Comparison of Upper and Lower Eyelid Edema and Ecchymosis Following Rhinoplasty: A Study of Osteotome Versus Piezoelectric Techniques.

Background: Edema and ecchymosis are common effects of rhinoplasty, but differences between the upper and lower eyelids have not been objectively well studied due to the challenges of measurement and comparison. Objective: To compare the eyelid edema and ecchymosis among patients undergoing rhinoplasty using osteotomes versus piezoelectric techniques, as measured by a standardized photograph grading scale. Methods: In this prospective study, postoperative upper and lower eyelid edema and ecchymosis were evaluated separately on days 1, 3, and 7 using a 0-4 scale. Mann-Whitney U, Friedman, Bonferroni-adjusted Wilcoxon signed-rank, and paired t-tests were used for statistical analysis. Results: A total of 113 patients were included. The two groups were similar in terms of age, sex distribution, and intraoperative blood pressure values. Upper eyelid edema was greater than lower eyelid edema at all time points (p < 0.001). Lower eyelid ecchymosis peaked on day 1, while upper eyelid ecchymosis was most pronounced on day 3. The piezoelectric group had significantly less ecchymosis in the lower eyelid across all days (p < 0.001). Conclusion: This study demonstrates that ecchymosis was consistently lower in the lower eyelid among patients who underwent piezoelectric osteotomy compared to those treated with osteotomes.