Comparison of Upper and Lower Eyelid Edema and Ecchymosis Following Rhinoplasty: A Study of Osteotome Versus Piezoelectric Techniques

Vural O, Koycu A.

What this paper says

In 113 patients, the upper eyelid swelled more than the lower at every time point, bruising peaked on day 1 below the eye and day 3 above it, and piezo osteotomies produced significantly less lower-eyelid bruising than chisels.

Overview

Eyelid swelling and bruising after rhinoplasty are common but have rarely been measured separately for the upper and lower lids. In this prospective study, upper and lower eyelid oedema and ecchymosis were graded on days 1, 3 and 7 using a 0-4 photographic scale, comparing patients whose osteotomies were done with an osteotome against those done with a piezoelectric device.

Sections of note

113 patients; groups similar in age, sex and intraoperative blood pressure.
Upper eyelid oedema exceeded lower eyelid oedema at all time points (p < 0.001).
Lower eyelid bruising peaked on day 1; upper eyelid bruising peaked on day 3.
The piezoelectric group had significantly less lower-eyelid ecchymosis on every day (p < 0.001).
Statistics used Mann-Whitney U, Friedman, Bonferroni-adjusted Wilcoxon and paired t-tests.

What it means for a patient

Expect the upper lid to look puffier than the lower one after rhinoplasty, and expect bruising above the eye to peak later than below it.
Ultrasonic bone cutting reduced bruising under the eyes in this study.
The study did not assess final nasal shape, only the first week.

Why this paper matters

It gives a day-by-day map of periorbital swelling and bruising with two osteotomy methods, useful for patient counselling. Limits: allocation not described as randomised, photographic grading, one-week window.

Terms

Ecchymosis: bruising.
Oedema: swelling.
Osteotome: a surgical chisel.
Piezoelectric technique: ultrasonic bone cutting.
Periorbital: around the eye.

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

From the abstract

“Edema and ecchymosis are common effects of rhinoplasty, but differences between the upper and lower eyelids have not been objectively well studied due to the challenges of measurement and comparison. Objective: To compare the eyelid edema and ecchymosis among patients undergoing rhinoplasty using osteotomes versus…”

Excerpt; the full abstract is on PubMed.