At the start of the episode, Patrick explained that he spent his career working in construction, spending a lot of time in the sun.
Over time, he started to notice that his nose would become red, but wearing sunscreen didn't seem to help. Dermatologists later told him he had rosacea , a common skin condition that causes skin redness, flushing, and acne-like breakouts, according to the American Academy of Dermatology (AAD).
The skin on Patrick's nose continued to worsen, building up a thick layer of what he referred to as "scar tissue."
"The scar tissue has built up to where it's just gotten really thick and kind of rubbery kind of like a fake nose," Patrick said during the episode.
He also noted that the weight of the excess tissue began to obstruct his nostrils.
"My nostrils have closed off quite a bit," Patrick said. "I try to breathe through my nose and the air passages aren't as large as they should be normally."
Patrick added that the appearance of his nose was affecting his relationships with others, even his grandchildren.
"The nose is the focal point of your face. If you've got a bad nose like I have, people notice it right off," he said. "I have some younger grandkids [and] I can tell when I show up, they kind of look at me kind of funny."
"I hope Dr. Lee can get the roughness taken off of my nose and make me look presentable again," Patrick said.
Lee said it was the most advanced case of rhinophyma shed ever seen
In the exam room, Lee told Patrick he had a rarer type of rosacea known as rhinophyma.
With rhinophyma, the skin on the nose becomes thickened and the oil glands become enlarged, according to DermNet NZ, the educational website of the New Zealand Dermatological Society. The affected skin can also be bulbous and red, with prominent blood vessels and pores. The causes of rhinophyma still aren't understood, but it is known to occur more frequently in men, DermNetNZ adds.
Lee has treated many people with rhinophyma on her YouTube channel over the years. In fact, her rhinophyma patients are often the source of excellent blackhead-popping videos .
But in the episode, she said that Patrick's case was unlike any others.
"Patrick has a very severe form of rhinophyma," she said. "In fact, it is the most advanced case that I've ever seen. So before I can be sure that I can treat him, I need to take a really good look."
Then Lee hit an unexpected roadblock: Patrick was taking blood thinning medications due to a previous history of blood clots.Before his appointment with Lee, Patrick had reduced his dose but not completely stopped taking the medication. That meant the procedure to treat his nose could have caused a risky amount of bleeding.
"My staff routinely calls my patients before any visits or any procedures ... to make sure that they're prepared," Lee said. "My staff told Patrick to please stop his blood thinners, but for some reason, he just decided to decrease the dose to half ... I'm worried that if we treat the entire nose, it will just bleed and bleed and not stop."
Eventually, Lee decided to just treat Patrick's nostrils.
"I think thats the area of most concern," she said. "Certainly if I see any profuse bleeding, I'm going to have to stop immediately."
"I'm going to have him come back in couple weeks and see how he's healingand make sure that he is off his blood thinner for another treatment," she added. "I'm not going to leave him with mohawk rhinophyma."
After two treatments, Patricks nose was transformed
"I'm going to use a really interesting surgical tool on Patrick," she said. "It's called a loop electrocautery [tool]. It's where an electric current [is] transferred to this wire loop and it heats it up ... it allows me to cut tissue and it cauterizes the superficial blood vessels, so hopefully that will also help to control bleeding."
Essentially, she used heated wire to slice away the excess tissue on top of Patrick's real nose.
After the first nostril-only treatment, Patrick noticed an immediate improvement.
"[Lee] showed me the mirror and I could tell right away that things were changing," he said. "Even this little bit that she's done today the results are amazing. I'm breathing better already."
Two weeks later, Patrick returned (with permission from his doctor to stop taking the blood thinner) for more electrosurgery on the remainder of his nose.
And, one month after the final treatment, Patrick gave an interview, fully healed, at his home in Montana. His nose looked unrecognizable: smooth, rounded, and complete with unobstructed nostrils.
"Now that the rhinophyma is gone I feel more outgoing," he said. "Being out in public now is like going back in time 15 years. I'm really relieved that Dr. Lee stuck by me to get this procedure done."
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