Background and Aim: post-operative edema and ecchymosis after rhinoplasty, is one of the common surgical complications and it seems the technique of osteotomy may affect severity of periorbital edema and ecchymosis. This study compared the effect of these two methods of osteotomy on periorbital edema and ecchymosis following rhinoplasty on patients referred to oral & maxillofacial surgery clinic, Ayatollah Kashani hospital of Isfahan at 2016.  
Materials and Methods: In this clinical trial study, twenty patients were chosen for primary rhinoplasty and we performed internal osteotomy on the right side and external osteotomy on the left side randomly. Periorbital edema and ecchymosis scores were determined after 1, 3 and 7 days post-operative and the data were subjected to t-test analysis.
Results: The difference of the edema scores was not significant between two approaches on the first post-operative day, while the differences was found to be significant on third (p=0.0001) and seventh (p=0.05) days between two techniques with the higher scores being reported for internal osteotomy. The difference of the ecchymosis scores was not significant between two approaches after 3 days post-operatively,(p>0.05) while the differences were significant on first (p=0.02) and seventh (p=0.05) days with the higher scores being reported for internal osteotomy.
Conclusion: Due to the lower scores of edema and ecchymosis and simplicity of the external osteotomy approach in comparison to the internal technique, the use of external osteotomy was suggested to decrease the incidence of edema and ecchymosis in the rhinoplasty surgery.
 
Key words: Rhinoplasty, osteotomy, Edema, Ecchymosis