Facial Plast Surg 2018; 34(01): 014-021
DOI: 10.1055/s-0037-1617444
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reducing Periorbital Edema and Ecchymosis after Rhinoplasty: Literature Review and Personal Approach

Abel-Jan Tasman
1   Division of Rhinology and Facial Plastic Surgery, Department of Otolaryngology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
06 February 2018 (online)

Abstract

Postoperative periorbital edema and ecchymosis are most bothersome to rhinoplasty patients. The degree of swelling and bruising is influenced by several factors, and numerous prophylactic and therapeutic measures have been described in the literature. This article reviews the current literature and concludes with the author's suggestions on how to best minimize postoperative periorbital edema and ecchymosis.

 
  • References

  • 1 Valente DS, Steffen N, Carvalho LA, Borille GB, Zanella RK, Padoin AV. Preoperative use of dexamethasone in rhinoplasty: a randomized, double-blind, placebo-controlled clinical trial. JAMA Facial Plast Surg 2015; 17 (03) 169-173
  • 2 Valente DS. Discussion: interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the kiterature. Plast Reconstr Surg 2016; 137 (05) 1463-1464
  • 3 Rankin M, Borah GL, Perry AW, Wey PD. Quality-of-life outcomes after cosmetic surgery. Plast Reconstr Surg 1998; 102 (06) 2139-2145 , discussion 2146–2147
  • 4 Pruzinski T, Edgerton MT. Body image change in cosmetic plastic surgery. In Cash TF, Pruzinsky T. , eds. Body Images: Development, Deviance and Change. New York: Guilford; 1990
  • 5 Adamson PA, Litner JA. Psychologic aspects of revision rhinoplasty. Facial Plast Surg Clin North Am 2006; 14 (04) 269-277 , v
  • 6 Tasman AJ. The psychological aspects of rhinoplasty. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (04) 290-294
  • 7 Gruber RP, Roberts C, Schooler W, Pitman RK. Preventing postsurgical dissatisfaction syndrome after rhinoplasty with propranolol: a pilot study. Plast Reconstr Surg 2009; 123 (03) 1072-1078
  • 8 Sclafani AP, Schaefer SD. Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: rationale, risks, rewards, and reality. Laryngoscope 2009; Apr; 119 (04) 778-91
  • 9 Bracaglia R, Tambasco D, D'ettorre M, Gentileschi S. Management of patients undergoing rhinoplasty while receiving anticoagulant therapy. Aesthetic Plast Surg 2012; 36 (05) 1087-1089
  • 10 Binhas M, Salomon L, Roudot-Thoraval F, Armand C, Plaud B, Marty J. Radical prostatectomy with robot-assisted radical prostatectomy and laparoscopic radical prostatectomy under low-dose aspirin does not significantly increase blood loss. Urology 2012; 79 (03) 591-595
  • 11 Chu EW, Telem DA, Chernoguz A, Divino CM. Assessing the risk of clopidogrel-related bleeding complications in patients undergoing inguinal herniorrhaphy. Hernia 2011; 15 (01) 31-35
  • 12 Mackinnon B, Fraser E, Simpson K, Fox JG, Geddes C. Is it necessary to stop antiplatelet agents before a native renal biopsy?. Nephrol Dial Transplant 2008; 23 (11) 3566-3570
  • 13 Yousfi M, Gostout CJ, Baron TH. , et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol 2004; 99 (09) 1785-1789
  • 14 Eichhorn W, Burkert J, Vorwig O. , et al. Bleeding incidence after oral surgery with continued oral anticoagulation. Clin Oral Investig 2012; 16 (05) 1371-1376
  • 15 Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med 2012; 125 (03) 265-269
  • 16 Gun R, Yorgancılar E, Yıldırım M, Bakır S, Topcu I, Akkus Z. Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty. Int J Oral Maxillofac Surg 2011; 40 (07) 722-729
  • 17 Koşucu M, Omür S, Beşir A, Uraloğlu M, Topbaş M, Livaoğlu M. Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty. J Craniofac Surg 2014; 25 (02) 471-475
  • 18 Tuncel U, Turan A, Bayraktar MA, Erkorkmaz U, Kostakoglu N. Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty. J Craniomaxillofac Surg 2013; 41 (02) 124-128
  • 19 Ha TN, van Renen RG, Ludbrook GL, Wormald PJ. The effect of blood pressure and cardiac output on the quality of the surgical field and middle cerebral artery blood flow during endoscopic sinus surgery. Int Forum Allergy Rhinol 2016; 6 (07) 701-709
  • 20 Walsh M, Devereaux PJ, Garg AX. , et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology 2013; 119 (03) 507-515
  • 21 Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg 2005; 100 (01) 4-10
  • 22 Bijker JB, van Klei WA, Vergouwe Y. , et al. Intraoperative hypotension and 1-year mortality after noncardiac surgery. Anesthesiology 2009; 111 (06) 1217-1226
  • 23 Zojajy M, Alani N, Abdi-Soofi S, Akbari-Delmaghani N. Does injection of lidocaine with 1/100000 epinephrine immediately before lateral osteotomy reduce post-operative periorbital edema and ecchymosis in rhinoplasty?. Novelty Biomedicine. 2014; 2 (02) 59-63
  • 24 Sari E, Simsek G. Comparison of the effects of total nasal block and central facial block on acute postoperative pain, edema, and ecchymosis after septorhinoplasty. Aesthetic Plast Surg 2015; 39 (06) 877-880
  • 25 Mckee DE, Lalonde DH, Thoma A, Dickson L. Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet. Hand (NY) 2015; 10 (04) 613-615
  • 26 McKee DE, Lalonde DH, Thoma A, Glennie DL, Hayward JE. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg 2013; 131 (04) 811-814
  • 27 Saedi B, Sadeghi M, Fekri K. Comparison of the effect of corticosteroid therapy and decongestant on reducing rhinoplasty edema. Am J Rhinol Allergy 2011; 25 (04) e141-e144
  • 28 Tebbetts JB. Dallas Rhinoplasty: Nasal Surgery by the Masters. In: Rorich RJ, Adams WP, Gunter J. , eds. Saint Louis, Missouri: Quality Medical Publishing; 2007: 225-226
  • 29 Caglar E, Celebi S, Topak M, Develioglu NO, Yalcin E, Kulekci M. How can periorbital oedema and ecchymose be reduced in rhinoplasty?. Eur Arch Otorhinolaryngol 2016; 273 (09) 2549-2554
  • 30 Spooner TR, Goode RL, Fascenelli FW. Lateral osteotomy drainage tubes in rhinoplasty. Arch Otolaryngol 1970; 92 (06) 596-598
  • 31 Erişir F, Tahamiler R. Lateral osteotomies in rhinoplasty: a safer and less traumatic method. Aesthet Surg J 2008; 28 (05) 518-520
  • 32 Becker DG, McLaughlin Jr RB, Loevner LA, Mang A. The lateral osteotomy in rhinoplasty: clinical and radiographic rationale for osteotome selection. Plast Reconstr Surg 2000; 105 (05) 1806-1816 , discussion 1817–1819
  • 33 Gryskiewicz JM, Gryskiewicz KM. Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique. Plast Reconstr Surg 2004; 113 (05) 1445-1456 , discussion 1457–1458
  • 34 Ghazipour A, Alani N, Ghavami Lahiji S, Akbari Dilmaghani N. Buccal sulcus versus intranasal approach for postoperative periorbital oedema and ecchymosis in lateral nasal osteotomy. J Craniomaxillofac Surg 2014; 42 (07) 1456-1459
  • 35 Kiliç C, Tuncel Ü, Cömert E, Şencan Z. Effect of the rhinoplasty technique and lateral osteotomy on periorbital edema and ecchymosis. J Craniofac Surg 2015; 26 (05) e430-e433
  • 36 van Loon B, van Heerbeek N, Maal TJ. , et al. Postoperative volume increase of facial soft tissue after percutaneous versus endonasal osteotomy technique in rhinoplasty using 3D stereophotogrammetry. Rhinology 2011; 49 (01) 121-126
  • 37 Al-Arfaj A, Al-Qattan M, Al-Harethy S, Al-Zahrani K. Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty. J Plast Reconstr Aesthet Surg 2009; 62 (11) e538-e539
  • 38 Kara CO, Kara IG, Topuz B. Does creating a subperiosteal tunnel influence the periorbital edema and ecchymosis in rhinoplasty?. J Oral Maxillofac Surg 2005; 63 (08) 1088-1090
  • 39 Taşkın Ü, Batmaz T, Erdil M, Aydın S, Yücebaş K. The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty. Eur Arch Otorhinolaryngol 2017; 274 (02) 861-865
  • 40 Ilhan AE, Cengiz B, Caypinar Eser B. Double-blind comparison of ultrasonic and conventional osteotomy in terms of early postoperative edema and ecchymosis. Aesthet Surg J 2016; 36 (04) 390-401
  • 41 Cochran CS, Roostaeian J. Use of the ultrasonic bone aspirator for lateral osteotomies in rhinoplasty. Plast Reconstr Surg 2013; 132 (06) 1430-1433
  • 42 Pribitkin EA, Lavasani LS, Shindle C, Greywoode JD. Sonic rhinoplasty: sculpting the nasal dorsum with the ultrasonic bone aspirator. Laryngoscope 2010; 120 (08) 1504-1507
  • 43 Beck DO, Kenkel JM. Evidence-based medicine: rhinoplasty. Plast Reconstr Surg 2014; 134 (06) 1356-1371
  • 44 Hettige R, Mansell N. Limiting oedema, ecchymosis and haemorrhage in septorhinoplasty with ice cooled swabs. Ann R Coll Surg Engl 2014; 96 (05) 395-396
  • 45 Kayiran O, Calli C. The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study. Rhinology 2016; 54 (01) 32-37
  • 46 Taskin U, Yigit O, Bilici S, Kuvat SV, Sisman AS, Celebi S. Efficacy of the combination of intraoperative cold saline-soaked gauze compression and corticosteroids on rhinoplasty morbidity. Otolaryngol Head Neck Surg 2011; 144 (05) 698-702
  • 47 Pool SM, van Exsel DC, Melenhorst WB, Cromheecke M, van der Lei B. The effect of eyelid cooling on pain, edema, erythema, and hematoma after upper blepharoplasty: a randomized, controlled, observer-blinded evaluation study. Plast Reconstr Surg 2015; 135 (02) 277e-281e
  • 48 Ozucer B, Yildirim YS, Veyseller B. , et al. Effect of postrhinoplasty taping on postoperative edema and nasal draping: a randomized clinical trial. JAMA Facial Plast Surg 2016; 18 (03) 157-163
  • 49 Farahvash MR, Khorasani G, Mahdiani Y, Taheri AR. The effect of Steri-strip dressing on patients' satisfaction and reduction of ecchymosis in lower eyelid, malar and cheek following rhinoplasty. World J Plast Surg 2016; 5 (01) 51-57
  • 50 Kara CO, Kara IG, Yaylali V. Subconjunctival ecchymosis due to rhinoplasty. Rhinology 2001; 39 (03) 166-168
  • 51 Al Arfaj AM. The use of nasal packing post rhinoplasty: does it increase periorbital ecchymosis? A prospective study. J Otolaryngol Head Neck Surg 2015; 44 (01) 22
  • 52 Hoffmann DF, Cook TA, Quatela VC, Wang TD, Brownrigg PJ, Brummett RE. Steroids and rhinoplasty. A double-blind study. Arch Otolaryngol Head Neck Surg 1991; 117 (09) 990-993 , discussion 994
  • 53 Hwang SH, Lee JH, Kim BG, Kim SW, Kang JM. The efficacy of steroids for edema and ecchymosis after rhinoplasty: a meta-analysis. Laryngoscope 2015; 125 (01) 92-98
  • 54 Coroneos CJ, Voineskos SH, Cook DJ, Farrokyar F, Thoma A. Perioperative corticosteroids reduce short-term edema and ecchymosis in rhinoplasty: a meta-analysis. Aesthet Surg J 2016; 36 (02) 136-146
  • 55 Mahant S, Keren R, Localio R. , et al; Pediatric Research in Inpatient Settings (PRIS) Network. Dexamethasone and risk of bleeding in children undergoing tonsillectomy. Otolaryngol Head Neck Surg 2014; 150 (05) 872-879
  • 56 Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg 2007; 120 (01) 271-274
  • 57 Pulikkottil BJ, Dauwe P, Daniali L, Rohrich RJ. Corticosteroid use in cosmetic plastic surgery. Plast Reconstr Surg 2013; 132 (03) 352e-360e
  • 58 da Silva EM, Hochman B, Ferreira LM. Perioperative corticosteroids for preventing complications following facial plastic surgery. Cochrane Database Syst Rev 2014; (06) CD009697
  • 59 Short TG, Leslie K. Dexamethasone-an effective antiemetic, but is it safe?. Anaesth Intensive Care 2015; 43 (02) 155-156
  • 60 Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth 2013; 110 (02) 191-200
  • 61 Gan TJ, Diemunsch P, Habib AS. , et al; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014; 118 (01) 85-113
  • 62 Desborough MJ, Oakland K, Brierley C. , et al. Desmopressin use for minimising perioperative blood transfusion. Cochrane Database Syst Rev 2017; 7: CD001884
  • 63 Gruber RP, Zeidler KR, Berkowitz RL. Desmopressin as a hemostatic agent to provide a dry intraoperative field in rhinoplasty. Plast Reconstr Surg 2015; 135 (05) 1337-1340
  • 64 British National Formulary: BNF 69. 69th ed. British Medical Association; 2015: 170
  • 65 Amer K, Rehman S, Haydel C. Efficacy and safety of tranexamic acid in orthopedic fracture surgery: a meta analysis and systematic literature review. J Orthop Trauma 2017; 31 (10) 520-525
  • 66 Sakallioğlu Ö, Polat C, Soylu E, Düzer S, Orhan İ, Akyiğit A. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 2015; 74 (04) 392-396
  • 67 Ghavimi MA, Taheri Talesh K, Ghoreishizadeh A, Chavoshzadeh MA, Zarandi A. Efficacy of tranexamic acid on side effects of rhinoplasty: A randomized double-blind study. J Craniomaxillofac Surg 2017; 45 (06) 897-902
  • 68 Simsek G, Sari E, Kilic R, Bayar Muluk N. Topical application of arnica and mucopolysaccharide polysulfate attenuates periorbital edema and ecchymosis in open rhinoplasty: a randomized controlled clinical study. Plast Reconstr Surg 2016; 137 (03) 530e-535e
  • 69 Rowe DJ, Baker AC. Perioperative risks and benefits of herbal supplements in aesthetic surgery. Aesthet Surg J 2009; 29 (02) 150-157
  • 70 Ong AA, Farhood Z, Kyle AR, Patel KG. Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 2016; 137 (05) 1448-1462
  • 71 Stucker FJ. Prevention of post-rhinoplasty edema. Laryngoscope 1974; 84 (04) 536-541
  • 72 Ozkose M, Baykan H, Coşkuner İ. The effect of patient positioning on amount of intraoperative bleeding in rhinoplasty: a randomized controlled trial. Aesthetic Plast Surg 2016; 40 (04) 453-457