatment.
In the early phymatous stage, changes are subtle and often mistaken for generic skin concerns:
Once the condition progresses, symptoms become more distinctive:
In severe rhinophyma, symptoms can extend beyond cosmetic concerns:
If you have progressive thickening or enlargement of the nose — particularly if accompanied by long-standing rosacea — a consultation is worth pursuing. The earlier rhinophyma is addressed, the smaller the reshaping required, the shorter the procedure, and the better the overall outcome.
Am I suitable for rhinophyma surgery?
Rhinophyma surgery is appropriate for most patients with established phymatous rosacea affecting the nose. At consultation, we’ll assess your individual case and confirm whether surgery is the right next step — or whether non-surgical treatments should be explored first.
The best candidates have visible, established phymatous changes — thickened skin, enlarged pores, bulbous contour — that have been progressing over years. Early rosacea without significant phymatous change is usually better treated non-surgically first (topical medications, oral antibiotics, laser vascular treatment), with surgery reserved for cases that don’t respond or progress despite medical management.
You should be in reasonable general health. Rhinophyma most commonly affects older men, some with other health conditions, so we work carefully with existing conditions rather than requiring perfect health. Significant cardiovascular disease, uncontrolled diabetes, or active skin infections on or around the nose need to be managed before proceeding. Smoking should be stopped for at least 2 weeks before and 2 weeks after surgery to optimise wound healing.
Rhinophyma can be a difficult condition to live with, and many patients have carried embarrassment about their appearance for years. We want to make sure patients come to surgery from a place of considered decision-making rather than crisis — having support from family or a close friend through the process is helpful.
Rhinophyma surgery produces significant improvement, but it’s important to understand what it can and can’t do. It reduces the bulk and reshapes the contour of the nose, restoring a more natural appearance. It doesn’t cure the underlying rosacea — skin redness and telangiectasia may persist and can be addressed separately with . Long-term skincare and sometimes continued rosacea treatment is needed to reduce the risk of recurrence.
Rhinophyma can recur if the underlying rosacea isn’t controlled. Most patients don’t need further surgery for many years after treatment, but maintaining good skincare, sun protection, and — where needed — ongoing rosacea management significantly reduces recurrence risk.
Rhinophyma surgery isn’t right for everyone. We don’t operate on patients with active nasal infections, significant uncontrolled medical conditions that make surgery unsafe, or unrealistic expectations about what surgery can achieve. In early rosacea without phymatous changes, medical management is the right first step rather than surgery.
Rhinophyma treatment techniques
The treatment of rhinophyma has evolved significantly over the past few decades. Modern approaches centre on laser ablation, which gives more precision and better cosmetic outcomes than older techniques. At Centre for Surgery, we use a combination of techniques tailored to each case.
CO2 laser is our primary approach for most rhinophyma cases. The laser vaporises thickened skin in controlled layers, allowing the surgeon to progressively reshape the nose while minimising bleeding and producing clean, precise tissue removal. The key advantages:
Erbium (Er:YAG) laser is an alternative to CO2 that’s particularly useful for finer work and surface finishing. It has a slightly more limited depth of penetration than CO2, which can be an advantage for gentle surface refinement but means it’s less efficient for removing large volumes of tissue. Often used in combination with CO2 — CO2 for bulk reduction, erbium for final surface smoothing.
For very large, nodular rhinophyma where laser alone would be inefficient, careful scalpel excision can be used to debulk larger areas first, followed by laser resurfacing for the final contour. The combined approach gives faster treatment of severe cases but requires more careful post-operative management. Scalpel-only techniques without laser finishing are an older approach and carry a higher risk of visible scarring; we don’t recommend this as a standalone technique.
Older techniques using electrocautery or electrosurgery are still used in some clinics. They can be effective but generate more heat damage to surrounding tissue than laser approaches, and generally produce inferior cosmetic results. We don’t use these as primary techniques.
Several techniques have been proposed for rhinophyma over the years that we don’t consider appropriate primary treatments: dermabrasion (too aggressive and imprecise), cryosurgery (unreliable results for this specific condition), and subcision (appropriate for scar treatment but not for rhinophyma).
Surgical treatment addresses the overgrown tissue but doesn’t cure the underlying rosacea. Most patients benefit from continued rosacea management alongside or after surgery — topical medications, oral treatments, or for residual redness and visible blood vessels.
Preparing for your rhinophyma surgery
Rhinophyma surgery is less invasive than full rhinoplasty, but careful preparation still makes a meaningful difference to your experience, recovery, and result.
At your consultation, your surgeon will examine your nose carefully, confirm the diagnosis, assess the severity, and discuss the appropriate surgical approach. Photographs are taken from multiple angles for planning. Your surgeon will also take a full medical history, particularly any existing rosacea treatment, relevant medical conditions, and current medications.
Smoking is a significant risk factor for wound-healing complications in any skin surgery. We recommend stopping at least 2 weeks before your procedure and continuing to abstain for at least 2 weeks afterwards. Vaping and nicotine replacement products have the same effect. If you need help stopping, the is free and effective.
Two weeks before surgery, stop aspirin, ibuprofen, and other NSAIDs to reduce the risk of bleeding. The same applies to common supplements: fish oil, vitamin E, ginkgo biloba, garlic supplements, and St John’s wort. Paracetamol is fine. If you take prescribed blood thinners (warfarin, DOACs, clopidogrel), let us know — these need careful management with your GP or cardiologist given the age group of most rhinophyma patients.
If you’re already using topical rosacea medications (metronidazole, ivermectin, azelaic acid) or oral medications (low-dose doxycycline), keep using them as prescribed unless your surgeon advises otherwise. These don’t affect the surgery and help control the underlying condition.
Stop or significantly reduce alcohol intake for at least a week before surgery and a week afterwards. Alcohol can trigger rosacea flares, thins the blood, and interferes with wound healing.
Rhinophyma surgery is performed under local anaesthetic, so you can drive yourself home if accompanied or use public transport. However, you’ll need someone to help with the intensive aftercare for the first 2 weeks — applying paraffin jelly multiple times a day to keep the wound moist and clean. If you live alone or have mobility issues, arrange for a friend or family member to help.
Before the day:
Rhinophyma surgery significantly improves the appearance and shape of the nose, but results take time to emerge. The nose will look raw and pink for the first 2 weeks, gradually transitioning to a more normal skin colour over 3 months. The final colour match and texture take up to 6 months. Patients who understand this timeline going in tend to cope with recovery much better than those expecting immediate perfection.
The rhinophyma surgery procedure
Rhinophyma surgery is performed as a day-case procedure at our Baker Street clinic under local anaesthetic. Most procedures take 1 to 2 hours, depending on severity and whether a combination of techniques is being used.
You’ll arrive at the clinic at your scheduled time and be taken to the treatment room. Your surgeon will review the plan, take final photographs, and mark the areas to be treated. The anaesthetist or surgeon will then prepare you for the procedure.
Topical numbing cream is applied to the nose first, followed by careful injection of local anaesthetic to fully numb the treatment area. Once numbness sets in (usually within 10 to 15 minutes), the procedure is essentially painless. You’ll remain fully awake throughout — you won’t need to stop eating or drinking beforehand, though we do ask you to avoid alcohol the day before and the morning of the procedure.
Using a CO2 or erbium laser (or a combination), your surgeon removes the thickened, overgrown skin in precise controlled layers. The laser allows the surgeon to assess the tissue as it’s worked, gradually uncovering the normal underlying nasal contour. For localised areas of severe overgrowth, a focused approach is used; for more generalised thickening, a broader resurfacing approach is applied. The deeper layers of skin, containing hair follicles and sebaceous glands, are left intact — this is important for healing.
For very large nodular overgrowths, careful scalpel excision may be used to debulk the tissue first, followed by laser resurfacing to smooth the contour. This combined approach is efficient for advanced cases.
Once the bulk of the overgrown tissue has been removed, your surgeon refines the nasal contour — smoothing transitions, feathering edges, and ensuring the shape looks natural from all angles. This stage is particularly important for cosmetic outcome.
Following the procedure, a thick layer of paraffin jelly or Aquaphor ointment is applied to the nose to protect the healing surface and keep the wound moist. A non-stick dressing may be applied briefly for transport, though many patients go home with just the ointment in place.
You’ll be observed for a short period before discharge. Most patients leave the clinic within 30 minutes of the procedure finishing. You’ll be given detailed written instructions on wound care, along with a direct contact number for any concerns in the first 24 to 48 hours.
Recovery and aftercare
Recovery from rhinophyma surgery is longer and more intensive than many patients expect — not because of pain, but because the healing wound needs diligent care for the first 2 weeks. Proper aftercare is the single biggest determinant of a good result.
The nose will feel sore and tender as the local anaesthetic wears off, but most patients find over-the-counter paracetamol sufficient. There’s typically some oozing of serous fluid from the treated area — this is completely normal and the reason for the ongoing paraffin jelly application. Don’t pick, rub, or touch the treated area.
This is the most demanding phase of recovery. The nose must be kept continuously moist with paraffin jelly or Aquaphor ointment. Practically:
The goal is to keep the wound moist and clean at all times. This dramatically accelerates re-epithelialisation (the formation of new skin) and reduces the risk of abnormal scarring, pigmentation changes, or infection.
By around day 10 to 14, new skin has typically formed across the treated area. The paraffin jelly regime can gradually be relaxed as the surface closes over. The new skin will be bright pink or red — this is normal and reflects active healing, not infection. From week 2 onwards you can introduce a mild sunscreen (SPF 50+) once wound closure is complete, as UV exposure at this stage can cause permanent pigmentary changes.
Most patients return to work from 7 to 14 days depending on the visibility of the healing wound and their comfort with how it looks. If your work doesn’t involve face-to-face contact, return earlier; if you’re client-facing, allow longer.
The pink/red colour gradually fades as healing matures. By the end of month 3, most patients see their nose colour return close to normal, though some residual pinkness is common. The overall shape and contour is essentially settled by this point, though subtle refinement continues.
Complete maturation of the healed skin. Any residual colour differences typically fade. The final cosmetic result is visible by 6 months.
Because rhinophyma is driven by underlying rosacea, ongoing rosacea management is important to reduce the risk of recurrence. This typically involves:
Contact the clinic promptly if you notice: increasing pain or tenderness, increasing redness or warmth around the wound, unusual discharge (especially yellow or green), a spreading rash, a temperature over 38°C, or any other concern. Our clinical team is available to review you promptly.
You’ll have follow-up reviews at 2 weeks, 6 weeks, 3 months, and 6 months to track healing and confirm the result. Additional reviews can be arranged if needed.
How much does rhinophyma surgery cost?
Rhinophyma surgery costs vary considerably depending on the severity of the condition, the techniques used, and whether a single session or multiple sessions are needed. Most cases can be treated in a single procedure; more advanced cases may benefit from staged treatment.
As a guide, rhinophyma surgery at Centre for Surgery typically falls in the range of £4,500 to £7,500. The lower end covers moderate cases treated with laser ablation in a single session. The upper end covers more advanced cases involving combined laser and scalpel debulking, longer operative time, or multiple sessions.
Your quote covers the full journey, not just the procedure itself:
Some private medical insurers cover rhinophyma surgery where it’s documented as treatment of phymatous rosacea with functional impact (for example, nasal airway obstruction). Coverage isn’t guaranteed and depends on your specific policy — check with your insurer in advance. Our patient coordinators can help you prepare the paperwork and supporting medical documentation you’ll need.
NHS treatment of rhinophyma is available in principle but varies significantly by region and local commissioning policies. Where available, it’s typically reserved for cases with functional impairment (breathing obstruction) or cases unresponsive to medical treatment. Waiting times can be long. For elective cosmetic improvement without functional impact, NHS treatment is generally not available.
Centre for Surgery is partnered with Chrysalis Finance, a specialist medical finance provider, so you can spread the cost of your rhinophyma surgery over monthly instalments. Plans start from around £120 per month, and 0% APR options are available subject to status. Apply before or after your consultation — you’re not committed to surgery by applying.
Full details of our are on our dedicated finance page, or speak to a patient coordinator directly on to discuss what works for your budget.
Why Choose Centre for Surgery for your rhinophyma surgery
Rhinophyma is a specialist condition — not every cosmetic surgery clinic takes on rhinophyma cases, and outcomes vary significantly with surgeon experience. Centre for Surgery is one of the UK’s leading clinics for rhinophyma surgery, accepting cases of all severities from across the country.
Our surgeons are on the and are members of recognised plastic surgery bodies including and the . They regularly treat rhinophyma of all grades — from early phymatous change through to severe, long-standing cases — using modern laser techniques combined where appropriate with careful surgical excision.
We use CO2 and erbium laser as the primary treatment for most cases, giving the precision and tissue-sparing quality that older scalpel-only or electrocautery techniques can’t match. Combined with surgical experience in cosmetic facial contouring, this produces the best possible cosmetic and functional outcomes.
Not every case of nasal thickening needs surgery. For early phymatous change without significant functional impact, medical management of the underlying rosacea is often the right first step. Our surgeons will tell you directly if surgery isn’t the best option for your specific case — including recommending medical dermatology review first in some cases.
Rhinophyma surgery addresses the overgrown tissue but doesn’t cure the underlying rosacea. We take a whole-condition approach, advising on ongoing rosacea management, sun protection, and — where indicated — offering for residual facial redness and visible blood vessels as part of your care.
Centre for Surgery is fully registered and regulated by the . Our aftercare programme was specifically rated "outstanding" by the CQC — the highest rating available. Given that rhinophyma recovery requires intensive wound care for the first 2 weeks, responsive aftercare matters more here than for many procedures.
Our clinic is at 95–97 Baker Street, London W1U 6RN — a short walk from Baker Street tube. The clinic has its own day-surgery theatre, so your consultation, procedure, and follow-up all take place in one location. Learn more about .
We’re partnered with Chrysalis Finance, a specialist medical finance provider, so you can spread the cost over monthly instalments. .
If you’re living with rhinophyma, the first step is a face-to-face consultation with one of our surgeons. We’ll examine your nose carefully, discuss the severity and appropriate treatment options, and give you a direct answer about what can realistically be achieved.
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Learn More About Rhinophyma
If you’d like to read more about rhinophyma and rosacea from independent UK sources before your consultation, these are the most trusted resources:
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