Journal archive · Revision and secondary rhinoplasty · Complications and management · Anatomy and nasal analysis · 2026
Preoperative Serotonin Antidepressants Are Associated With Increased Postoperative Complications Following Rhinoplasty: A Propensity Score-Matched Analysis
Zontag N, Skorochod R, Wolf Y.
What this paper says
In 4,917 matched pairs from a global records database, rhinoplasty patients taking serotonergic antidepressants had higher 30-day rates of readmission, opioid use and bleeding or hematoma, but the same one-year revision rate.
Overview
Many rhinoplasty candidates have anxiety or depression and take SSRIs or similar drugs, which affect platelet function. Using the TriNetX Global Collaborative Network, the authors compared adults who had rhinoplasty with documented preoperative serotonergic antidepressant use against those without, after 1:1 propensity matching on demographic and clinical variables. Outcomes were measured at 30, 60 and 90 days and at one year.
Sections of note
- 4,917 patients in each matched cohort.
- Within 30 days: readmission relative risk 1.793 (P = .01), opioid use RR 1.361 (P < .0001), bleeding/hematoma RR 1.596 (P = .005).
- The elevated risks persisted at 60 and 90 days.
- Revision surgery rates at one year were comparable between groups.
- Level of Evidence 3.
What it means for a patient
- Taking an SSRI or similar antidepressant was linked to more short-term problems, mainly bleeding and readmission, in this database.
- The drugs were not linked to a higher chance of needing revision surgery.
- Patients should tell their surgeon about antidepressant use; the study does not say whether stopping the drug helps, and stopping should never be done without the prescribing doctor.
Why this paper matters
It is the largest analysis of antidepressant use and rhinoplasty complications, drawn from real-world records. Limits: retrospective database coding, no information on dose or duration, and association does not prove the drug caused the complications.
Terms
- Serotonergic antidepressant: drugs such as SSRIs and SNRIs that raise serotonin levels; serotonin also affects platelet clotting.
- Propensity score matching: a statistical method that pairs treated and untreated patients with similar characteristics.
- Relative risk (RR): the ratio of event rates between two groups; 1.6 means 60% more events.
- Hematoma: a collection of blood under the skin after surgery.
- TriNetX: a large network of de-identified electronic health records.
Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows. All 1,262 summaries.
From the abstract
“Rhinoplasty is a common facial aesthetic procedure, but a high proportion of candidates for rhinoplasty present with anxiety and depressive disorders. Serotonergic antidepressants are widely used to manage these disorders, and recent reports linking these medications to increased postoperative complications suggest…”
Excerpt; the full abstract is on PubMed.
Citation
Start here
What the rhinoplasty literature says on this paper's topics, cited line by line to PubMed.
Revision and secondary rhinoplasty
Between 5% and 15% of rhinoplasties are done again, and the published series say the second operation is a different problem from the first: the cartilage is gone, the skin is scarred and less able to survive, and the airway is usually part of the complaint.
Complications and management
Serious complications after rhinoplasty are rare: infection runs under 1% in the two largest single-surgeon series, pooled rib harvests record no pneumothorax, and the bleeding series record no thromboembolism.
Anatomy and nasal analysis
Before any technique is chosen, the nose has to be read: the bone measured, the cartilage counted, the skin assessed, and the result the patient wants agreed on a photograph that is not yet true.
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