Cryotherapy to reduce pain and swelling after facial surgery

Bariatric surgery and marked weight loss is likely to improve knee complaints but there is a need for high quality studies

Facial cooling (cryotherapy) is a traditional approach to minimising pain, swelling and discomfort following trauma or surgery. However, there are concerns that it may affect microvascular blood flow and lymph drainage causing damage. Contoured facial masks have been developed to channel a current of cool, sterile water adjacent to the skin to provide regulated cryotherapy. Although studies have provided conflicting evidence of it efficacy.

The aim of this review to assess the evidence for the use of perioperative cryotherapy after facial surgery.


Searches were conducted in Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and and the national research register for completed, discontinued, and ongoing trials.

Randomised controlled trials (RCTs) comparing facial cooling by hilotherapy with standard dressings or cold compression after facial reconstructive or aesthetic procedures in both adults and children were considered.  The primary outcome measures were oedema and pain. Secondary outcome measures were tolerance, haematoma, and ecchymosis.

Risk of bias was assessed using the Cochrane tool. Mean differences and 95% CI were calculated for continuous outcomes, risk ratios (RR) and 95% CI for dichotomous outcomes.


  • 6 RCTs involving a total of 286 patients were included.
  • All trials used Hilotherm® (Hilotherm GmbH, Ludwigshafen, Germany) Hilotheraphy was instated immediately postoperatively but regimens varied.
  • 5 trials evaluated facial oedema
  • Hilotherapy was associated with significant reductions in facial pain on postoperative day 2 (p < 0.00001), and facial oedema on days 2 (p = 0.0004) and 3 (p = 0.02)
  Number of studies in meta-analysis Mean difference (95%CI)
Facial Pain – day 2 4 -2.37 (-3.24 to -1.50)
Oedema – day 2 4 -22.39 (-34.82 to -9.96)
Oedema – day 3 3 -26.53 (-49.54 to -3.53)
Oedema – day 28 3 -0.77 (-2.53 to -0.99)
  • 4 trials evaluated patient satisfaction with hilotherapy being significantly more satisfied with hilotherapy than with cold compression.


The authors concluded

when applied after bony facial surgery, hilotherapy is well tolerated by patients and it reduces swelling and pain in the early postoperative period. There are insufficient data at present to support the use of hilotherapy to reduce ecchymosis and haematoma formation, features that also reflect surgical technique, tumescent infiltration, and the use of drains. Well-designed randomised controlled trials of the use of hilotherapy after aesthetic and soft tissue facial surgery are required.


The authors have conducted a broad database search for trials to address this question. However, they have not reported whether duplicate and independent study selection, data abstraction and risk of bias assessment has been carried out.  None of the included studies are at low risk of bias and 3 of the 5 have been conducted by the same lead author. The included studies are relatively small and the meta-analysis only includes 146 patients a point noted by the authors. All of the included studies used the same device to apply the cryotherapy and there is no indication of whether the trials had received manufactures support.  An earlier review of this topic by Bates et al (Dental Elf – 29th Oct 2015) included  5  of the same RCTs and had similar findings.


Primary paper

Glass GE, Waterhouse N, Shakib K. Hilotherapy for the management of perioperative pain and swelling in facial surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg.2016Oct;54(8):851-856. doi:10.1016/j.bjoms.2016.07.003. Review. PubMed PMID: 27516162.

Other references

 Dental Elf – 29th Oct 2015

Hilotherapy improved levels of facial pain and oedema after maxillofacial surgery suggests review



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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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