Rhinophyma is a less-common subtype of rosacea that presents as thickened skin with enlarged sebaceous glands that may progress to large bulbous growths with dilated pores on the nose. Rhinophyma can lead to morbidity aesthetically and sometimes functionally. The prevalence of rosacea ranges from 1% to 20%. The exact pathogenesis is not known, but potential factors include altered circulation, changes in microorganisms and/or alterations in immunity. Here the authors present a unique case where a patient presented with unilateral rhinophyma: a presentation warranting work up to rule out other more worrisome entities.