Effectiveness of Arnica and Bromelain for Improving Ecchymosis Following Facial Plastic Surgery: A Systematic Review.

Introduction: Individual studies have suggested a benefit in using Arnica and Bromelain for reducing ecchymosis following facial plastic surgery; however, the literature remains inconsistent and methodologically heterogeneous. An up-to-date review is therefore necessary to synthesize the available evidence and provide clearer guidance to clinicians and patients alike. The objective of this study was therefore to investigate the effectiveness of Arnica and Bromelain in reducing postoperative ecchymosis after facial plastic surgery. Methods: A PRISMA-guided search of Medline, Embase, Cochrane databases, Epistemonikos, and ClinicalTrials.gov was conducted up to August 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies evaluating Arnica and/or Bromelain use in facial plastic surgeries. The primary outcome was postoperative ecchymosis. Secondary outcomes included edema, adverse effects, and patient satisfaction. Results: Ten articles were included, comprising 6 RCTs, 3 prospective, and one retrospective cohort study, with a total of 696 patients (mean age 35 years, range 15-78). Most studies examined rhinoplasty (60%), followed by blepharoplasty (30%). Most studies (80%) evaluated Arnica use, of which 63% demonstrated significant reductions in postoperative ecchymosis at various time points. Edema was assessed in 2 Arnica studies, both of which showed significant reductions. Two studies evaluated Bromelain, with one demonstrating reduced ecchymosis by postoperative day 7. Adverse events were rare and mild. Conclusion: Arnica may help reduce postoperative ecchymosis and edema after facial plastic surgery; however, the evidence for Bromelain is limited. Marked heterogeneity in dosing and assessment tools limits the generalizability of findings and the ability to perform meta-analysis.