Comparative Efficacy of Dexamethasone and Tranexamic Acid in Reducing Bleeding, Edema, and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-Analysis

Rhinoplasty carries risks such as edema, ecchymosis, and bleeding. Techniques to reduce these include medical treatments (corticosteroids such as dexamethasone, tranexamic acid [TXA], and herbal remedies) and surgical modifications. TXA minimizes blood loss, while dexamethasone reduces inflammation and swelling. Although effective, the systemic risks of TXA remain unclear. We aimed to compare the efficacy of dexamethasone and TXA in intraoperative bleeding and early postoperative edema and ecchymosis management in rhinoplasty. We searched for relevant articles up to May 2025 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, operative duration, complications, drug dosage, administration route, timing of doses, postoperative assessment intervals, mean intraoperative blood loss, edema scores, and ecchymosis scores. We collected 1,944 records after excluding 2,661 duplicates. Screening identified 37 entries eligible for inclusion. Dexamethasone significantly reduced ecchymosis scores (mean difference [MD] -0.92, p<0.001); however, its effects were transient (p=0.002). TXA was comparable to dexamethasone in reducing ecchymosis (p=0.129). Dexamethasone reduced edema scores (MD -0.583, p<0.001), although the effects diminished over time (MD 0.024, p=0.019). TXA showed slightly greater edema reduction than dexamethasone (MD -0.386, p=0.043). Bleeding reduction was similar between TXA and dexamethasone (MD -40.18, p=0.4108). Dexamethasone and TXA reduce early postoperative ecchymosis, edema, and bleeding post-rhinoplasty; however, their effects wane over time. Dexamethasone reduces ecchymosis and edema, whereas TXA may show stronger anti-edematous effects; neither is superior for bleeding reduction. Although their safety profiles appear favorable, the optimal dosing and administration need further study.