It is counterintuitive to call rhinophyma the Hidden Disease, since its primary characteristic is its prominence in the middle of the face, but there is a real and rather poignant reason for thinking of it in this way.


Not many people outside of the medical profession and those unfortunates affected by the condition – mostly older, white males – will be aware of the term, which derives from the Greek rhino, for nose, and phyma for skin tumour.


It is a disfiguring nasal deformity caused by the proliferation of sebaceous glands and underlying connective tissue and, as the condition progresses, the nose becomes redder, swollen at the end and develops a bumpy and misshapen surface.


Why do we call it the Hidden Disease? Well, the sad fact is that it is the sufferers themselves who hide it. It is wholly natural to be embarrassed and, as the deformity worsens, the people affected withdraw into themselves and, in some cases, refuse to leave their homes.


The tragic consequence of this reclusivity is that often they do not seek help and it is only when the disease approaches the end stage that professional intervention is sought, often by other members of the family.


Ever Clinic, Scotland’s leading skin, scarring and anti-aging centre, has now treated a large number of advanced cases of the condition since opening its new Glasgow city centre facility in April 2021, one of whom has bravely waived anonymity and agreed to the publication of before and after pictures on our website.


I say “bravely” because the condition is so visual and so disfiguring that patients have talked to me about being unwilling to walk down the street because they felt that everyone was looking at them.


It is not just a physical ailment, but can have a profound effect on mental health. One man’s wife told me that she effectively entered into a period of mourning for her husband’s loss, since he ceased to interact with her and shut himself away.


On the completion of successful laser surgery, she said that “he had got his life back”. He once again became confident and self-assured, and the couple now enjoy going out for lunch and other social activities.


The difficulties of obtaining non-private treatment have only been compounded by the current beleaguered state of the NHS, by whom the majority of rhinophyma cases are turned away because plastic surgeons within the service simply do not have the capacity.


A scientific paper, admittedly published in 2004, showed that although the condition was common in the West of Scotland, the respected Canniesburn Plastic Surgery Unit in Glasgow only took in 12 or 13 people a year for remedial surgery.


The tragedy is that people currently will often wait two to three years to be told by the NHS that nothing can be done for them, during which time the rhinophyma, inevitably, will have significantly worsened.


The appropriate surgical lasers, such as the Lumenis Ultrapulse, have allowed specialists such as Ever Clinic’s Dr Cormac Convery to successfully treat increasing numbers of sufferers. Indeed, it is the only clinic in the UK outside London which has this capability.


Using the CO2 laser, Dr Convery can remove the excess skin tissue from the anaesthetised nose, cutting off large lumps or nodules and debulking with the laser in continuous wave mode with high power output.


In order to restore the original shape of the nose, Dr Convery then uses a pulsed mode to sculpt and shape the remaining tissue. A controlled full ablation is then performed on the rest of the nose, blending the skin and avoiding obvious scarring.


This procedure is typically performed within 45 minutes, though supplementary sessions may be required for larger and more complex rhinophymas. The skin of the nose is functional and normal within two weeks and recovery is normally complete within three months.


The term “life-changing” can be over-used in association with medical intervention, but with this so-prominent condition it is wholly appropriate. And it has to be good news that treatment is now available in a part of the UK where it is so prevalent.


Jonathan Toye is co-director at Ever Clinic.

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