Offering pearls for nasal sculpting, Dr. Sarnoff advises asking patients to bring in a personal photograph taken at a younger age before the onset of rhinophyma to serve as a guide. She also cautioned being conservative with tissue removal and removing slightly less tissue than considered necessary to allow for post-procedure fibrosis and contraction.
“Less is more. You can always go back if additional sculpting is desired, but taking off too much tissue and going below the depth of the pilosebaceous apparatus will result in a waxy, shiny, hypopigmented appearance,” Dr. Sarnoff says.
Therefore, she suggests dividing the sculpting into two sessions. Debulking is the goal for the first procedure while the second is designed to fine-tune the result.
Because cancers can be masked by sebaceous hyperplasia, tissue removed in sculpting should be sent for pathologic review, especially if it is taken from an area of ulcerated skin.
“If there is any doubt over whether there might be a basal cell or squamous cell carcinoma, put some tissue in a bottle and send it to the pathologist,” Dr. Sarnoff says.