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Open Access
CC BY 4.0 · Arch Plast Surg 2026; 53(01): 003-014
DOI: 10.1055/a-2706-1208
Cosmetic
Review Article

Effectiveness of Bleeding Control Methods in Rhinoplasty: A Systematic Review and Meta-Analysis

Authors

  • Mohammad Reza Zamani 

    1   Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran

  • Behzad Imani 

    2   Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran

  • Rohollah Abbasi 

    3   Department of Otolaryngology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

  • Ashkan Karimi 

    2   Department of Operating Room, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran

  • Samad Moslehi 

    4   Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran

Funding Information This study was funded by the Vice Chancellor for Research and Technology of Hamadan University of Medical Sciences (grant number 140303292677).
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Abstract

One of the most common complications of rhinoplasty and septorhinoplasty is intraoperative bleeding, which poses challenges for both surgeons and patients. This systematic review and meta-analysis aimed to evaluate the effectiveness of various bleeding control methods in rhinoplasty and septorhinoplasty surgeries.

This study conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed in reputable international databases to identify relevant studies. Ultimately, 16 randomized controlled trials (RCTs) with 933 patients were included in the analysis. The bleeding control methods evaluated included tranexamic acid (TXA), desmopressin, steroids, magnesium sulfate, clonidine, remifentanil, and patient positioning (reverse Trendelenburg position). Data were combined using meta-analysis methods in STATA version 17, and the standardized mean difference (SMD) with 95% confidence intervals (CIs) was calculated to assess the effects of the methods. The results showed that TXA (SMD: −1.31; 95% CI: −2.01 to −0.62) and steroids (SMD: −1.07; 95% CI: −1.70 to −0.43) had the most significant impact on reducing bleeding. Patient positioning also showed a considerable effect (SMD: −0.65; 95% CI: −1.01 to −0.30), and desmopressin had a positive impact (SMD: −1.53; 95% CI: −3.12 to 0.06), though this effect was not statistically significant. This study demonstrates that pharmacological and non-pharmacological interventions, such as TXA and patient positioning, can significantly reduce intraoperative bleeding. However, further studies with larger sample sizes and standardized designs are recommended for magnesium sulfate, clonidine, and remifentanil methods.

Level of Evidence I.

Keywords

rhinoplasty - septorhinoplasty - intraoperative bleeding - systematic review - meta-analysis

Contributors' Statement

M.R.Z.: Writing—original draft, data curation.


B.I.: Writing—review and editing, supervision.


R.A.: Writing—review and editing, investigation.


A.K.: Writing—original draft, investigation, resources.


S.M.: Formal analysis.


Ethical Approval

This study is a systematic review and meta-analysis based exclusively on previously published data. Therefore, ethical/IRB approval is not required.


Informed Consent

This study is a systematic review and meta-analysis based exclusively on previously published data. Therefore patient consent was not required.




Publication History

Received: 10 May 2025

Accepted: 16 September 2025

Accepted Manuscript online:
22 September 2025

Article published online:
30 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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