Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis

Mehdizadeh M, Ghassemi A, Khakzad M, Mir M, Nekoohesh L, Moghadamnia A, Bijani A, Mehrbakhsh Z, Ghanepur H.

What this paper says

In a randomized triple-blinded trial of 60 patients, dexamethasone, tranexamic acid, and the two combined each reduced swelling and bruising around the eyes compared with placebo, with no difference between the three active groups.

Overview

Swelling and bruising around the eyes are the most visible part of recovery from rhinoplasty. Two drugs are used to reduce them: a steroid and a drug that slows the breakdown of blood clots. This trial compared each drug alone, both together, and neither.

Sections of note

Prospective, randomized, triple-blinded study in 60 patients undergoing primary open rhinoplasty.
Four groups of 15: dexamethasone 8 mg, tranexamic acid 10 mg per kg, both drugs, and placebo control.
Medications were given intravenously 1 hour before surgery and in three further doses every 8 hours afterward.
Digital photographs were taken on postoperative days 1, 3, and 7.
One expert examiner, blinded to group assignment, graded periorbital swelling and bruising on a scale of 0 to 4.
All three active groups had significantly lower swelling and bruising ratings than the control group, p below 0.01.
No significant difference was found between the dexamethasone, tranexamic acid, and combination groups. Level of evidence III.

What it means for a patient

Either drug reduces the visible bruising and puffiness around the eyes after rhinoplasty.
Taking both together gave no measurable additional benefit over either alone in this trial.
Assessment ran only to day 7, so any difference in how quickly the last swelling clears is not covered.
Limits: 60 patients in four groups of 15, single center, photographic grading by one examiner, and no reporting of drug side effects in the abstract.

Why this paper matters

Both drugs are in routine use and the question of whether to combine them is practical. A randomized blinded design makes this stronger evidence than most rhinoplasty literature. With 15 patients per group, a modest advantage of the combination could have been missed.

Terms

Dexamethasone: A corticosteroid drug that reduces inflammation and swelling.
Tranexamic acid: A drug that slows the breakdown of blood clots, reducing bleeding and bruising.
Periorbital: Around the eye.
Ecchymosis: Bruising under the skin.
Triple-blinded: Patients, surgeons, and assessors all unaware of who received which treatment.

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

From the abstract

“Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard. Methods: A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty.…”

Excerpt; the full abstract is on PubMed.