Periorbital Ecchymosis Post Closed Rhinoplasty: Natural History, Risk Factors, and Validation of a New Scoring System

Mizrachi M, Layous E, Dror AA, Yakir O, Bader A, Sela E.

PubMed 37448765 Publisher (DOI)Free full text (PMC)

What this paper says

In 183 closed rhinoplasties by one surgeon, bruising consistently started in the inner quarters of the eye area on days 1-2 and spread to the lower outer quarters by day 7, and a new quarter-by-quarter colour scoring system showed excellent agreement between three physicians.

Overview

Bruising around the eyes after rhinoplasty is universal and distressing, and no validated, rhinoplasty-specific score existed to compare treatments. The Israeli authors prospectively photographed 183 patients on days 1, 2 and 7, divided the periorbital area into quarters, and had three independent physicians assign the dominant colour of each quarter.

Sections of note

183 patients, closed rhinoplasty, same surgeon and method.
No significant variation between the three raters; inter-observer consistency rated excellent.
Pattern: medial (inner) quarters dominated on days 1 and 2; lower lateral quarters by day 7.
No correlation between patient demographics or clinical characteristics and bruising pattern or spread.
The score is proposed as a research tool for testing anti-bruising treatments.

What it means for a patient

Bruising migrating downward and outward over the first week is the normal course, not a complication.
No patient characteristic in this study predicted worse bruising.
The scoring system is for research and follow-up, not for patient self-assessment.

Why this paper matters

It supplies a validated bruising score, which many later drug and drain trials need. Limits: single surgeon, closed technique only, one-week window.

Terms

Periorbital ecchymosis: bruising around the eyes.
Natural history: the usual course of a condition without intervention.
Inter-observer reliability: agreement between different raters.
Medial / lateral quarters: the inner and outer halves of the upper and lower eye regions.

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

Abstract

Unlabelled: Postrhinoplasty periorbital ecchymosis is an inevitable side effect contributing to patients' psychological aspect and early postoperative morbidity. Efforts are constantly being made to reduce ecchymosis using different methods with varying success. To evaluate treatment response, it is mandatory to have a reliable score. Several studies suggest other scoring systems, but none has been postrhinoplasty-specific, validated, and accepted. This study aimed to demonstrate the natural history of postrhinoplasty ecchymosis, find potential risk factors for worsening patterns, and suggest a useful and reliable periorbital ecchymosis scoring system for postrhinoplasty follow-up.

Methods: This prospective study included 183 patients who underwent closed rhinoplasty by the same surgeon and the same principle method. Photographs of the periorbital ecchymosis were taken on postoperative days 1, 2, and 7. The periorbital area was divided into quarters, and three independent physicians assigned the dominant color of each quarter.

Results: There were no significant variations between the three physicians' scoring. The interobserver consistency defined as an excellent scoring system reliability, according to our statistical analysis. The postoperative ecchymosis demonstrated a consistent pattern of spread over time, dominating the medial quarters on early postoperative days 1 and 2, following into the lower lateral quarters in postoperative day 7. We found no correlation between patient demographics and clinical characteristics to ecchymosis patterns and temporal spread.

Conclusions: Our study suggests a reliable and easy-to-use postrhinoplasty ecchymosis scoring system. This scoring method can be used for postrhinoplasty ecchymosis assessment and as a research-validated tool to quantify different perioperative treatments to reduce ecchymosis and estimate mid-face trauma.

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