BACKGROUND Several methods have been used to decrease the periorbital edema and ecchymosis after rhinoplasty. In this study, we evaluated the efficacy of hirudoid and dexamethasone in reduction of the periorbital edema and ecchymosis. METHODS Sixty patients who underwent primary rhinoplasty were randomly divided into 3 groups. Group H received hirudoid cream, 3 times per day for 5 days from postoperative-day (POD). Group D received 10 mg of dexamethasone IV, immediately before surgery; and group C (control) received neither dexamethasone nor hirudoid. Two surgeons who were unaware of administered medications rated the severity of edema and intensity of ecchymosis, on 2 nd , 5 th , and 7 th POD. RESULTS On 2 nd POD, the edema in group D was significantly lower than groups H and C; but there was no significant difference in severity and intensity of ecchymosis between 3 groups. On 7 th POD, the intensity of ecchymosis was significantly lower in group H in comparison to group C. When the difference between 2 nd and 7 th POD was evaluated, the resolution of severity of edema and intensity of ecchymosis was significantly better in group H (p<0.001). CONCLUSION Hirudoid was shown to be effective in reducing edema and ecchymosis after rhinoplasty. The use of dexamethasone was effective in prevention of periorbital edema at early postoperative days, but it was not effective on resolution of ecchymosis.