Interventions to Decrease Postoperative Edema and Ecchymosis after Rhinoplasty: A Systematic Review of the Literature

Overview

Rhinoplasty causes significant swelling and bruising around the eyes, and many interventions have been proposed to reduce them. The authors searched PubMed, Scopus and EMBASE, applied inclusion criteria, and grouped the eligible articles into five categories in order to produce evidence-based recommendations.

Sections of note

• 50 articles were included and grouped into five categories.
• 14 articles studied corticosteroids exclusively.
• 10 articles reviewed other medications and herbal supplements.
• 9 articles evaluated methods of reducing bleeding during surgery.
• 4 articles studied interventions applied after surgery, and 13 studied surgical techniques.
• Consensus favoured steroids, lowered blood pressure during surgery, cooling during surgery and elevating the head afterwards. Nasal packing and lifting the periosteum before bone cuts increased swelling and bruising. Herbal supplements were judged usable with minimal risk. More study was called for before recommending an external or internal approach to lateral bone cuts.

What it means for a patient

• Several measures that reduce early swelling and bruising are decisions made by the surgical team rather than by the patient.
• Nasal packing, historically routine, was associated with more swelling and bruising rather than less.
• Herbal preparations were judged low risk, but that is different from being shown to work.
• A systematic review inherits the quality of what it pools, and the abstract reports a consensus across studies rather than combined numerical estimates.

Why this paper matters

Recovery appearance is what patients ask about most, and the interventions are cheap and easily adopted where the evidence supports them. Grouping 50 studies into actionable categories is the practical contribution. Which approach to the lateral bone cut causes less bruising remains explicitly unresolved.

Terms

• Edema: fluid swelling in tissue.
• Ecchymosis: bruising, blood visible under the skin.
• Corticosteroid: a drug that suppresses inflammation and swelling.
• Intraoperative hypotension: deliberately lowering blood pressure during surgery to reduce bleeding.
• Nasal packing: material placed inside the nose after surgery to control bleeding.
• Periosteal elevation: lifting the membrane covering bone before cutting it.