Menstrual cycle phase and early periorbital edema and ecchymosis after rhinoplasty: an observational study

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.

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.

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).

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.