Evaluation of the Efficacy of Hilotherapy for Postoperative Edema, Ecchymosis, and Pain After Rhinoplasty Deniz Hanci, MD, * Onur € Ust € un, MD,y Ayc ¸a Bas ¸kadem Yılmazer, MD,z Ays ¸e Enise G€ oker, MD,x Semih Karaketir, MD,k and Yavuz Uyar, MD{ Purpose: Edema and ecchymosis are among the most important morbidities after rhinoplasty. The aim of the present study was to investigate the effects of hilotherapy application compared with traditional ice applications after rhinoplasty in terms of periorbital edema, ecchymosis, and pain. Patients and Methods: A total of 60 patients (35 women and 25 men) had undergone primary rhino- plasty with the same surgeon. In the postoperative period, 30 patients in the study group received contin- uous cooling at 15  C using Hilotherm (Hilotherm GmbH, Argenb€ uhl-Eisenharz, Germany), and 30 patients in the control group were treated with conventional cryotherapy with ice packs. Both treatments started within 45 minutes after the end of the surgery and were maintained for 24 hours. For the following 1 week, the patients were examined for edema, ecchymosis, and pain. Results: When the postoperative periorbital region was evaluated for mean edema and mean ecchy- mosis for 7 days, less edema and less ecchymosis were detected in the Hilotherm group compared with that observed in the ice pack group (P < .001). When the mean pain scores were compared both morning and evening for 7 days, less pain had been recorded with Hilotherm application compared with ice appli- cation (P < .001). Conclusions: Hilotherapy is a useful method to prevent postoperative edema, ecchymosis, and pain compared with traditional ice application. Ó 2020 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 78:1628.e1-1628.e5, 2020 Edema, ecchymosis, and hemorrhage after rhinoplasty are among the most important morbidities affecting patients’ postoperative life and comfort. Osteotomy has been the most commonly responsible procedure for these morbidities. Although bone fractures are formed during the osteotomy, the angular veins in the osteotomy line will be damaged and cause bleeding in the tissue. 1,2 Several methods, such as steroids, decongestants, herbal supplements, and various lateral osteotomy techniques, have been tried for many years to reduce the postoperative edema and ecchymosis. 1,3-9 In addition, the amount of edema and ecchymosis can vary among different patients, even if they have undergone surgery with similar techniques *Specialist, Department of Otorhinolaryngology Okmeydani Training and Research Hospital, Istanbul, Turkey. ySpecialist, Department of Otorhinolaryngology, Haseki Training and Research Hospital, Istanbul, Turkey. zSpecialist, Department of Otorhinolaryngology Okmeydani Training and Research Hospital, Istanbul, Turkey. xSpecialist, Department of Otorhinolaryngology Okmeydani Training and Research Hospital, Istanbul, Turkey. kSpecialist, Department of Otorhinolaryngology Okmeydani Training and Research Hospital, Istanbul, Turkey. {Professor Doctor and Department Head, Department of Otorhinolaryngology, Okmeydani Training and Research Hospital, Istanbul, Turkey. Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest. Address correspondence and reprint requests to Dr Hanci: Department of Otolaryngology, Okmeydani Training and Research Hospital, Kaptanpasa Mahallesi, Darulaceze Caddesi, No. 25, Okmey- dani, Sisli, _ Istanbul 34384, Turkey; e-mail: dhanci007@hotmail.com Received February 5 2020 Accepted March 20 2020 Ó 2020 American Association of Oral and Maxillofacial Surgeons 0278-2391/20/30326-8 https://doi.org/10.1016/j.joms.2020.03.032 1628.e1