The Effectiveness of Bromelain on Oedema, Subconjunctival Haemorrhage, and Ecchymosis After Rhinoplasty: A Randomised, Double-Blind, Placebo-Controlled Trial

Rahmaty B, Naraghi M, Mesbahi A, Mohebbi A, Sadeghi B, Zadeh AR, Almasi A.

What this paper says

In 46 patients randomised to bromelain or placebo after open preservation rhinoplasty, bromelain reduced bruising and bleeding into the whites of the eyes at day 7 but did not reduce swelling.

Overview

Bromelain, a pineapple-derived enzyme, is widely sold as a post-surgery supplement. The Iranian authors ran a double-blind placebo-controlled trial in patients aged 18-45 having open push-down preservation rhinoplasty with lateral osteotomies: 23 received bromelain and 23 placebo. Registered IRCT20180519039720N2.

Sections of note

46 patients: 8 men (17.39%), 38 women (82.61%).
Ecchymosis: bromelain significantly better on both sides at day 7 (p = 0.012).
Subconjunctival haemorrhage: bromelain significantly better at day 7 (p = 0.015).
Oedema: no significant difference at any time point.
Proposed mechanism: increased fibrinolytic activity and lower plasma fibrinogen. Level of Evidence I.

What it means for a patient

Bromelain helped bruising clear by a week in this trial but did nothing for swelling.
Forty-six patients is a small trial, and the effect appeared at only one time point.
As a supplement, it should still be cleared with the surgeon because it can affect bleeding.

Why this paper matters

It is a placebo-controlled test of a popular over-the-counter remedy. Limits: small sample, single time point of benefit, one surgical technique.

Terms

Bromelain: a protein-digesting enzyme extracted from pineapple stems.
Subconjunctival haemorrhage: a red patch of blood on the white of the eye.
Ecchymosis: bruising; oedema: swelling.
Fibrinolytic: relating to the breakdown of blood clots.
Push-down technique: a preservation method that lowers the bony vault by impaction.

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

From the abstract

“To evaluate the effectiveness of bromelain on periorbital oedema, subconjunctival haemorrhage, and ecchymosis after preservation rhinoplasty. Study Design: Randomised, double-blind, placebo-controlled trial SETTING: Tertiary referral centre METHODS: In this double-blind clinical trial, participants aged 18-45 who were…”

Excerpt; the full abstract is on PubMed.