Complications Associated with Rhinoplasty: An Umbrella Review of Meta-analyses

Wu B, Chen S, Sun K, Xu X.

PubMed 34590168 Publisher (DOI)Free full text (PMC)

What this paper says

Reviewing 14 systematic reviews containing 128 meta analyses of randomized trials, steroids, tranexamic acid, periosteal preservation, external lateral osteotomy and piezoelectric bone cutting were each linked to fewer complications.

Overview

Many studies have investigated ways to avoid complications in rhinoplasty. This umbrella review, meaning a review of existing reviews, set out to summarize what those pooled analyses show about the connection between surgical choices and complication rates. PubMed, MEDLINE, Embase and the Cochrane Database were searched for the relevant systematic reviews.

Sections of note

Umbrella review including 14 systematic reviews containing 128 meta analyses of randomized clinical trials; level of evidence III.
Swelling and bruising were the two most investigated outcomes.
Steroid use was linked with significantly lower incidence of several complications.
Tranexamic acid was also linked with lower complication incidence.
Periosteal preservation, meaning keeping the membrane over the nasal bone intact, was similarly linked.
The external approach to lateral bone cutting was linked with fewer complications.
Piezoelectric osteotomy was also linked with fewer complications.
Multiple administrations of steroids were associated with fewer complications over a prolonged period.

What it means for a patient

Most of the pooled evidence concerns swelling and bruising rather than serious complications.
Five specific choices, three of them surgical technique and two medication, were associated with better results.
The tranexamic acid finding conflicts with individual randomized trials that found no effect, which reflects disagreement in the underlying literature.
An umbrella review inherits the limitations of the reviews beneath it, and no pooled rates are given in the abstract.

Why this paper matters

Rhinoplasty complication prevention has generated many small trials with inconsistent findings, and this review assembles the pooled evidence in one place. It identifies which interventions have repeated support. It cannot resolve the disagreements between the underlying trials.

Terms

Umbrella review: a review that synthesizes existing systematic reviews rather than individual studies.
Meta analysis: a statistical pooling of results from multiple studies.
Edema: swelling from fluid in the tissues.
Ecchymosis: bruising, meaning blood collected under the skin.
Periosteum: the membrane covering bone.
Piezoelectric osteotomy: cutting bone with a high frequency vibrating instrument.

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

Abstract

Background: An increasing number of studies have investigated the effect of various methods in avoiding complications in rhinoplasty. Our study aims to analyze the connections between various choices in rhinoplasty and the rate of multiple complications by summarizing results in related meta-analyses.

Materials And Methods: Through Pubmed, MEDLINE, Embase, and the Cochrane Database were associated systematic reviews searched to gather and review the available evidence of different plans and health outcomes in rhinoplasty for this umbrella review.

Results: The study included 14 systematic reviews with 128 meta-analyses of randomized clinical trials. Edema and ecchymosis were the two most investigated outcomes. The implementations of steroid, tranexamic acid, periosteal preservation, external approach in lateral osteotomy, and piezoelectric osteotomy were linked with significantly lower incidence of several complications. Multiple administration of steroids was found to be associated with fewer complications in a prolonged time.

Conclusions: With summarized evidence of complications related to rhinoplasty, this research can help surgeons to avert patients from suffering complications and optimize cosmetic outcomes.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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