Tranexamic acid (TXA) is an anti-fibrinolytic agent shown to decrease intraoperative bleeding, reduce transfusions, and improve outcomes across multiple specialties. Within plastic surgery, initial reports are encouraging but formal studies are lacking. A study was designed to assess whether TXA demonstrates noticeable benefit for rhytidectomy to warrant further investigation.
To determine whether intravenous (IV) TXA has effect on intraoperative bleeding, or postoperative sequelae in patients undergoing a deep-plane facelift.
This is a prospective, randomized, double-blind, case series in a private practice surgery center. Participants included 44 patients undergoing rhytidectomy with the senior authors (R.A.G. or M.J.G). Treatment group received 1 gram of IV TXA prior to skin incision, and 4 hours later (vs saline). Bleeding was rated mild, moderate, or severe. Postoperative ecchymosis and edema were subjectively evaluated by patient and surgeon and scores were aggregated for analysis.
The TXA group showed decreased intraoperative bleeding but did not reach statistical significance. Postoperative ecchymosis/edema ratings were lower for patients who received TXA, including a statistically significant decrease in surgeon-rated bruising. TXA resulted in a statistically significant decrease in postoperative collections in this study and no major complications occurred.
TXA is a safe, low-cost, addition to any existing surgical protocol and may lead to less surgical sequelae and improved satisfaction. Although, we did not observe a dramatically different intraoperative experience, postoperative bruising and collections were significantly reduced. Tranexamic acid may have great value in the management of patients undergoing rhytidectomy and warrants further study.

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