Download PDF
Facial Plast Surg 2023; 39(04): 427-433
DOI: 10.1055/s-0043-1764146
Original Article

Reducing Postoperative Swelling, Edema, and Ecchymosis after Open Rhinoplasty Using Intranasal Drainage

Sebastian Haack
1   Department for Facial Plastic Surgery, Marienhospital Stuttgart, Stuttgart, Germany
,
Steven Mann
1   Department for Facial Plastic Surgery, Marienhospital Stuttgart, Stuttgart, Germany
,
Brigitta Gahl
2   Surgical Outcome Research Center Basel, University Hospital Basel, Basel, BS, Switzerland
,
Martin Haug
3   Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Reducing postoperative strain on the patient after rhinoplasty is an important goal for the surgeon. Many strategies are described to reach that goal. One strategy is to remove blood from under the dissected soft tissue envelope by drains, before it can infiltrate the different layers causing ecchymosis, edema, and swelling. In our setting with wide degloving and using drains, we could show a significant reduction in ecchymosis on day 2 and 14 after surgery (p = 0.006 and p = 0.017). We also observed a significant effect for edema and general swelling on day 2 (p = 0.027 and p = 0.004), but this effect did not reach significance for these two parameters on day 14. And although the long-term effect needs to be assessed in the future, we found that using drains in open rhinoplasty with wide degloving is an easily applicable, cheap, and reproducible approach to reduce postoperative ecchymosis, edema, and swelling.

Keywords

rhinoplasty - ecchymosis - edema - drains - osteotomy


Publication History

Article published online:
14 March 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Accessed February 9, 2023 at: https://de.statista.com/statistik/daten/studie/449461/umfrage/anzahl-an-nasenkorrekturen-in-ausgewaehlten-laendern/
    PubMed
  • 2 Accessed February 9, 2023 at: https://www.plasticsurgery.org/documents/News/Statistics/2018/plastic-surgery-statistics-full-report-2018.pdf
    PubMed
  • 3 Daniel RK, Palhazi P. The nasal ligaments and tip support in rhinoplasty: an anatomical study. Aesthet Surg J 2018; 38 (04) 357-368
    Google Scholar
  • 4 Belek KA, Gruber RP. The beneficial effects of postrhinoplasty taping: fact or fiction?. Aesthet Surg J 2014; 34 (01) 56-60
    CrossrefPubMedGoogle Scholar
  • 5 Gürlek A, Fariz A, Aydoğan H, Ersöz-Oztürk A, Evans GR. Effects of high dose corticosteroids in open rhinoplasty. J Plast Reconstr Aesthet Surg 2009; 62 (05) 650-655
    CrossrefPubMedGoogle Scholar
  • 6 Seltzer AP. Minimizing post-operative edema and ecchymoses by the use of an oral enzyme preparation (bromelain). A controlled study of 53 rhinoplasty cases. Eye Ear Nose Throat Mon 1962; 41: 813-817
    PubMedGoogle Scholar
  • 7 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
    CrossrefPubMedGoogle Scholar
  • 8 Ong AA, Farhood Z, Kyle AR, Patel KG, kyle AR, Patal KG. Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 2016; 137 (05) 1448-1462
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Ghassemi A, Prescher A, Hilgers RD, Riediger D, Gerressen M. Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome. Aesthetic Plast Surg 2011; 35 (04) 603-607
    CrossrefPubMedGoogle Scholar
  • 11 Gutierrez S, Wuesthoff C. Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg (Oakv) 2014; 22 (02) 83-87
    CrossrefPubMedGoogle Scholar
  • 12 Mehdizadeh M, Ghassemi A, Khakzad M. et al. Comparison of the effect of dexamethasone and tranexamic acid, separately or in combination on post-rhinoplasty edema and ecchymosis. Aesthetic Plast Surg 2018; 42 (01) 246-252
    CrossrefPubMedGoogle Scholar
  • 13 Robiony M, Toro C, Costa F, Sembronio S, Polini F, Politi M. Piezosurgery: a new method for osteotomies in rhinoplasty. J Craniofac Surg 2007; 18 (05) 1098-1100
    CrossrefPubMedGoogle Scholar
  • 14 Rohrich RJ, Janis JE, Adams WP, Krueger JK. An update on the lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 2003; 111 (07) 2461-2462 , discussion 2463
    CrossrefPubMedGoogle Scholar
  • 15 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
    PubMedGoogle Scholar
  • 16 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
    CrossrefPubMedGoogle Scholar
  • 17 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
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 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
    CrossrefPubMedGoogle Scholar
  • 20 Wähmann M, Riedel F, Kovacevic M, Hopf A, Albers AE. [Comparison of piezoelectric and conventional osteotomy in rhinoplasty: a systematic review]. [Article in German] HNO 2019; 67 (02) 98-109
    PubMedGoogle Scholar