Is Nasal Skin Thickness a Prognostic Indicator to Postoperative Edema and Ecchymosis?

Aldosari, Badi

doi:10.1177/0145561319868452

Cited by 10 publications

(5 citation statements)

References 19 publications

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“…The main reasons for these soft-tissue reactions are periorbital swelling and vascular injuries due to trauma that occurs during nasal osteotomy procedures. In a recently conducted study that used the subjective “skin pinch test” to determine NSTE thickness, it was demonstrated that periorbital edema and ecchymosis were greater in patients with thicker NSTE 28 . However, according to our results, there was no significant difference between patients with thin and thick NSTE for both upper and lower eyelid edema and ecchymosis severity in all postoperative examinations.…”

Section: Discussioncontrasting

confidence: 44%

Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

Erdur¹,

Öktem²,

İnci³

et al. 2021

Journal of Craniofacial Surgery

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Objective: Understanding the postoperative dynamics of the nasal soft-tissue envelope (NSTE) is necessary to obtain the desired cosmetic results after rhinoplasty. This study was conducted to determine the changes of NSTE thickness and its effects on periorbital edema and ecchymosis following rhinoplasty. Methods: Thirty-five patients who underwent rhinoplasty were included in the study. Nasal skin and subcutaneous tissue thickness at the tip, supratip, rhinion, and nasion were measured using ultrasonography preoperatively and at the postoperative 3rd and 10th months. Periorbital edema and ecchymosis were evaluated at postoperative days 1, 3, and 7. The patients were categorized as the thick NSTE group (n ¼ 17) and the thin NSTE group (n ¼ 18) according to the preoperative median NSTE thickness. Results: In the thin NSTE group, supratip skin, subcutaneous tissue, and total NSTE thickness were lowest on the preoperative day but no statistically significant difference was found for the thick NSTE group. In the thin NSTE group, total NSTE thickness of the rhinion was highest at the postoperative 3rd month, but in the thick NSTE group, there was no statistically significant difference between postoperative 3rd and 10th months. In both groups, total NSTE thickness of the nasion was highest at the postoperative 3rd month and lowest at the postoperative 10th month. Conclusions: Supratip fullness occurs more prominent in patients with thin NSTE. Postoperative edema in the rhinion is greater in patients with thin NSTE for the early postoperative period but it lasts longer in patients with thick NSTE. Soft-tissue envelope atrophy at the nasion occurs in both groups in the late postoperative period. Periorbital edema and ecchymosis severity are not affected by NSTE thickness.

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Section: Discussioncontrasting

confidence: 44%

Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

Erdur¹,

Öktem²,

İnci³

et al. 2021

Journal of Craniofacial Surgery

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“…He found a significant association between skin thickness and worse edema results but no significant relationship to ecchymosis. 25 Our study did not examine nasal skin thickness, and additional research is needed to determine the potential contribution of these factors on ecchymosis color and pattern characteristics. Another limitation of our study includes the lacking record of the Fitzpatrick skin types of the participating patients.…”

Section: Discussionmentioning

confidence: 96%

“…Little is known about risk factors for those patients showing considerably worse PRE patterns. Aldosari 25 investigates the relationship between postrhinoplasty periorbital edema and ecchymosis to mean nasal skin thickness. He found a significant association between skin thickness and worse edema results but no significant relationship to ecchymosis.…”

Section: Discussionmentioning

confidence: 99%

Periorbital Ecchymosis Post Closed Rhinoplasty: Natural History, Risk Factors, and Validation of a New Scoring System

Mizrachi

Layous

Dror

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Postrhinoplasty periorbital ecchymosis is an inevitable side effect contributing to patients’ psychological aspect and early postoperative morbidity. Efforts are constantly being made to reduce ecchymosis using different methods with varying success. To evaluate treatment response, it is mandatory to have a reliable score. Several studies suggest other scoring systems, but none has been postrhinoplasty-specific, validated, and accepted. This study aimed to demonstrate the natural history of postrhinoplasty ecchymosis, find potential risk factors for worsening patterns, and suggest a useful and reliable periorbital ecchymosis scoring system for postrhinoplasty follow-up. Methods: This prospective study included 183 patients who underwent closed rhinoplasty by the same surgeon and the same principle method. Photographs of the periorbital ecchymosis were taken on postoperative days 1, 2, and 7. The periorbital area was divided into quarters, and three independent physicians assigned the dominant color of each quarter. Results: There were no significant variations between the three physicians’ scoring. The interobserver consistency defined as an excellent scoring system reliability, according to our statistical analysis. The postoperative ecchymosis demonstrated a consistent pattern of spread over time, dominating the medial quarters on early postoperative days 1 and 2, following into the lower lateral quarters in postoperative day 7. We found no correlation between patient demographics and clinical characteristics to ecchymosis patterns and temporal spread. Conclusions: Our study suggests a reliable and easy-to-use postrhinoplasty ecchymosis scoring system. This scoring method can be used for postrhinoplasty ecchymosis assessment and as a research-validated tool to quantify different perioperative treatments to reduce ecchymosis and estimate mid-face trauma.

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“…Only Ghavimi et al [ 20 ] explicitly stated nasal bone thickness > 3mm as an exclusion criteria. An initial increased incidence of oedema and ecchymosis in patients with thicker nasal skin has been recorded, thought to increase obstruction during surgery and interfere with lymphatic drainage [ 28 ]. The relationship between nasal bone thickness and osteotome size also impacts oedema and ecchymosis [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review

2022

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Piezosurgery use has become increasingly prevalent in osteotomies. Piezoelectric ultrasound waves can cut bone effectively, and some studies have shown reduced post-operative morbidities compared to conventional osteotomies. Oedema and ecchymosis are common complications of rhinoplasty and can impact patient satisfaction, wound healing, and recovery. We aim to provide an up-to-date comparison of post-operative oedema and ecchymosis in piezosurgery and conventional osteotomies. A literature search was conducted using the following online libraries; Pubmed, Cochrane, Science Direct, and ISRCTN (International Standard Randomised Controlled Trial Number). English publications between 2015 and 2020 were included. A systematic review was completed, and a comparison of oedema and ecchymosis in piezosurgery and conventional osteotomies was examined alongside other outcomes such as pain, mucosal injury, and surgery time. Eight randomised controlled trials (RCTs) met our criteria with a combined total of 440 patients: 191 male and 249 female. Piezosurgery had statistically significant (p < 0.05) reduction in short-term oedema compared to conventional osteotomies in 75% of the papers included, and in 50% this persisted across the whole follow-up period. Similarly, ecchymosis scoring was initially statistically lower (p < 0.05) in piezosurgery in 87.5% of the RCTs, and in 75% this persisted across the whole follow-up period. A reduction in pain (p < 0.05) and mucosal injury (p < 0.05) was also seen in piezoelectric osteotomies. The length of surgery time varied. Piezoelectric osteotomies reduce oedema and ecchymosis compared to conventional osteotomies, in addition to improving pain and mucosal injury. However, disadvantages such as length of surgery time and cost have been reported. 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.

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Is Nasal Skin Thickness a Prognostic Indicator to Postoperative Edema and Ecchymosis?

Cited by 10 publications

References 19 publications

Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

Effect of Nasal Soft-Tissue Envelope Thickness on Postoperative Healing Process Following Rhinoplasty

Periorbital Ecchymosis Post Closed Rhinoplasty: Natural History, Risk Factors, and Validation of a New Scoring System

A Comparison Between Piezosurgery and Conventional Osteotomies in Rhinoplasty on Post-Operative Oedema and Ecchymosis: A Systematic Review

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