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Perioperative Arnica montana for Reduction of Ecchymosis in Rhinoplasty Surgery

Chaiet, Scott R. MD; Marcus, Benjamin C. MD

doi: 10.1097/SAP.0000000000000312
Aesthetic Surgery
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Background Studies of homeopathic therapies to decrease postrhinoplasty ecchymosis have previously used subjective measurements, limiting their clinical significance. Recently, Arnica montana was shown to decrease postoperative ecchymosis after rhytidectomy, using an objective measuring tool. We believe that oral A. montana, given perioperatively, can be objectively shown to reduce extent and intensity of postoperative ecchymosis in rhinoplasty surgery.

Methods Subjects scheduled for rhinoplasty surgery with nasal bone osteotomies by a single surgeon were prospectively randomized to receive either oral perioperative A. montana (Alpine Pharmaceuticals, San Rafael, Calif) or placebo in a double-blinded fashion. Ecchymosis was measured in digital “three-quarter”–view photographs at 3 postoperative time points. Each bruise was outlined with Adobe Photoshop (Adobe Systems Incorporated, San Jose, Calif), and the extent was scaled to a standardized reference card. Cyan, magenta, yellow, black, and luminosity were analyzed in the bruised and control areas to calculate change in intensity. P value of <0.1 was set as a meaningful difference with statistical significance.

Results Compared with 13 subjects receiving placebo, 9 taking A. montana had 16.2%, 32.9%, and 20.4% less extent on postoperative days 2/3, 7, and 9/10, a statistically significant difference on day 7 (P = 0.097). Color change initially showed 13.1% increase in intensity with A. montana but 10.9% and 36.3% decreases on days 7 and 9/10, a statistically significant difference on day 9/10 (P = 0.074). One subject experienced mild itching and rash with the study drug that resolved during the study period.

Conclusions Arnica montana seems to accelerate postoperative healing, with quicker resolution of the extent and the intensity of ecchymosis after osteotomies in rhinoplasty surgery, which may dramatically affect patient satisfaction.

From the Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.

Received September 12, 2013, and accepted for publication, after revision, June 6, 2014.

Conflicts of interest and sources of funding: Alpine Pharmacies (San Rafael, California) provided the study drug, Arnica montana, at no cost for this research study. None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article.

Reprints: Scott R. Chaiet, MD, Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin, K4/764 Clinical Science Center, 600 Highland Ave, Madison, WI 53792-7375. E-mail: scottchaiet@yahoo.com.

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