Perioperative corticosteroids for preventing complications following facial plastic surgery

Abstract

BACKGROUND: Early recovery is an important factor for people undergoing facial plastic. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling) and ecchymosis (bruising), which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis. OBJECTIVES: To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults. METHODS:Search strategy: In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). There were no restrictions on the basis of date or language of publication. Selection criteria: We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. Data collection and analysis: Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data. MAIN RESULTS: We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema) and bruising (ecchymosis). Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only possible for two studies, with a total of 60 participants, and showed that a single perioperative dose of 10 mg dexamethasone decreased oedema formation in the first two days after surgery (SMD = -1.16, 95% CI: -1.71 to -0.61, low quality evidence). The evidence for ecchymosis was less consistent across the studies, with some contradictory results, but overall there was some evidence that perioperatively administered corticosteroids decreased ecchymosis formation over the first two days after surgery (SMD = -1.06, 95% CI:-1.47 to -0.65, two studies, 60 participants, low quality evidence). The difference was not maintained after this initial period. One study, with 40 participants, showed that high

Postoperative Care in Aesthetic Rhinoplasty Patients

“…[22][23][24][25][26][27][28][29][30] Despite this, a Cochrane review in 2014 found insufficient evidence to merit its use. 31 Both senior authors (H.A.S. and F.A.)…”

Getting Better Results in Facelifting

“…However, available evidence at this time does not support the use of postoperative steroid use. 55,56 An exception is in patients who undergo laser skin resurfacing, who are started on a methylprednisolone dose pack taper on postoperative day 1.…”

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

“…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. One recent review, referring to 14 studies totaling 1449 patients, found no evidence of an increased risk of infection during short observation periods, often restricted to in-hospital observations, or even just the first postoperative day, and a lack of adequate definitions for the side effects.…”