LAUSR

As the authors have underscored, there are many barriers to patients seeking rhinoplasty including financial, social, cultural, and recovery. Recovery from rhinoplasty is not insignificant. Patient testimonials on social media regarding pain, edema, and especially ecchymoses are common. Ecchymoses due to hemosiderin deposits can last an indefinite period of time and should be quickly treated when they occur with 515-nm broadband light (intense pulsed light) to diminish them early on. But avoidance is the key point of this very well designed and controlled study regarding the roles of dexamethasone and tranexamic acid. Encouraged by an earlier report by Guyuron at the annual meeting of the Rhinoplasty Society in 2011 about the use of DDAVP to control epistaxis after rhinoplasty [1], we presented to that same society’s annual meeting in 2013, greatly reduced, and in some cases, elimination of ecchymoses with a combined use of dexamethasone and DDAVP 0.3 mcg/kg routinely given 30 min prior to the procedure [2]. The use of power tools at that time (Stryker ultra-high-frequency micro-saws and burrs at 3000 cycles per second) was also implicated in this remarkable comparison to patients done with hand tools and without the benefit of DDAVP (photographs 1 through 6) [2]. Piezo ultra-high-frequency power tools that vibrate at 30,000 cycles per second have also been recently demonstrated alone to reduce the severity of ecchymoses [4].