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Ali Manafi, Navid Manafi, Commentary on: The Effect of Autologous Fat Grafting on Edema and Ecchymoses in Primary Open Rhinoplasty, Aesthetic Surgery Journal, Volume 40, Issue 4, April 2020, Pages 367–368, https://doi.org/10.1093/asj/sjz323
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Bruising and edema are usual postoperative complications of rhinoplasty and are related to the extent of soft tissue dissection and osteotomy; the more extension and manipulation of bones and adjacent soft tissues, the higher the chance of bruising. Although some patients exhibit a greater tendency to ecchymoses and bruise more easily, a finer and less traumatic surgical technique lessens postoperative bruising. Intraoperative treatment with steroids, desmopressin, tranexamic acid, and burr and piezoelectric surgery, can be helpful in reducing bleeding and bruising.1-4 Although postoperative bruising generally resolves within a few weeks after surgery, we usually warn patients preoperatively about this complication and its occurrence in the periorbital and malar area. In the early postoperative period, patients need to avoid heavy physical activities and emotional excitements that increase blood pressure and the chance of bleeding. Head elevation and the application of cold compresses are also very helpful.
This study is noteworthy for injecting autologous fat into the nasolabial groove and the area around the medial canthus and tear trough as a potential approach to decrease edema and bruising of the lateral osteotomy site, and for the idea of dividing patients into 2 groups with and without fat injection along with rhinoplasty.5 However, in this excellent study the use of lipoplasty combined with rhinoplasty to reduce edema and shorten the time required for ecchymoses to clear, mediated by anti-inflammatory factors such as M2-type macrophages, and utilizing fat as a mechanical barrier that blocks extravasation thereby controlling oozing and leakage from the osteotomy site vasculature, is a thoughtful method of considerable scientific merit.
