Topical Tranexamic Acid and Systemic Dexamethasone for Post-rhinoplasty Edema and Ecchymosis: First Direct Comparison

Abstract Background Postoperative edema and ecchymosis are common concerns following rhinoplasty, often prolonging recovery and affecting patient satisfaction. Systemic dexamethasone is widely used to reduce these complications, and topical tranexamic acid has recently gained attention. However, no study has directly compared their efficacy or evaluated their combined effect. Objectives This study aimed to compare the effectiveness of topical tranexamic acid, systemic dexamethasone, and their combination in reducing postoperative edema and ecchymosis after rhinoplasty. Methods A prospective, randomized, triple-blind controlled trial was conducted on 60 patients, who were randomly assigned into 4 groups: topical tranexamic acid (n = 15), systemic dexamethasone (n = 15), combination therapy (n = 15), and control (n = 15). Standardized clinical scoring was used to assess periorbital edema and ecchymosis on postoperative days 1, 3, and 7. Intergroup and intragroup comparisons were performed using appropriate statistical tests, with a significance threshold of P ≤ .05. Results Both topical tranexamic acid and systemic dexamethasone significantly reduced postoperative edema and ecchymosis compared with the control group (P < .05), with no significant difference between them. The combination therapy provided no additional benefit over monotherapy. Conclusions Topical tranexamic acid is as effective as systemic dexamethasone in reducing postoperative edema and ecchymosis, making it a viable alternative, especially for patients with contraindications to corticosteroids. The combination of both agents did not yield additional benefits. Level of Evidence: 2 (Therapeutic)