Topical, Local Injection, and Intravenous Tranexamic Acid for Postoperative Recovery in Implant-Based Rhinoplasty

Postoperative edema, ecchymosis, and delayed social recovery remain major concerns following implant-based rhinoplasty. Tranexamic acid (TXA) has been widely used to mitigate postoperative bleeding; however, the optimal route of administration in implant-based rhinoplasty remains controversial.

This study aimed to compare the effects of different perioperative TXA administration strategies-local injection, topical application, and intravenous administration-on early postoperative recovery following implant-based rhinoplasty.

This study included 82 patients undergoing primary implant-based rhinoplasty. Patients were allocated into 4 groups: no TXA (control), local TXA injection, topical TXA application via intraoperative soaked gauze, and intravenous TXA administration. Postoperative outcomes included edema and ecchymosis scores, pain scores, and time to social recovery. Assessments were performed on postoperative day (POD) 1, 3, 7, and 1 month. Group comparisons were performed using appropriate parametric or nonparametric statistical tests.

Significant differences in early postoperative recovery were observed among groups. The topical TXA group demonstrated the lowest edema and ecchymosis scores on POD1 and POD3, followed by the local injection and intravenous TXA groups, while the control group consistently showed the poorest outcomes. By POD7, all TXA-treated groups showed improved recovery compared with controls; however, locally administered TXA remained superior to intravenous administration. At 1 month postoperatively, no clinically meaningful differences were observed among the 4 groups. Time to social recovery was shortest in the topical TXA group and longest in the control group.

Local administration of TXA, particularly topical intraoperative application, significantly improves early postoperative recovery following implant-based rhinoplasty. These benefits appear to be limited to the early postoperative period, with no impact on long-term outcomes. Topical TXA represents a simple and effective adjunct for enhanced recovery in aesthetic rhinoplasty.