• Denis S Valente, Niveo Steffen, Lauro A Carvalho, Giuliano B Borille, Rafaela K Zanella, and Alexandre V Padoin.
• Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
• JAMA Facial Plast Surg. 2015 May 1; 17 (3): 169-73.

ImportancePostoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events.ObjectiveTo determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty.Design, Setting, And ParticipantsRandomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly.InterventionsPatients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery.Main Outcomes And MeasuresWhen patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis.ResultsForty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered.Conclusions And RelevancePreoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure.Level Of Evidence1.

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