Rhinophyma is a common nasal skin problem that is mistakenly assumed to be due to excessive alcohol use. It is really a problem of sebaceous hyperplasia of the skin and has little to do with alcohol intake. Most affected patients have varying degrees of enlargement of the nasal skin with bumpiness, redness and irregularity to the skin as well as multiple sebaceous cysts. There are multiple ways treat this problem. One is to excise the skin and replace it with a skin graft. However the cosmetic result is generally poor with obvious surgery performed to the skin. The second was to tangentially excise the skin with a surgical blade and reshape the nose. This is effective but has a great deal of blood loss associated with it as well as a long protracted healing time. My ideal approach is the use of a loop cautery to literally reshape and carve out the new nasal shape from the rhinophyma tissue. This has little to no bleeding, takes 3-4 weeks to heal and usually gives an excellent cosmetic result.