Topical Tranexamic Acid and Systemic Dexamethasone for Post-rhinoplasty Edema and Ecchymosis: First Direct Comparison

Vural O, Koycu A.

What this paper says

In a 60-patient triple-blind trial, topical tranexamic acid reduced post-rhinoplasty swelling and bruising as much as intravenous dexamethasone, and giving both added nothing.

Overview

Dexamethasone (a steroid) is the standard drug to limit swelling and bruising after rhinoplasty; topical tranexamic acid is a newer option. The Turkish authors randomised 60 patients into four groups of 15 (topical tranexamic acid, systemic dexamethasone, both, control) and scored periorbital oedema and ecchymosis on days 1, 3 and 7 with a standardised clinical scale.

Sections of note

Both tranexamic acid and dexamethasone reduced oedema and ecchymosis versus control (P < .05).
No significant difference between the two drugs.
Combination therapy gave no extra benefit over either alone.
Prospective, randomised, triple-blind design.

What it means for a patient

Patients who cannot take steroids (diabetes, certain infections, psychiatric history) have an equally effective alternative applied locally.
Taking both drugs is unnecessary.
The study covers the first week only; neither drug affects the final result.

Why this paper matters

It is the first direct comparison of these two common anti-swelling strategies. Limits: 15 per group, single centre, one-week follow-up.

Terms

Tranexamic acid: a drug that stabilises blood clots; here applied to the surgical field rather than given by vein.
Dexamethasone: a corticosteroid that reduces inflammation and swelling.
Periorbital oedema / ecchymosis: swelling and bruising around the eyes.
Triple-blind: patient, surgeon and assessor unaware of group.

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

From the abstract

“Postoperative edema and ecchymosis are common concerns following rhinoplasty, often prolonging recovery and affecting patient satisfaction. Systemic dexamethasone is widely used to reduce these complications, and topical tranexamic acid has recently gained attention. However, no study has directly compared their…”

Excerpt; the full abstract is on PubMed.