A prospective double-blind randomized pilot study was performed to test the benefits of steroids versus placebo in controlling edema and ecchymosis in rhinoplasty within the immediate postoperative period. Thirty consecutive patients who underwent rhinoplasty with osteotomies were entered into the study. Sixteen patients received 10 mg of intravenous dexamethasone before the procedure and 14 patients received placebo. All rhinoplasties were performed by residents under the supervision of staff otolaryngologists. A 4-point scale was used to assess the extent of periorbital edema and ecchymosis at 24 hours postoperatively. A one-time bolus of 10 mg of dexamethasone was beneficial in decreasing edema and ecchymosis in rhinoplasty. This benefit was demonstrated statistically (p less than .005). No complications were attributed to the administration of dexamethasone.