REFERENCES
1. Kara CO, Gökalan I. Effects of single-dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plastic and reconstructive surgery. 1999;104(7):2213-8.
2. Gersema L, Baker K. Use of corticosteroids in oral surgery. Journal of oral and maxillofacial surgery. 1992;50(3):270-7.
3. Ho D, Jagdeo J, Waldorf HA. Is there a role for arnica and bromelain in prevention of post-procedure ecchymosis or edema? A systematic review of the literature. Dermatologic surgery. 2016;42(4):445-63.
4. Kouzi SA, Nuzum DS. Arnica for bruising and swelling. American Journal of Health-System Pharmacy. 2007;64(23):2434-43.
5. Lyss G, Schmidt TJ, Merfort I, Pahl HL. Helenalin, an anti-inflammatory sesquiterpene lactone from Arnica, selectively inhibits transcription factor NF-κB. Biological chemistry. 1997;378(9):951-62.
6. Bedi MK, Shenefelt PD. Herbal therapy in dermatology. Archives of dermatology. 2002;138(2):232-42.
7. Verma N, Tripathi SK, Sahu D, Das HR, Das RH. Evaluation of inhibitory activities of plant extracts on production of LPS-stimulated pro-inflammatory mediators in J774 murine macrophages. Molecular and cellular biochemistry. 2010;336(1-2):127-35.
8. Kotlus BS, Heringer DM, Dryden RM. Evaluation of homeopathic Arnica montana for ecchymosis after upper blepharoplasty: a placebo-controlled, randomized, double-blind study. Ophthalmic Plastic & Reconstructive Surgery. 2010;26(6):395-7.
9. Robertson A, Suryanarayanan R, Banerjee A. Homeopathic Arnica montana for post-tonsillectomy analgesia: a randomised placebo control trial. Homeopathy. 2007;96(1):17-21.
10. Jeffrey S, Belcher H. Use of Arnica to relieve pain after carpal-tunnel release surgery. Alternative Therapies in Health and Medicine. 2002;8(2):66.
11. Kang JY, Tran KD, Seiff SR, Mack WP, Lee WW. Assessing the effectiveness of Arnica montana and Rhododendron tomentosum (Ledum palustre) in the reduction of ecchymosis and edema after oculofacial surgery: preliminary results. Ophthalmic Plastic & Reconstructive Surgery. 2017;33(1):47-52.
12. Hart O, Mullee MA, Lewith G, Miller J. Double-blind, placebo-controlled, randomized clinical trial of homoeopathic arnica C30 for pain and infection after total abdominal hysterectomy. Journal of the Royal Society of Medicine. 1997;90(2):73-8.
13. Reider N, Komericki P, Hausen B, Fritsch P, Aberer W. The seamy side of natural medicines: contact sensitization to arnica (Arnica montana L.) and marigold (Calendula officinalis L.). Contact Dermatitis. 2001;45(5):269-72.
14. Maurer H. Bromelain: biochemistry, pharmacology and medical use. Cellular and Molecular Life Sciences CMLS. 2001;58(9):1234-45.
15. Bhui K, Prasad S, George J, Shukla Y. Bromelain inhibits COX-2 expression by blocking the activation of MAPK regulated NF-kappa B against skin tumor-initiation triggering mitochondrial death pathway. Cancer letters. 2009;282(2):167-76.
16. Wu S-Y, Hu W, Zhang B, Liu S, Wang J-M, Wang A-M. Bromelain ameliorates the wound microenvironment and improves the healing of firearm wounds. Journal of Surgical Research. 2012;176(2):503-9.
17. Isola G, Matarese M, Ramaglia L, Iorio-Siciliano V, Cordasco G, Matarese G. Efficacy of a drug composed of herbal extracts on postoperative discomfort after surgical removal of impacted mandibular third molar: A randomized, triple-blind, controlled clinical trial. Clinical oral investigations. 2019;23(5):2443-53.
18. Ghensi P, Cucchi A, Creminelli L, Tomasi C, Zavan B, Maiorana C. Effect of oral administration of bromelain on postoperative discomfort after third molar surgery. Journal of Craniofacial Surgery. 2017;28(2):e191-e7.
19. Singh T, More V, Fatima U, Karpe T, Aleem MA, Prameela J. Effect of proteolytic enzyme bromelain on pain and swelling after removal of third molars. Journal of International Society of Preventive & Community Dentistry. 2016;6(Suppl 3):S197.
20. Bormann KH, Weber K, Kloppenburg H, Koch A, Meiser P, Gellrich NC. Perioperative Bromelain Therapy after Wisdom Teeth Extraction–A Randomized, Placebo‐Controlled, Double‐Blinded, Three‐Armed, Cross‐Over Dose‐Finding Study. Phytotherapy Research. 2016;30(12):2012-9.
21. Coroneos CJ, Voineskos SH, Cook DJ, Farrokhyar F, Thoma A. Perioperative corticosteroids reduce short-term edema and ecchymosis in rhinoplasty: a meta-analysis. Aesthetic surgery journal. 2016;36(2):136-46.
22. Koc S, Gürbüzler L, Yaman H, Eyibilen A, Süren M, Kaya Z, et al. The effectiveness of steroids for edema, ecchymosis, and intraoperative bleeding in rhinoplasty. American Journal of Rhinology & Allergy. 2011;25(2):e95-e8.
23. Saedi B, Sadeghi M, Fekri K. Comparison of the effect of corticosteroid therapy and decongestant on reducing rhinoplasty edema. American journal of rhinology & allergy. 2011;25(4):e141-e4.
24. Taskin U, Yigit O, Bilici S, Kuvat SV, Sisman AS, Celebi S. Efficacy of the combination of intraoperative cold saline-soaked gauze compression and corticosteroids on rhinoplasty morbidity. Otolaryngology–Head and Neck Surgery. 2011;144(5):698-702.
25. Ong AA, Farhood Z, Kyle AR, Patel KG. Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plastic and Reconstructive Surgery. 2016;137(5):1448-62.
26. Kelley BP, Koshy J, Hatef D, Hollier Jr LH, Stal S. Packing and postoperative rhinoplasty management: a survey report. Aesthetic surgery journal. 2011;31(2):184-9.
27. Lee HS, Yoon HY, Kim IH, Hwang SH. The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European archives of oto-rhino-laryngology. 2017;274(7):2685-94.
28. Seamont D, Vrcek I, Nakra T, Mancini R. Arnica and Bromelain for Blepharoplasty-Associated Ecchymosis. The American Journal of Cosmetic Surgery. 2018;35(3):130-4.
29. Simsek G, Sari E, Kilic R, Bayar Muluk N. Topical application of arnica and mucopolysaccharide polysulfate attenuates periorbital edema and ecchymosis in open rhinoplasty: a randomized controlled clinical study. Plastic and Reconstructive Surgery. 2016;137(3):530e-5e.
30. Sakallioglu Ö, Polat C, Soylu E, Düzer S, Orhan I, Akyigit A. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Annals of plastic surgery. 2015;74(4):392-6.
31. Mehdizadeh M, Ghassemi A, Khakzad M, Mir M, Nekoohesh L, Moghadamnia A, et al. Comparison of the effect of dexamethasone and tranexamic acid, separately or in combination on post-rhinoplasty edema and ecchymosis. Aesthetic Plastic Surgery. 2018;42(1):246-52.
32. Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plastic and reconstructive surgery. 2007;120(1):271-4.
33. Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT. Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty. Aesthetic plastic surgery. 2006;30(2):150-4.
34. Kargi E, Hosnuter M, Babucçu O, Altunkaya H, Altinyazar C. Effect of steroids on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Annals of plastic surgery. 2003;51(6):570-4.
35. Hwang SH, Lee JH, Kim BG, Kim SW, Kang JM. The efficacy of steroids for edema and ecchymosis after Rhinoplasty: A meta‐analysis. The Laryngoscope. 2015;125(1):92-8.
36. Gun R, Yorgancılar E, Yıldırım M, Bakır S, Topcu I, Akkus Z. Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty. International journal of oral and maxillofacial surgery. 2011;40(7):722-9.
37. Chaiet SR, Marcus BC. Perioperative Arnica montana for reduction of ecchymosis in rhinoplasty surgery. Annals of Plastic Surgery. 2016;76(5):477-82.
38. Kara CO, Kara InG, Topuz B. Does creating a subperiosteal tunnel influence the periorbital edema and ecchymosis in rhinoplasty? Journal of oral and maxillofacial surgery. 2005;63(8):1088-90.
39. Sakallioglu Ö, Cingi C, Polat C, Soylu E, Akyigit A, Soken H. Open versus closed septorhinoplasty approaches for postoperative edema and ecchymosis. Journal of Craniofacial Surgery. 2015;26(4):1334-7.
40. Kelles M, Erdem T, Firat Y, Kalcioglu MT, Akarcay M, Selimoglu E, et al. Efficacy of local heparinoids on preventing edema and ecchymosis after rhinoplasty. Kulak burun bogaz ihtisas dergisi: KBB= Journal of ear, nose, and throat. 2010;20(4):191.
41. Knackstedt R, Gatherwright J. Perioperative Homeopathic Arnica and Bromelain: Current Results and Future Directions. Annals of Plastic Surgery. 2020;84(3):e10-e5.
Figure 1. Grading scale for periorbital edema. 0, none. (+) 1, minimal. (+) 2, extending onto the iris. (+) 3, covering the iris. (+) 4, massive edema.
Figure 2. Grading scale for periorbital ecchymosis. (+) 1, extending to the medial canthus. (+) 2, extending to the pupil. (+) 3, past the pupil. (+) 4, extending onto the lateral canthus.
Figure 3. Mean ecchymosis scores of upper eyelids. POD, indicates postoperative day.
Figure 4. Mean ecchymosis scores of lower eyelids.
Figure 5. Mean edema scores of upper eyelids.
Figure 6. Mean edema scores of lower eyelids.