Perioperative Corticosteroids Reduce Short-Term Edema and Ecchymosis in Rhinoplasty: A Meta-Analysis

Coroneos CJ, Voineskos SH, Cook DJ, Farrokyar F, Thoma A.

PubMed 26773090 Publisher (DOI)Free full text (PMC)

What this paper says

Pooling eight randomised trials and 336 patients, steroids given around the time of rhinoplasty reduced swelling and bruising at one day but showed no benefit by seven days, and did not increase bleeding during surgery.

Overview

Several small randomised trials had tested steroids for rhinoplasty swelling, none large enough to settle the question, and three previous reviews reached three different conclusions. The authors ran a formal meta-analysis, searching electronic databases without language restriction, applying the Cochrane risk of bias tool and grading the quality of evidence with GRADE.

Sections of note

Included trials compared systemic steroids given around surgery against placebo, and reported at least one of swelling, bruising, bleeding, cosmetic outcome or satisfaction.
Eight trials with 336 patients in total were pooled.
Steroids reduced the worst swelling, standardised mean difference minus 1.03, 95 percent confidence interval minus 1.30 to minus 0.76, p less than 0.001.
Steroids reduced the worst bruising, standardised mean difference minus 0.78, p less than 0.001.
At one day after surgery a single dose reduced swelling, minus 1.15, and bruising, minus 0.79, both p less than 0.001.
No benefit for swelling or bruising remained at seven days, and bleeding during surgery did not increase. Level of evidence 2.

What it means for a patient

A steroid dose around the operation visibly reduces swelling and bruising in the first day or two.
By one week the difference has gone, so the effect shortens the worst of the recovery rather than the whole of it.
The steroid did not make bleeding during surgery worse, which was a stated concern.
The pooled trials did not measure patient satisfaction or the eventual appearance of the nose, which the authors name as the gap for future trials to fill.

Why this paper matters

It resolves a question that three earlier reviews had answered differently, using a rigorous method and grading the evidence as high quality for the short-term effect. That makes it the reference point for a routine many surgeons already follow. What remains unknown is whether reducing early swelling changes how patients rate their result.

Terms

Corticosteroid: a drug that suppresses inflammation and swelling.
Perioperative: the period immediately before, during and after an operation.
Edema: fluid swelling in tissue.
Ecchymosis: bruising, blood visible under the skin.
Standardised mean difference: a way of expressing effect size when trials used different scales.
GRADE: a system for rating how much confidence to place in pooled evidence.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: A number of randomized controlled trials (RCTs) have investigated the role of perioperative corticosteroids in rhinoplasty. Each of these trials however has an insufficient sample sizes to reach definitive conclusions and detect harms. Three recent reviews have analyzed edema and ecchymosis outcomes following rhinoplasty; each arrived at a different conclusion and recommendation.

Objective: To estimate the effectiveness of systemic perioperative corticosteroid treatment compared to placebo for clinical outcomes in rhinoplasty using a methodologically rigorous meta-analysis.

Methods: Electronic databases were searched without language restriction. Included trials were randomized controlled trials of systemic perioperative corticosteroid treatment vs placebo in rhinoplasty evaluating at least one of: edema, ecchymosis, bleeding, cosmetic outcome, and patient satisfaction. The Cochrane risk of bias tool was applied to included trials, and the quality of evidence for each outcome was assessed using the GRADE approach.

Results: Analyses included 336 patients from eight trials. Perioperative corticosteroids reduced the worst edema (SMD: -1.03, 95%CI -1.30 to -0.76, P < .001) and ecchymosis (SMD: -0.78, 95%CI -1.09 to 0.47, P < .001) after rhinoplasty. At one day postoperative, a single dose of perioperative corticosteroid reduced edema (SMD -1.15, 95%CI -1.42 to -0.87, P < .001) and ecchymosis (SMD -0.79, 95%CI -1.05 to -0.52, P < .001). No clinical benefit in edema or ecchymosis was found seven days postoperatively, nor did intraoperative bleeding increase.

Conclusions: There is high quality evidence to support perioperative systemic corticosteroid treatment in rhinoplasty to reduce short-term edema and ecchymosis without increased intraoperative bleeding. These findings are not present at seven days. For future trials, we suggest evaluation of patient satisfaction, and correlation with long-term cosmetic outcome. LEVEL OF EVIDENCE 2: Therapeutic.

Abstract as indexed by PubMed; the article is open access (PubMed Central).