Oral Bromelain Reduces Postoperative Edema Following Upper Blepharoplasty: A Randomized Triple-Blind Placebo-Controlled Trial

BACKGROUND: Periorbital edema and ecchymosis are common and distressing postoperative sequelae after blepharoplasty, often causing patient anxiety and delaying social recovery. Bromelain, a proteolytic enzyme from pineapple, is known for its anti-inflammatory and anti-edematous effects. OBJECTIVE: To investigate the efficacy of oral bromelain in reducing postoperative edema and ecchymosis after upper blepharoplasty. METHODS: This randomized, triple-blind, placebo-controlled clinical trial was performed at our tertiary center. Forty-six blepharoplasty candidates were randomly assigned to two groups of 23: the intervention group received bromelain capsules (200 mg, equivalent to 500 GDU) every 8 hours, while the control group received identical placebo capsules containing starch for 2 weeks. The severity of edema and ecchymosis was evaluated on postoperative days 1, 3, 7, and 11 using a validated photographic grading scale (grades 1-4). RESULTS: Both groups had similar baseline demographic characteristics (p>0.05). The bromelain group showed significantly lower edema scores on days 3, 7, and 11 (p<0.001, p=0.0002, and p=0.001, respectively). Ecchymosis scores were significantly reduced on day 3 (p=0.0002), but there were no significant differences between groups on days 7 and 11. Similarly, adverse effects did not differ significantly between the two groups. CONCLUSION: Oral bromelain markedly reduces swelling after blepharoplasty and has a notable effect on ecchymosis during the early recovery period. It may represent a safe and effective postoperative adjunct following upper blepharoplasty, although larger multicenter trials are required.