Rhinoplasty is one of the most commonly performed aesthetic facial surgery procedures and is one of the oldest as well. It has great success at reshaping the nose but every patient hates to undergo the inevitable swelling and bruising that is well known to accompany the procedure. In many cases the bruising under the eyes can persist for up to three weeks after surgery. The use of intraoperative epinephrine injections into the nasal tissues and the use of postoperative taping and splinting help, but there is no getting around that some bruising and swelling will occur.
In the Online First edition of the February 2015 issue of the JAMA Archives of Facial Plastic Surgery, a paper appeared entitled ‘Preoperative Use of Dexamethasone in Rhinoplasty – A Randomized, Double-blind, Placebo-Controlled Clinical Trial’. In this paper the author set out to determine whether preoperative use of dexamethasone sodium phosphate decreases the occurrence of swelling and bruising after rhinoplasty surgery. In a randomized, double-blind, placebo-controlled clinical trial consisting of forty two enrollees, two groups of patients were created where dexamethasone was intravenously injected before surgery while the other group had just saline injections. In group 2, normal saline solution was intravenously injected before surgery. One week after surgery photographs were evaluated by five plastic surgeons. The group that received dexamethasone showed lower rates of after surgery bruising and swelling than the group that received saline presurgery in a statistical significant way.
Dexamethasone is a type of glucocorticoid steroid medication. It has both anti-inflammatory and immunosuppressant actions. It works by switching off multiple inflammatory genes that are capable of being activated during inflammatory process. In higher concentrations it has the additional effects of suppression of the synthesis of anti-inflammatory proteins. It is one of the most commonly used drugs in the world to treat a variety of acute and chronic inflammatory conditions.
Swelling and bruising after rhinoplasty is hard to evaluate as every rhinoplasty surgery is somewhat different and each patient reacts in their own way. But this study did use the scientific method in a rigorous manner and demonstrated a beneficial effect of preoperative corticosteroid administration in nose reshaping surgery. Most surgeons probably already believe that steroids are beneficial and use them regularly. But for those who don’t this study may give them the nudge to do so.
Dr. Barry Eppley
Indianapolis, Indiana