Objective <p>To evaluate the effectiveness of bromelain on periorbital oedema, subconjunctival haemorrhage, and ecchymosis after preservation rhinoplasty.</p> Study Design <p>Randomised, double-blind, placebo-controlled trial</p> Setting <p>Tertiary referral centre</p> Methods <p>In this double-blind clinical trial, participants aged 18–45 who were scheduled for open preservation rhinoplasty using the push-down technique and lateral osteotomy were recruited. Twenty-three cases were assigned to the placebo group and twenty-three to the experimental group Bromelain.</p> Results <p>Regarding gender, 17.39% (8 cases) were male, and 82.61% (38 cases) were female. Comparing the severity of left and right eye ecchymosis between groups at different times showed that bromelain was significantly effective on both sides on the 7th day (<i>p</i> = 0.012). Like ecchymosis, the results demonstrated that bromelain was also considerably effective on subconjunctival haemorrhage on the seventh day post-operatively (<i>p</i> = 0.015). However, the intensity of oedema between groups at different times did not significantly differ.</p> Conclusion <p>Bromelain increases serum fibrinolytic activity and decreases plasma fibrinogen levels. It is significantly more effective on subconjunctival haemorrhage and ecchymosis compared with the placebo on the seventh day in both eyes after rhinoplasty. Hence, this study indicates that bromelain is remarkably more effective than a placebo in reducing subconjunctival haemorrhage and ecchymosis.</p> Trial registration <p>Iranian Registry of Clinical Trials ID: IRCT20180519039720N2</p> Level of Evidence I <p> This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>