Use of low dose steroids to decrease postoperative Rhinoplasty swelling and ecchymosis.

Decreasing postoperative swelling after rhinoplasty is one of the most important aspects to achieving an excellent outcome since chronic swelling can lead to permanent expansion of the soft-tissue-skin envelope. Postoperative steroid administration has been shown in most clinical studies to decrease post-rhinoplasty edema and ecchymosis. The swelling and ecchymosis is decreased in the upper and lower eyelid area. According to Dr. Sam Rizk ,a new york rhinoplasty specialist and board certified facial plastic surgeon, a postoperative medrol dose pack and an intraoperative intravenous dose is better than just an intraoperative intravenous dose. In addition a low dose kenalog shot in the nose postoperatively at 1 week and repeated doses every few months also reduces postoperative swelling and helps thin some of patients with thick skin. Steroid shots should be reserved for patients undergoing ethnic rhinoplasty with thick skin. Kenalog shots in the nose in thin skin patients should not be performed as it can lead to irregularities and cartilage visibility.

Periorbital ecchymosis and edema are inconvenient sequelae after rhinoplasty and although expected, prolonged cases of ecchymosis can discolor the skin and are concerning for patients and surgeons. Severe edema can compromise healing, leading to suboptimal formation of scar tissue and significantly altering the intended result.

The periorbital area (eye area) is especially prone to postoperative swelling and bruising that may be difficult for the patient to camouflage. In addition to Dr. Sam Rizk's intraoperative minimally invasive techniques which decrease the use of swelling and bruising, the use of specific doses of steroids during and after the rhinoplasty, is also one of Dr. Rizk's pearls to achieve his rapid recovery outcomes after rhinoplasty. Dr. Sam Rizk uses 8-10mg of intravenous corticosteroids during the surgery which is the dose shown by most studies as necessary to decrease postoperative rhinoplasty edema. In addition , an oral prednisone taper with a medrol dose pack over a few days post-rhinoplasty is also used by Dr. Sam Rizk since it has been proven by many studies to statistically significantly decrease swelling and ecchymosis.

Risks of steroid use - Steroid administration postoperatively as a tapering dose is not always harmless and should not be used universally without regard to a patient's medical or psychological history. A history of Gastrointestinal acid formation or ulcers should preclude the use of steroids without antacids at the same time. Also in diabetics, it can cause sugar abnormalities postoperatively. Furthermore, patients with history of depression or mood problems can become aggravated or more anxious after the surgery with the use of steroids. Insomnia is also another potential side effects of oral steroid use postoperatively.

Steroid use is not the only medication used by Dr Sam Rizk to reduce postoperative swelling-it is only one part of his postoperative medication protocol. Dr. Sam Rizk also uses a certain type of vitamin k as well as arnica Montana and eating kiwi and pineapples after surgery. Dr. Rizk no longer uses Bromelin as it causes too much gastrointestinal irritation.

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