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This is actually the most severe form of rosacea, with the development of an enlarged nose, with large pores and increased sebaceous oily glands. Some gain quite a prominent and embarrassing nose, often mistaken for heavy alcohol use. A marked cosmetic improvement can be achieved by reshaping the nose using repeated CO2 laser treatments, involving local anaesthesia. Radiofrequency ablation can be used similarly, but bkleeds more. Dressings afterward are needed for some days each treatment, but results are gratifying. They can be maintained with effective UV screen use and topical Vitamin A and Vitamin C.