Recurrent Rhinophyma: A Case of Triple Relapse and Therapeutic Challenges

Rhinophyma recurrence after surgical excision poses a significant therapeutic challenge, often stemming from the incomplete removal of deep hyperplastic pilosebaceous units. We present the case of a 66-year-old male with a third occurrence of rhinophyma after two prior failed cold-steel excisions. The definitive intervention consisted of a modified deep tangential excision, removing all rhinophymatous tissue to a deep dermal plane that approached, but did not violate, the nasal perichondrium, thereby eradicating the pathologic glandular nidus while preserving the deepest adnexal remnants essential for re-epithelialization. The wound was primarily managed by secondary intention healing, guided by selective, tension-free suture re-approximation of key wound edges to optimize contour. Cold-steel excision was specifically chosen to ensure a specimen free of thermal artifact for definitive histopathology, a critical step in a recurrent case, which ultimately confirmed marked sebaceous gland hypertrophy and excluded malignancy. The postoperative course was uneventful, and at an 18-month follow-up, the patient demonstrated a stable, successfully restored nasal contour with no signs of recurrence. This case demonstrates that for severe, recurrent rhinophyma, a surgical strategy that balances thorough debulking of pathologic tissue with meticulous preservation of deep adnexal structures is critical for achieving a durable, long-term outcome.