Efficacy of Dexamethasone for Reducing Edema and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-analysis

Bian X, Liu H, Sun J, Zhang X, Li N, Chen M.

What this paper says

Pooling 10 studies with 374 participants, dexamethasone given during rhinoplasty produced medium to large reductions in blood loss, swelling and bruising compared with saline placebo.

Overview

Rhinoplasty produces swelling and bruising around the eyes and beside the nose, and corticosteroids are widely recommended to reduce them. This systematic review and meta-analysis assembled the trials comparing dexamethasone against saline and combined their results.

Sections of note

Systematic search following PRISMA guidelines across MEDLINE, Scopus, EMBASE and CENTRAL.
The meta-analysis compared dexamethasone against normal saline given during rhinoplasty.
Outcomes compared: intraoperative blood loss, postoperative swelling, and postoperative bruising.
Of 1,045 records, 10 articles including 374 participants were included; mean age 25.8 years SD 2.5.
The review presents 1b level of evidence supporting dexamethasone use.
Effect sizes as Hedge's g: blood loss -0.69, mean swelling score -1.09, mean bruising score -1.03.
The authors recommend administering dexamethasone with rhinoplasty. Level of evidence III.

What it means for a patient

A single steroid given during surgery reduced bleeding, swelling and bruising across the pooled trials.
The effect sizes of around -1.0 for swelling and bruising are large by conventional standards.
The evidence rests on 10 trials totaling 374 patients, mostly in young adults.
Limits: the abstract reports no side effect data for steroids, no dosing comparison, and no follow-up duration.

Why this paper matters

Several agents compete to reduce postoperative swelling and bruising, and dexamethasone is the most established. Pooling the randomized evidence puts numbers on how well it works. Comparative evidence against tranexamic acid, evaluated elsewhere, is not addressed here.

Terms

Dexamethasone: A corticosteroid drug that reduces inflammation and swelling.
Edema: Swelling caused by fluid in tissue.
Ecchymosis: Bruising under the skin.
Hedge's g: A standardized effect size; values near 1.0 indicate a large effect.
PRISMA: A standard set of reporting rules for systematic reviews.

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

From the abstract

“Rhinoplasty is one of the most challenging cosmetic surgical operations. The procedure has been known to precipitate higher levels of edema and ecchymosis in the periorbital and paranasal regions. The literature recommends the use of corticosteroids such as dexamethasone to alleviate these postoperative morbidities.…”

Excerpt; the full abstract is on PubMed.