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Effects of Intravenous Tranexamic Acid During Rhytidectomy: A Randomized, Controlled, Double-Blind Pilot Study.

Justin C Cohen, Robert A Glasgold, Les M Alloju

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    Tranexamic acid (TXA) may reduce bruising and fluid collections after facelifts, though intraoperative bleeding differences were not significant. This safe, low-cost antifibrinolytic agent warrants further investigation for rhytidectomy procedures.

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    Area of Science:

    • Plastic Surgery
    • Anesthesiology
    • Pharmacology

    Background:

    • Tranexamic acid (TXA) is an effective antifibrinolytic agent used across various surgical fields to reduce bleeding and improve outcomes.
    • While initial reports in plastic surgery are promising, robust clinical studies are needed to confirm its efficacy.
    • Deep-plane rhytidectomy presents unique challenges regarding intraoperative bleeding and postoperative swelling.

    Purpose of the Study:

    • To evaluate the impact of intravenous tranexamic acid (TXA) on intraoperative bleeding during deep-plane rhytidectomy.
    • To assess the effect of TXA on postoperative sequelae, including ecchymosis, edema, and fluid collections.
    • To determine the safety and potential benefits of TXA in patients undergoing facelift surgery.

    Main Methods:

    • A prospective, randomized, double-blind, case series involving 44 patients undergoing rhytidectomy.
    • Participants received either intravenous tranexamic acid (TXA) or a saline placebo.
    • Intraoperative bleeding was assessed, and postoperative ecchymosis and edema were subjectively evaluated by patients and surgeons.

    Main Results:

    • The tranexamic acid (TXA) group demonstrated a trend toward decreased intraoperative bleeding, though not statistically significant.
    • Patients receiving TXA experienced significantly reduced surgeon-rated bruising and overall ecchymosis/edema.
    • A statistically significant reduction in postoperative fluid collections was observed in the TXA group, with no major complications reported.

    Conclusions:

    • Intravenous tranexamic acid (TXA) is a safe and cost-effective adjunct for rhytidectomy.
    • While intraoperative bleeding benefits were not statistically significant, TXA significantly reduced postoperative bruising and fluid collections.
    • TXA shows potential for improving patient satisfaction and outcomes in facelift surgery, meriting further research.