Dermatologist Sandra Lee has become known as “Dr. Pimple Popper” thanks to her popular YouTube channel and her TLC reality television show, which is currently in it’s second season. Despite her years of experience, Lee ran into a very difficult situation when she met a patient suffering from a serious problem during last week’s episode.

The patient was a man named Patrick who had a skin condition on his nose that had gotten so large that it was hindering his ability to breathe.

Patrick told Lee that he had spent years working as a construction worker and therefore was outdoors in the sun most of the day. He noticed that his nose became more red over the years, and sunscreen did not seem to help. Finally, Patrick was diagnosed with rosacea, a common skin condition that causes skin redness, flushing, and acne-like breakouts.

As the skin condition worsened, Patrick’s nose developed 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.

Things got so bad that the scar tissue had started to cover up his nostrils entirely.

“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 starting to impact his relationships with others, especially 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.”

Even Lee was surprised by his nose at first, calling it the “most advanced case” of rhinophyma she’d ever seen.

“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.”

Lee ran into another obstacle when she discovered that Patrick was still taking blood thinners that would make treating his nose riskier.

“My staff routinely calls my patients before any visits or any procedures … to make sure that they’re prepared,” she 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.”

Despite this, Lee was finally able to push forward and treat Patrick.

“I think that’s 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 healing…and make sure that he is off his blood thinner for another treatment,” she added. “I’m not going to leave him with mohawk rhinophyma.”

Lee decided to use electrosurgery to reshape Patrick’s nose.

“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.”

After this first treatment, Patrick saw results right away.

“[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 for additional electrosurgery.

These days, Patrick looks completely different!

“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.”

It seems that Dr. Pimple Popper has worked her magic once again!