Corticosteroid Use in Cosmetic Plastic Surgery

Pulikkottil, Benson J.; Dauwe, Phillip; Daniali, Lily N.; Rohrich, Rod J.

doi:10.1097/prs.0b013e31829acc60

Cited by 35 publications

(44 citation statements)

References 28 publications

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“…Administering a single perioperative dose of dexamethasone decreases edema and ecchymosis formation over the first 2 postoperative days 97 ; there is also evidence that corticosteroids decrease pain and discomfort. 15,98,99 In addition, corticosteroids reduce nausea and vomiting in the immediate postoperative period, which may improve patient satisfaction. Conversely, there is some evidence that perioperative steroids may prolong postoperative ecchymosis 100 (see key action statement 8).…”

mentioning

confidence: 99%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

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Objective. Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work.The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre-and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri-and postoperative strategies to maximize patient safety and to optimize surgical results for patients.Purpose. The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age.Action Statements. The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for...

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mentioning

confidence: 99%

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Ishii

Tollefson

Basura

et al. 2017

Otolaryngol.--head neck surg.

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“…Oedema and ecchymosis were reported to reach a peak level However, oedema is the usual result of soft tissue trauma and leads to excess interstitial fluid due to impaired lymphatic and venous systems. 19 Limited subperiosteal dissection is recommended to reduce oedema and swelling. 15 With a piezoelectric device, the relatively bulky ultrasonic tip generates heat and requires constant cooling by saline irrigation.…”

Section: Summary Of Main Resultsmentioning

confidence: 99%

“…However, oedema is the usual result of soft tissue trauma and leads to excess interstitial fluid due to impaired lymphatic and venous systems . Limited subperiosteal dissection is recommended to reduce oedema and swelling .…”

Section: Discussionmentioning

confidence: 99%

Effect of piezoelectric osteotomy on postoperative oedema and ecchymosis after rhinoplasty

Kim

Kang

Jin

et al. 2019

Clinical Otolaryngology

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Objectives This study evaluated the efficacy of piezoelectric osteotomy in reducing oedema and ecchymosis during rhinoplasty via a systematic review with meta‐analysis. Design and setting Two authors independently searched the referenced databases. PubMed, Embase, SCOPUS, the Web of Science, the Cochrane library and Google Scholar databases were systematically searched from inception to January 2019. Participants Sufficient data were retrieved for a meta‐analysis of six trials with a total of 327 patients. Main outcome measures They included studies that compared piezoelectric osteotomy (treatment groups) with conventional osteotomy (control group). The outcomes of interest were operative time, mucosal injury, oedema, ecchymosis and postoperative pain. Baseline study characteristics, quality of study, numbers of patients in the treatment and control groups and outcomes were extracted. Results Intraoperative mucosal injury was significantly lower in the treatment group vs the control group, but operative time was longer in the treatment group. Eyelid oedema and ecchymosis in the first seven days postoperatively were statistically decreased in the treatment group vs the control group. In addition, pain in the first three days postoperatively was statistically decreased in the treatment group vs the control group. However, in a subgroup analysis according to osteotomy visibility in the control group (blind osteotomy vs osteotomy under direct vision), there was no significant difference in oedema and ecchymosis between treatment and osteotomy under direct vision. Conclusions Piezoelectric osteotomy during rhinoplasty can reduce eyelid oedema and eyelid ecchymosis compared to conventional osteotomy. However, piezoelectric osteotomy had no significant advantages in terms of postoperative oedema and ecchymosis compared to osteotomy under direct vision.

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“…56 On a similar note, the routine use of corticosteroids, while being effective for the prophylaxis of postoperative nausea and vomiting, was considered not warranted, as it reduced edema and ecchymosis on the first 2 postoperative days only. 57 A Cochrane Database Systematic review found the evidence for this effect to be of low quality and concluded that in 2014, the available evidence did not support the use of corticosteroids for prevention of complications following facial plastic surgery. 58 Insufficient evidence supporting the use of corticosteroids in facial plastic surgery raises the question whether perioperative corticosteroid administration is safe.…”

Section: Corticosteroidsmentioning

confidence: 99%

Reducing Periorbital Edema and Ecchymosis after Rhinoplasty: Literature Review and Personal Approach

Tasman

2018

Facial plast Surg

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Postoperative periorbital edema and ecchymosis are most bothersome to rhinoplasty patients. The degree of swelling and bruising is influenced by several factors, and numerous prophylactic and therapeutic measures have been described in the literature. This article reviews the current literature and concludes with the author's suggestions on how to best minimize postoperative periorbital edema and ecchymosis.

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Corticosteroid Use in Cosmetic Plastic Surgery

Abstract: Steroid use is not warranted in the postoperative period and only reduces transient edema and ecchymosis. A significant benefit for steroid use after rhytidectomy is not evident as well. Steroid use may benefit in postoperative nausea and vomiting.

Cited by 35 publications

References 28 publications

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Effect of piezoelectric osteotomy on postoperative oedema and ecchymosis after rhinoplasty

Reducing Periorbital Edema and Ecchymosis after Rhinoplasty: Literature Review and Personal Approach

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