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American Association of Plastic Surgeons
4. A Randomized, Controlled Comparison between Arnica and Steroids in the Management of Post-Rhinoplasty Ecchymosis
Bahman Guyuron, MD, Ali Totonchi, MD, Janine David, RN.
Case Western Reserve University, Cleveland, OH, USA.

PURPOSE:Both Arnica and corticosteroids have been recommended for the reduction of postoperative edema and bruising associated with rhinoplasty. This randomized, single blind study was designed to compare the efficacy of these products following rhinoplasty.
METHODS:Following IRB approval, 48 primary rhinoplasty patients were randomly assigned to 3 groups. The first group (P) received Dexamethasone (10 mg/kg, IV) intraoperatively followed by a six-day oral tapering dose of methylprednisolone. The second group (A) received Arnica (SinEcch) following the manufacturer’s recommended regimen. The last group (C) received neither agent and served as the control. Digital images were obtained on postoperative days 2 and 8. These images were reviewed by 4 panelists who were blinded to the nature of the treatment. The panelists rated the extent of ecchymosis (on a scale of 0 to 5), the intensity of the ecchymosis (on a scale of 0 to 4) and the severity of the edema (on a scale of 0 to 3).
RESULTS:On postoperative day 8, the average extent of ecchymosis, intensity of the ecchymosis, and severity of the edema was significantly less for all 3 groups when compared to postoperative day 2 (p =0.0037). Additionally, on postoperative day 8, there was no significant difference between groups A and C, while group P had a greater extent of ecchymoses than both groups A and C. Interestingly, the intensity of the ecchymosis was less for group C than group P. There were no significant differences between groups A and C and groups A and P. Finally, group P had significantly less edema compared to groups A and C. There was no significant difference between groups A and C.
CONCLUSION:We conclude that Arnica does not seem to offer any benefits to patients who undergo rhinoplasty. Although corticosteroids reduce edema, this gained benefit may not be justified because of their effects on the extent and intensity of ecchymoses.

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