Menstrual cycle phase and early periorbital edema and ecchymosis after rhinoplasty: an observational study.
- 1Department of Otorhinolaryngology, Faculty of Medicine, Uşak University, Uşak, Türkiye.
- 2Department of Otorhinolaryngology, University of Health Sciences, Istanbul, Türkiye.
Abstract
Background
Whether estimated menstrual cycle phase affects postoperative recovery after rhinoplasty remains unclear. Although previous rhinoplasty research has addressed intraoperative bleeding, its relationship with visible early postoperative outcomes such as periorbital edema and ecchymosis has not been well characterized.Methods
This prospective observational cohort study included 72 regularly menstruating women who underwent primary open rhinoplasty between February 1 and December 1, 2025. All procedures were performed by the same senior surgeon using a standardized piezoelectric technique. Menstrual phase was estimated from the last menstrual period and usual cycle length using predefined calendar-based criteria. Preoperative serum estradiol and progesterone were measured as biochemical characteristics and were not used to determine phase assignment. Lower eyelid edema, upper eyelid edema, lower eyelid ecchymosis, and upper eyelid ecchymosis were scored separately on postoperative days 1 and 3 using a 0-4 ordinal scale by an independent evaluator blinded to menstrual phase and hormone values. Between-group comparisons were performed using the Kruskal-Wallis test with Dunn-Bonferroni post hoc analysis. Exploratory cumulative-logit mixed-effects models accounted for repeated assessments and adjusted for postoperative day, age, operative duration, and septal correction.Results
The mean age was 25.75 ± 5.46 years. Calendar-based classification identified 28 patients in the estimated follicular group, 8 in the estimated periovulatory group, and 36 in the estimated luteal group. Estradiol levels were highest in the periovulatory phase, whereas progesterone levels were highest in the luteal phase. Significant between-phase differences were observed for all edema and ecchymosis outcomes on both postoperative days. The follicular phase consistently showed the lowest scores. Although no statistically significant difference was detected between the periovulatory and luteal phases, the small periovulatory subgroup precludes interpreting this finding as evidence of equivalence. Adjusted analyses generally supported these associations, although the periovulatory-follicular contrast for upper eyelid edema was imprecise and not statistically significant (aOR 4.80, 95% CI 0.96-23.95).Conclusion
Estimated menstrual cycle phase was associated with early postoperative periorbital edema and ecchymosis, with generally lower scores in the follicular group. These exploratory findings are hypothesis-generating and do not establish causality or justify routine modification of rhinoplasty scheduling based solely on menstrual phase.
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BibTeX
@article{topan2026menstrual,
title = {{Menstrual cycle phase and early periorbital edema and ecchymosis after rhinoplasty: an observational study.}},
author = {Yunus Emre Topan and Alper Tabaru and Ramazan Yavuz and Sedat Rüzgar},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1943506},
url = {https://europepmc.org/article/MED/42923336},
note = {CC BY},
}
RIS
TY - JOUR
TI - Menstrual cycle phase and early periorbital edema and ecchymosis after rhinoplasty: an observational study.
AU - Yunus Emre Topan
AU - Alper Tabaru
AU - Ramazan Yavuz
AU - Sedat Rüzgar
PY - 2026
DA - 2026/10/08
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1943506
UR - https://europepmc.org/article/MED/42923336
AB - Background Whether estimated menstrual cycle phase affects postoperative recovery after rhinoplasty remains unclear. Although previous rhinoplasty research has addressed intraoperative bleeding, its relationship with visible early postoperative outcomes such as periorbital edema and ecchymosis has not been well characterized.Methods This prospective observational cohort study included 72 regularly menstruating women who underwent primary open rhinoplasty between February 1 and December 1, 2025. All procedures were performed by the same senior surgeon using a standardized piezoelectric technique. Menstrual phase was estimated from the last menstrual period and usual cycle length using predefined calendar-based criteria. Preoperative serum estradiol and progesterone were measured as biochemical characteristics and were not used to determine phase assignment. Lower eyelid edema, upper eyelid edema, lower eyelid ecchymosis, and upper eyelid ecchymosis were scored separately on postoperative days 1 and 3 using a 0-4 ordinal scale by an independent evaluator blinded to menstrual phase and hormone values. Between-group comparisons were performed using the Kruskal-Wallis test with Dunn-Bonferroni post hoc analysis. Exploratory cumulative-logit mixed-effects models accounted for repeated assessments and adjusted for postoperative day, age, operative duration, and septal correction.Results The mean age was 25.75 ± 5.46 years. Calendar-based classification identified 28 patients in the estimated follicular group, 8 in the estimated periovulatory group, and 36 in the estimated luteal group. Estradiol levels were highest in the periovulatory phase, whereas progesterone levels were highest in the luteal phase. Significant between-phase differences were observed for all edema and ecchymosis outcomes on both postoperative days. The follicular phase consistently showed the lowest scores. Although no statistically significant difference was detected between the periovulatory and luteal phases, the small periovulatory subgroup precludes interpreting this finding as evidence of equivalence. Adjusted analyses generally supported these associations, although the periovulatory-follicular contrast for upper eyelid edema was imprecise and not statistically significant (aOR 4.80, 95% CI 0.96-23.95).Conclusion Estimated menstrual cycle phase was associated with early postoperative periorbital edema and ecchymosis, with generally lower scores in the follicular group. These exploratory findings are hypothesis-generating and do not establish causality or justify routine modification of rhinoplasty scheduling based solely on menstrual phase.
SN - 2296-875X
ER -