Ecchymosis Scores Research Articles

Microliposuction and Radiofrequency Combined With Fat Grating as a New Method for Hybrid-Type Nasolabial Folds.

The hybrid-type nasolabial fold is a special, complex type of nasolabial fold with various causes, making it difficult to obtain an ideal effect with a single treatment. This study aimed to investigate the effect and complications of a comprehensive therapy combining microliposuction, radiofrequency, and fat grafting on hybrid-type nasolabial folds. Twenty-one patients aged 27 to 45 (mean: 34.71±5.41) years, who underwent the therapy for hybrid-type nasolabial folds were retrospectively analyzed. All patients were followed up for 12 months. Two independent observers conducted postoperative follow-ups at 1 week and 12 weeks. One week postoperatively, the hematoma, mass nodule, and skin scald ecchymosis scores were 1.24±0.43, 1.62±0.58, and 1.48±0.59, respectively. At 12 weeks, the scores of mass nodules and skin scald ecchymosis decreased (1.19±0.39 and 1.05±0.21, respectively) without obvious hematoma. The WSRS grade decreased from 4.33±0.47 to 2.19±0.39 (P<0.001), and the hybrid-type nasolabial folds significantly improved. The Face-Q scale score was 20.43±2.63 points (standard score: 85.12±10.95 points). 76.19% of the patients scored more than 80 points in the subjective Face-Q evaluation. Microliposuction and radiofrequency combined with fat grafting effectively treats hybrid-type nasolabial folds, resulting in high patient satisfaction. Most complications can be prevented, and optimal outcomes can be obtained by comprehensive surgical methods and correct procedures, which is thus worthy of clinical promotion.

Use of Intravenous Tranexamic Acid in Patients Undergoing Plastic Surgery: Implications and Recommendations per a Systematic Review and Meta-Analysis.

With increasing interest in aesthetic plastic procedures, the event of blood loss has compromised patients' safety and satisfaction. Tranexamic acid (TXA) is a drug used for the reduction of blood loss during surgical procedures. This systematic review aims to evaluate the clinical efficacy and safety of TXA in aesthetic plastic surgery for the reduction of bleeding and related complications. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Electronic databases PubMed, EMBASE, Cochrane Library, and Google Scholar were searched. The medical subject headings (MeSH) keywords used for data extraction were ("TXA," OR "tranexamic acid,") AND ("plastic surgery," OR "aesthetic surgery," OR "rhinoplasty," OR "blepharoplasty,") AND ("blood loss" OR "bleeding" OR "TBL") AND ("Edema" OR "ecchymosis"). A combination of these MeSH terms was used in the literature search. The timeline of research was set from 2015 to January 2024. A total of 7380 research articles were identified from the above-mentioned databases, and only 13 research articles met the inclusion criteria. There was a significant difference in total blood loss (TBL) among patients who had undergone plastic surgery procedures while on TXA as compared to a placebo (mean difference = -6.02; Cl: -1.07 to -0.16; p > 0.00001), and heterogeneity was found (degrees of freedom (df) = 9; I2 = 97%). Only two studies reported the average ecchymosis scores after TXA among interventions in comparison to the placebo group. This review provides evidence that TXA lowers TBL, ecchymosis, edema, and anemia during cosmetic surgery without significantly increasing thromboembolic consequences.

Peroperative Cooling in Rhinoplasty: Does it Differ?

The main causes of ecchymosis and edema are osteotomy (bone manipulation), dissection of subcutaneous tissue, and skin manipulation in the rhinoplasty procedure. Eyelid edema following surgery can potentially affect visual acuity, particularly during the initial twenty-four hours after the procedure. These may also delay the patient's return to their normal social life therefore hampering their quality of life. Various surgical and medical methods have been reported to address these issues. This study aimed to compare the effects of using cold saline (0-4°C) versus room temperature saline (20-25°C) irrigation throughout the surgery on postoperative edema, ecchymosis, and pain. Fifty patients who underwent open-approach primary rhinoplasty between August 2022 and August 2023 at a tertiary academic center were included. Fifty patients were randomly divided into two groups depending on using cold saline (0-4°C) (group 1) or room temperature saline (20-25°C) (group 2) during surgical site irrigation. Patients were assessed for pain, edema, and bruising using a VAS (Visual Analog Scale) on the second and seventh postoperative days. Visual analog score (VAS) was used for subjective outcome analyses. Each patient scored the severity of their periorbital ecchymosis on day two and seven. Periorbital ecchymosis was also evaluated on the second and seventh postoperative days using the SPREE (Surgeon Periorbital Rating of Edema and Ecchymosis) scale. On the second postoperative day, the VAS pain score in group 1, where cold water was used, was found to be statistically and significantly different from the control group (group 2) (p < 0.05). However, there was no statistically significant difference between both groups when comparing the VAS pain scores on the seventh postoperative day. Regarding the VAS ecchymosis score on the seventh postoperative day, there was a statistically significant difference favoring group 1 (p < 0.05). The SPREE scale data also indicated that group 1 had significantly lower scores on the seventh day (p < 0.05). While the SPREE scores on the second day were lower in group 1 than in group 2, this difference did not reach statistical significance (p = 0.061). The findings from our study show that cold saline irrigation may contribute to intraoperative hemostasis by inducing local vasoconstriction. We observed that intraoperative bleeding decreased with the use of cold saline. This approach has the potential to improve patient satisfaction and overall quality of life by reducing postoperative ecchymosis without significantly increasing the cost of the surgical procedure.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of Preoperative Intravenous Versus Subcutaneous Tranexamic Acid on Postoperative Periorbital Ecchymosis and Edema Following Upper Eyelid Blepharoplasty: A Prospective, Randomized, Double-Blinded, Placebo-Controlled, Comparative Study.

To compare the effects of preoperative tranexamic acid (TXA) administered intravenously (IV) versus subcutaneously on postoperative ecchymosis and edema in patients undergoing bilateral upper eyelid blepharoplasty. A prospective, double-blinded, placebo-controlled study of patients undergoing bilateral upper eyelid blepharoplasty at a single-center. Eligible participants were randomized to preoperatively receive either (1) 1 g of TXA in 100 ml normal saline IV, (2) 50 µl/ml of TXA in local anesthesia, or (3) no TXA. Primary outcomes included ecchymosis and edema at postoperative day 1 (POD1) and 7 (POD7). Secondary outcomes included operative time, pain, time until resuming activities of daily living, patient satisfaction, and adverse events. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), ecchymosis scores were significantly lower on POD1 (1.31 vs. 1.56 vs. 2.09, p = 0.02) and on POD7 (0.51 vs. 0.66 vs. 0.98, p = 0.04) among those that received TXA. By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA), significant reductions in edema scores occurred in those that received TXA on POD1 (1.59 vs. 1.43 vs. 1.91, p = 0.005) and on POD7 (0.85 vs. 0.60 vs. 0.99, p = 0.04). By comparison (IV TXA vs. local subcutaneous TXA vs. no TXA) patients treated with intravenous and local subcutaneous TXA preoperatively were more likely to experience shorter operative times (10.8 vs. 11.8 vs. 12.9 minutes, p = 0.01), reduced time to resuming activities of daily livings (1.6 vs. 1.6 vs. 2.3 days, p < 0.0001), and higher satisfaction scores at POD1 (8.8 vs. 8.7 vs. 7.9, p = 0.0002). No adverse events occurred were reported. In an analysis of 106 patients, preoperative TXA administered either IV or subcutaneously safely reduced postoperative ecchymosis and edema in patients undergoing upper eyelid blepharoplasty. While statistical superiority between intravenous versus local subcutaneous TXA treatment was not definitively identified, our results suggest clinical superiority with IV dosing.

The Effects of Two Different Cold Application Times on Edema, Ecchymosis, and Pain After Rhinoplasty: A Randomized Clinical Trial

PurposeThis study was performed to determine the effects of different cold application times to the periorbital area after rhinoplasty on edema, ecchymosis, and pain. DesignA randomized clinical study. MethodsPatients were divided into two groups, and cold application was applied to one group for 4 hours and to the other for 48 hours. The cold application was applied with ice packs for 20 minutes every hour to the periorbital region in both groups. Data were collected with the Patient Information Form, Scoring Diagram for Edema, the Scoring Diagram for Ecchymosis, and the Visual Analogue Scale for Pain. FindingsPeriorbital edema, eyelid ecchymosis, and pain were not significantly different between the two groups. The mean edema score of the 48-hour group was 0.87 ± 0.93, while the mean edema score of the 4-hour group was 0.70 ± 0.87 (P = .48) on the 2nd day. The mean ecchymosis score was found as 2.03 ± 1.12 in the 48-hour group and 2.10 ± 1.09 in the 4-hour group (P = .817). The mean pain score was 12.50 ± 17.40 in the 48-hour group and 13.00 ± 16.00 in the 4-hour group (P = .98). ConclusionsThe effects of 48-hour and 4-hour cold applications are similar. Cold application for 4 hours may be recommended to patients who undergo rhinoplasty, as it is more practical and easier to apply than the 48-hour practice.

Use of Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratio to Predict Early Postoperative Periorbital Edema and Ecchymosis After Primary Septorhinoplasty.

To investigate the benefit of preoperative neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in predicting early postoperative periorbital edema and ecchymosis in patients undergoing primary septorhinoplasty. Sixty patients in ASA-I (American Society of Anesthesiologists) who were scheduled for elective primary septorhinoplasty were prospectively included in the study. Periorbital edema and ecchymosis levels of the patients were scored on the postoperative second day. The relationship between early postoperative periorbital edema and ecchymosis levels and preoperative neutrophil, lymphocyte, platelet, NLR, and PLR values were investigated. The mean age of the 60 patients was 24.05 ± 6.83 years. The patients were divided into 2 groups according to the total periorbital edema scores in both eyes on the second day after surgery. There was no significant difference between the two groups in terms of neutrophil, platelet, and NLR ( P > 0.05). In addition, the lymphocyte count was found to be statistically significantly lower and PLR significantly higher in the group with high edema scores ( P < 0.05). When the patients were divided into groups according to their periorbital ecchymosis scores, no significant correlation was found between any blood values and periorbital ecchymosis ( P > 0.05). Preoperative PLR may be used to predict early postoperative periorbital edema in patients undergoing primary rhinoplasty. However, a blood value that can predict periorbital ecchymosis has not been determined yet.

The Comparison of Conventional Osteotomes and Magic Saws in Terms of Edema and Ecchymosis After Rhinoplasty.

The goal of this study was to compare conventional osteotomes and Magic Saws in terms of edema and ecchymosis, in rhinoplasty patients. A retrospective, case-control study. In this prospective, randomized study, we evaluated the results of 258 rhinoplasty patients who underwent osteotomy by either conventional osteotomes or new designed saws called; "Magic Saws." On postoperative days 2 and 7, the patients were photographed by the surgeon; photographs were evaluated by another otolaryngologist, blinded from the osteotomy procedure. There were no statistically differences between the groups, in terms of age, sex, weight, or average arterial blood pressure (P > 0.05). The postoperative periorbital edema (days 2 and 7) and ecchymosis (day 2) scores were significantly higher in the conventional osteotomy group, as compared to Magic Saw group (P < 0.05). However, on postoperative day 7, the differences in the periorbital ecchymosis scores between the groups, were not statistically significant (P > 0.05). As compared to conventional osteotomes, Magic Saws were reported to be associated with minimal soft tissue injury, as well as decreased edema and ecchymosis, in the early postoperative period after rhinoplasty.

Surgical Burr-Assisted Lateral Osteotomy Technique in Septorhinoplasty.

Achieving aesthetic and functional results in rhinoplasty requires meticulous techniques, and postoperative edema, ecchymosis, and pain can deteriorate the desired outcomes. Different osteotomy techniques are defined to have optimal outcomes while reducing edema, ecchymosis, and pain. In this study, the authors compared conventional and power-assisted surgical burr osteotomy techniques in terms of early postoperative complications. Patients who underwent primary open septorhinoplasty were included in the study and were divided into 2 groups. The first group had lateral endonasal osteotomy with conventional guided osteotomes, and the second group had lateral osteotomy with surgical round burr. Edema and ecchymosis scoring systems were used on the postoperative first, third, and seventh day to evaluate postoperative edema and ecchymosis, and the visual analog scale was used to evaluate pain severity on the postoperative period. Out of 70 patients who had undergone septorhinoplasty, 36 received conventional osteotomy and 34 received surgical round burr osteotomy. Periorbital ecchymosis scores were significantly lower in the second group on the postoperative first, third, and seventh days. The periorbital edema scores were significantly lower in the second group on the first postoperative day but no difference was found between postoperative days 3 and 7. Also, the pain scores were significantly lower in the second group. Osteotomy with surgical round burr yields less ecchymosis, edema, and pain in the early postoperative period than conventional osteotomy in primary septorhinoplasty patients.

The Effect of 3D-Printed Custom External Nasal Splint on Edema and Ecchymosis After Rhinoplasty

The aim of this study was to investigate the effects of traditional thermoplastic splints vs a 3D-printed custom external nasal splint designed to apply pressure to the lateral osteotomy lines and neighboring periorbital region on edema and ecchymosis after rhinoplasty. Forty patients undergoing open rhinoplasty were included in this prospective randomized controlled study. The patients were divided into 2 groups. In the study group, the new 3D-printed custom external nasal splint was used. In the control group, the thermoplastic external nasal splint was used. Periorbital edema and ecchymosis scores were assessed peroperative before external nasal splint application, postoperatively at the 1st and 4th hours, and 1st, 2nd, 5th, 7th, 10th, and 15th days. There were lower scores of ecchymosis and edema in the study group compared to the control group for all the follow-up controls. There was a significant difference between the 2 groups with respect to the occurrence of ecchymosis for all follow-up controls except for the first postoperative hour and the seventh postoperative day (P<.05). Comparison of the 2 groups with respect to the grade of edema showed a significant difference only in the first and fourth postoperative hours (P<.05). The study detected less edema and ecchymosis scores using this 3D custom external nasal splint, thus creating a new area of use for 3D printers in the field of facial esthetic surgery. New thermoplastic splints of different shapes and sizes can be produced that can compress the osteotomy lines and the neighboring periorbital region.

Investigation of the Effects of Internal and External Lateral Osteotomies on Periorbital Edema and Ecchymosis in Patients Undergoing a Septorhinoplasty.

Objective: Periorbital ecchymosis and edema are common after septorhinoplasty surgery. This study aimed to compare internal and external lateral nasal osteotomies performed in septorhinoplasty in terms of postoperative ecchymosis and edema.Methods: Patients who underwent septorhinoplasty between January 2020 and July 2020 in our clinic were included in the study. In all patients, right lateral nasal osteotomies were performed endonasally and left lateral nasal osteotomies externally. The postoperative 1st, 7th, and 14th day ecchymosis and edema scores of all patients were calculated separately for the two groups and compared.Results: A total of 60 patients (29 females, 31 males) were included in the study. The mean age of the patients was 33.88 ± 10.30 years. No significant difference was observed between the two groups in terms of the postoperative periorbital ecchymosis scores on the first day and the first and second weeks (0.314, 0.344, and 0.468, respectively). There was also no significant difference between the two groups in terms of the postoperative periorbital edema scores on the first day and at the first and second weeks (0.272, 0.359, and 0.513, respectively).Conclusion: The results obtained from this study showed no significant difference in the periorbital ecchymosis and edema scores between the patients who had undergone septorhinoplasty with internal or external lateral osteotomies. Further multicenter studies are recommended to verify the findings of this study with a larger sample size.

Effect of Nasal Skin Type on Skin Problems following Rhinoplasty.

Skin problems following rhinoplasty may cause dissatisfaction concerning the esthetic expectations of the patients. This study was conducted to determine whether nasal skin type has an effect on skin problems after rhinoplasty. Thirty-five patients undergoing rhinoplasty in our tertiary referral center between May 2018 and August 2019 were included in the study. The nasal skin sebum level was measured with Sebumeter preoperatively and patients were divided into two groups according to the median sebum level. Among the 35 patients, half of them with higher nasal skin sebum were categorized as oily skin group (n = 17; 14 males, 3 females; mean sebum level: 200.3 ± 26.9), and the other half were categorized as dry skin group (n = 18; 10 males, 8 females; mean sebum level: 101.9 ± 38). Periorbital edema and ecchymosis were assessed at postoperative days 1, 3, and 7. Acne and seborrhea severity determined with Global Acne Grading System and Seborrheic Dermatitis Area Severity Index the day before operation and postoperative days 7 and 14 and months 1, 3, and 10. Compared with dry skin group, upper eyelid ecchymosis score at postoperative day 7 was statistically higher in oily skin group (p = 0.044). There was no significant difference in upper eyelid edema scores between postoperative days 1 and 3 for oily skin group (p = 0.020). No statistically significant differences were found for acne and seborrhea severity. Nasal skin sebum levels may affect periorbital edema and ecchymosis after the procedure but no significant effect has been observed for acne and seborrhea. Predicting the effect of nasal skin types on these problems may help the surgeon to inform patients more correctly.

Bipolar or monopolar electrosurgery in blepharoplasty: A comparison of surgical outcomes and patient satisfaction.

An electrosurgery unit (ESU) is the mainstay of bleeding control in blepharoplasty. There are two different types of ESUs: monopolar (m-ESU) and bipolar (b-ESU). We used m- and b-ESUs in upper, lower, and combined blepharoplasty and compared their outcomes. In this retrospective file review of 292 blepharoplasty patients, we excluded 14 who were lost to follow-up or had missing data; among the 278 enrolled patients, we recorded operative time, a surgeon panel's score for edema and ecchymosis on the third postoperative day, patients' scores of their satisfaction and inconvenience, and postoperative complications. One hundred thirty-nine patients were included in the m-ESU and b-ESU group. Overall, 105 patients underwent upper blepharoplasty, 77 underwent lower blepharoplasty, and 96 underwent combined blepharoplasty. The total mean operative time in the m-ESU and b-ESU was 67.94 and 62.82minutes, respectively. This difference was not significant (P>.05). The panel's edema and patient satisfaction and inconvenience scores were significantly better in the b-ESU group (P<.05). There were no significant differences in the panel's ecchymosis score and frequency as well as nature of complications between the m-ESU and b-ESU group (P>.05). In this cohort of blepharoplasty patients, minimally invasive b-ESUs were efficient in obtaining reliable surgical results with higher satisfaction and lower inconvenience rates of patients than m-ESUs. We would like to recommend the use of b-ESUs in blepharoplasty, especially for plastic surgeons inexperienced in periorbital esthetic surgery.

A meta-analysis of pre- and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery

IntroductionEdema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. ObjectiveWe conducted this systematic review and meta-analysis to determine the effect of pre- and postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. MethodsA comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of pre- or postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. ResultsNineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo −0.82, 95% CI (−1.37, −0.26), and -0.95, 95% CI (−1.32, −0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. ConclusionThis comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.

Efficacy of Dexamethasone for Reducing Edema and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-analysis.

Rhinoplasty is one of the most challenging cosmetic surgical operations. The procedure has been known to precipitate higher levels of edema and ecchymosis in the periorbital and paranasal regions. The literature recommends the use of corticosteroids such as dexamethasone to alleviate these postoperative morbidities. In this review, we aim to provide a current state of evidence concerning the influence of dexamethasone together with rhinoplasty on intraoperative and postoperative morbidities. A systematic identification of the literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis compared the influence of dexamethasone and normal saline administered during rhinoplasty on the amount of intraoperative blood loss, postoperative edema and ecchymosis. Out of 1045 records, ten articles including 374 participants (mean age: 25.8 ± 2.5years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of dexamethasone during rhinoplasty to reduce the amount of intraoperative blood loss, edema and ecchymosis as compared to normal saline. The meta-analysis reveals beneficial effects for dexamethasone interventions by demonstrating medium to large effect reduction of the amount of intraoperative blood loss (Hedge'sg: - 0.69), mean edema score (- 1.09) and mean ecchymosis score (- 1.03) as compared to placebo groups using normal saline. The current systematic review and meta-analysis recommend the administration of dexamethasone with rhinoplasty. The review reports beneficial effects of dexamethasone's administration as compared to normal saline for reducing the amount of intraoperative blood loss, postoperative edema and ecchymosis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty: A Randomized Clinical Trial.

Periorbital ecchymosis and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty. Several methods have been evaluated to minimize these sequelae including creation of subperiosteal tunnels, which involves elevating the vascular periosteal layer, preserving it from trauma when creating osteotomies. To assess the efficacy of the creation of subperiosteal tunnels prior to lateral osteotomies during rhinoplasty for reducing postoperative ecchymosis and edema. A randomized, blinded, matched-paired, prospective, clinical trial took place between April 1 and August 30, 2015, in a private practice in a stand-alone clinic and surgical center. All patients who were undergoing aesthetic rhinoplasty requiring bilateral lateral osteotomies were offered inclusion in the trial. All 34 enrolled patients completed the follow-up requirements. Creation of subperiosteal tunnels prior to lateral osteotomies on 1 randomly selected side. Three blinded evaluators independently graded the degree of ecchymosis and edema on a visual analog scale of 0 to 10 on each side of the nose on postoperative days 2 and 7. Each patient had 1 side that was randomly selected to undergo creation of subperiosteal tunnels. A difference in mean score between sides of the nose was calculated for each patient using a paired t test. Of the 34 patients (28 females and 6 males; mean [SD] age, 27.3 [9.2]), the mean (SD) difference in ecchymosis scores between sides on day 2 was -0.05 (1.94) (95% CI, -0.43 to 0.33) and on day 7 was -0.22 (1.23) (95% CI, -0.47 to 0.02), favoring the side without tunnels. The mean (SD) difference in edema scores on day 2 was -0.21 (1.66) (95% CI, 0.53-0.12) and on day 7 was -0.29 (1.11) (95% CI, -0.51 to -0.07). There were no clinically significant differences between sides in terms of postoperative ecchymosis and edema. Ecchymosis and edema can have significant postoperative practical, emotional, and financial effects on patients. Creation of subperiosteal tunnels prior to lateral osteotomies showed no clinically significant differences in edema and ecchymosis after the procedure. 1. isrctn.org Identifier: ISRCTN42741475.

Early Results of a Randomized Clinical Trial of Mechanochemical Ablation Versus Cyanoacrylate Adhesive for the Treatment of Varicose Veins

Endovenous thermal ablation techniques have become the first-line treatment of truncal veins. However, these techniques use heat and have need of tumescent anesthesia, which are often associated with pain. To overcome these side effects, novel nonthermal techniques, such as mechanochemical ablation (MOCA) and cyanoacrylate embolization (CAE), have been developed; these do not require tumescence or use heat. This randomized controlled trial aimed to assess the degree of pain resulting from MOCA compared with CAE. We are herein reporting the early results of this randomized clinical trial. Patients with saphenous vein incompetence were randomized to receive treatment with either MOCA or CAE. The primary end point is pain score immediately after completion of truncal ablation, measured by a 100-mm visual analog scale. The secondary end points include entire treatment pain scores, clinical scores, and quality of life scores. Additional assessments include ecchymosis scores, occlusion rates, and time to return to usual activities/work at 2 weeks. Patients are observed at 2 weeks, 3 months, 6 months, and 12 months. So far, 84 patients have been recruited (66% women; mean age, 56 years). The vein treated was the great saphenous vein in 86% of cases, and 51% of the cases were randomized to cyanoacrylate ablation. Both groups had similar baseline characteristics. Patients in both groups experienced similar maximum pain score by visual analog scale (CAE: median 24 mm (interquartile range [IQR], 9-45 mm); MOCA: median, 23 mm (IQR 11-49 mm); P = .464) and number scale (CAE: median, 3 (IQR, 1-5); MOCA: median, 3 (IQR, 2-5); P =.333). Average pain score was also similar between treatment groups. Eighty-three percent (70 patients) of the population attended the 2-week follow-up. Postprocedure ecchymosis score, recovery time, and clinical and quality of life scores were similar between groups. The early results of this trial showed that pain score is comparable between CAE and MOCA endovenous ablation. The results also indicated similar improvement in quality of life, clinical improvement, and recovery time. Recruitment of patients is ongoing, and longer term follow-up data are currently being collected.

Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty

Evidence has emerged on the efficacy of tranexamic acid to control blood loss and postoperative complications after rhinoplasty. To investigate the results of tranexamic acid use to reduce intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis in rhinoplasty. For this systematic review of randomized clinical trials, searches were performed in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, Science Direct, Google Scholar, OpenThesis, and ClinicalTrials.gov from inception to December 23, 2017. Key words included tranexamic acid, rhinoplasty, and nasal surgical procedures. The following elements were used to define eligibility criteria: (1) population: patients undergoing rhinoplasty surgery; (2) intervention and controls: tranexamic acid vs placebo solution or no-treatment control group; (3) outcomes: intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis, and thromboembolic events; and (4) study type: randomized clinical trials. Two reviewers extracted data and assessed study quality according to the Cochrane guidelines for randomized clinical trials. Treatment effects were defined as weighted mean difference (WMD) and 95% CIs. The strength of evidence was analyzed using the Grading of Recommendations Assessment, Development, and Evaluation rating system. Intraoperative bleeding, postoperative eyelid edema and periorbital ecchymosis. To calculate the effect sizes, means and SDs were obtained for each study group and outcome of interest. Five studies comprising 276 patients were included in the systematic review: 177 patients (64.1%) were women, and mean age was 26.8 (range, 16-42) years. Four studies comprising 246 patients estimated the amount in intraoperative bleeding as a primary outcome and were included in the meta-analysis. Eyelid edema and ecchymosis were evaluated as outcomes in 2 studies. Tranexamic acid was associated with reduced bleeding during rhinoplasty was found (WMD, -42.28 mL; 95% CI, -70.36 to -14.21 mL), with differences (P = .01) between oral (WMD, -61.70 mL; 95% CI, -83.02 to -40.39 mL; I2 = 0%) and intravenous (WMD, -23.88 mL; 95% CI, -45.19 to -2.58 mL; I2 = 56%) administration. Eyelid edema and ecchymosis scores in patients receiving tranexamic acid were significantly lower compared with the control group within the first postoperative week: lower eyelid edema, WMD, -0.76; 95% CI, -1.04 to -0.49 and lower eyelid ecchymosis, WMD, -0.94; 95% CI, -1.80 to -0.08. No cases of thromboembolic events were reported. Current available evidence suggests that preoperative administration of tranexamic acid is safe and may reduce intraoperative bleeding as well as postoperative eyelid edema and ecchymosis in patients undergoing rhinoplasty.

A comparison of piezosurgery with conventional techniques for internal osteotomy.

To compare conventional osteotomy with the piezosurgery medical device, in terms of postoperative edema, ecchymosis, pain, operation time, and mucosal integrity, in rhinoplasty patients. In this prospective study, 49 rhinoplasty patients were randomly divided into two groups according to osteotomy technique used, either conventional osteotomy or piezosurgery. For all patients, the total duration of the operation was recorded, and photographs were taken and scored for ecchymosis and edema on postoperative days 2, 4, and 7. In addition, pain level was evaluated on postoperative day 2, and mucosal integrity was assessed on day 4. All scoring and evaluation was conducted by a physician who was blinded to the osteotomy procedure. In the piezosurgery group, edema scores on postoperative day 2 and ecchymosis scores on postoperative days 2, 4, and 7 were significantly lower than in the conventional osteotomy group (p < 0.05). On postoperative day 2, the pain level was lower in the piezosurgery group than in the conventional osteotomy group (p < 0.05). In an endoscopic examination on postoperative day 4, while 24% of the patients in the conventional osteotomy group had mucosal damage, no such damage was observed in the piezosurgery group. When total operation duration was compared, there was no significant difference between the groups (p > 0.05). Piezosurgery is a safe osteotomy method, with less edema (in the early postoperative period) and ecchymosis compared with conventional osteotomy, as well as less pain, a similar operation duration, and no mucosal damage.

Effect of the Rhinoplasty Technique and Lateral Osteotomy on Periorbital Edema and Ecchymosis.

The present study aimed to compare edema and ecchymosis in the early and late postoperative periods following the application of different surgical techniques (open and endonasal) and different types of lateral osteotomy (internal and external). The files and photographs of a total of 120 patients whose records were regularly maintained/updated and who underwent septorhinoplasty operation with the same surgeon were retrospectively evaluated. Sixty-nine (57.5%) patients were women and 51 (43.5%) were men. The patients were divided into 4 different groups according to the operations they underwent as follows--Group I: open technique septorhinoplasty + internal/continuous lateral osteotomy; Group II: endonasal rhinoplasty + internal/continuous lateral osteotomy; Group III: open technique septorhinoplasty + external/perforating lateral osteotomy; and Group IV: endonasal rhinoplasty + external/perforating lateral osteotomy. Postoperative edema and ecchymosis, and lateral nasal wall mucosal damage because of osteotomy were evaluated. Postoperative second day edema and ecchymosis scores were statistically significantly better in patients in Group II compared with the patients in Group I (P = 0.010 and P = 0.004, respectively). Postoperative first day edema and postoperative seventh day ecchymosis scores were statistically significantly better in the patients in Group IV compared with the patients in Group III (P = 0.025 and P = 0.011, respectively). Intraoperative bleeding was similar in all groups. The nasal tip was more flexible in patients who underwent closed technique rhinoplasty. Unilateral mucosal damage occurred in 3 patients (4%) with internal lateral osteotomy, whereas no mucosal damage was present in patients with external osteotomy. The difference in the rate of edema and ecchymosis in the early postoperative period between the closed technique rhinoplasty and the open surgical approach was statistically significant, whereas osteotomy did not cause a significant difference. According to these results, the authors suggest endonasal surgery to prevent the development of edema and ecchymosis, whereas the choice of lateral osteotomy should be dependent on the experience of the surgeon.

The Efficacy of Tranexamic Acid and Corticosteroid on Edema and Ecchymosis in Septorhinoplasty

The aim of this study was to investigate the efficacy of tranexamic acid (TA) and methylprednisolone on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open septorhinoplasty (oSRP). Seventy-five patients performing hump extraction and osteotomies were allocated into 3 groups as follows: group 1, 25 patients as control; group 2, 25 patients who were administered oral TA as first dose 1 g starting 2 hours before surgery, 3 g daily in divided doses (1 g, every 8 hours) for 5 days; and group 3, 25 patients who were administered a single dose of 1 mg/kg intravenous methylprednisolone at the beginning of the surgery. Operation time, amount of intraoperative bleeding, and complications were recorded. Scoring of eyelid edema and periorbital ecchymosis was evaluated on postoperative first, third, and seventh days using scale of 0 to 4 by 2 observers. In groups using TA and methylprednisolone, periorbital edema and ecchymosis scores were significantly lower compared with the control group (P < 0.05). No significant difference was seen clinically and statistically in preventing or decreasing both periorbital edema and ecchymosis between group 2 and group 3. Patients given TA showed significantly less intraoperative bleeding compared with controls and patients who were administered methylprednisolone. We observed that the administration of methylprednisolone significantly decreases periorbital edema and ecchymosis. Additionally, our results support that TA use in patients who underwent oSRP with osteotomies was found clinically and statistically effective for prevention of bleeding during oSRP operations and reduction of both periorbital edema and ecchymosis.