Interventions to Decrease Postoperative Edema and Ecchymosis After Rhinoplasty

A Systematic Review of the Literature

Adrian A. Ong, M.D.; Zachary Farhood, M.D.; Andrew R. Kyle, B.S.; Krishna G. Patel, M.D., Ph.D.

Disclosures

Plast Reconstr Surg. 2016;137(5):1448-1462. 

In This Article

Abstract and Introduction

Abstract

Background: Today, minimally invasive procedures are becoming more popular because of the fast recovery. Rhinoplasty is a common facial plastic surgery procedure that can be associated with significant postoperative morbidities, especially periorbital edema and ecchymosis. The aim of this review is to summarize the results of published literature that studied interventions that decrease postoperative edema and ecchymosis after rhinoplasty, and provide evidence-based strategies for surgeons to incorporate into practice.

Methods: A systematic review of the PubMed, Scopus, and EMBASE databases was performed to investigate interventions studied to decrease postoperative edema and ecchymosis after rhinoplasty. After inclusion and exclusion criteria were applied, articles were grouped into one of the following categories: corticosteroids, other medications and herbal supplements, interventions to decrease intraoperative bleeding, other postoperative interventions, and surgical techniques.

Results: A total of 50 articles were included for review. Fourteen articles studied corticosteroids exclusively, whereas another 10 articles reviewed other medications and herbal supplements. Nine articles evaluated methods to decrease intraoperative bleeding during rhinoplasty, and four articles studied postoperative interventions to decrease edema and ecchymosis. Thirteen articles studied various surgical techniques to decrease postoperative morbidities.

Conclusions: There was a consensus within the literature that steroids, intraoperative hypotension, intraoperative cooling, and head elevation postoperatively decrease postoperative edema and ecchymosis, whereas nasal packing and periosteal elevation before osteotomy increased these postoperative morbidities. Studies of herbal supplements may be incorporated into practice with minimal risk to the patient. More studies must be performed before recommending an external or internal approach to lateral osteotomy.

Introduction

Rhinoplasty is considered one of the most common facial plastic surgical procedures; however, it is associated with significant morbidities, including bleeding intraoperatively and periorbital edema and ecchymosis postoperatively, which may influence patient and surgeon perception of surgical outcome.[1] The edema and ecchymosis may be distressing to patients, which could lead to a prolonged postoperative recovery and disruption of the patient's social life.[2,3] The patient's desire to have minimal downtime and return to normal activities has become a very influential force causing many surgeons to adopt more minimally invasive procedures. For this reason, identifying means of improving and hastening recovery after rhinoplasty procedures is essential.

A number of investigators have studied various methods for decreasing edema and ecchymosis since the 1950s, with variable success.[4] These methods include medications such as steroids and decongestants, herbal supplements, and various surgical techniques, including different approaches to lateral osteotomies.[5–11] Although there have been meta-analyses on the efficacy of corticosteroids in the management of rhinoplasty and a recent survey of practice patterns on the management of rhinoplasty patients, no concise review of all possible techniques for decreasing postoperative edema currently exists.[12,13] This review will detail the different pharmacologic treatments, postoperative practices, and surgical techniques that have been studied to minimize edema and ecchymosis in rhinoplasty along with their results. Although it is difficult to understand and apply all of the varying practices, the goal of this review is to summarize the literature and provide the evidence behind the current practices used by surgeons for decreasing postoperative edema and ecchymosis after rhinoplasty.

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