Is Local Tranexamic Acid Worth Using in Hair Transplantation? An Intrapatient Comparison

Excessive bleeding during donor area harvesting may impair surgical control and graft quality in hair transplantation. While adrenaline-based tumescent solutions are routinely used, the additional value of local tranexamic acid (TXA) in this setting remains unclear.

To evaluate whether local TXA provides additional benefit compared with standard adrenaline-based tumescence during donor area follicular unit excision (FUE).

This intrapatient-controlled, single-blinded study included 57 male patients undergoing FUE. In each patient, two adjacent 4 cm² donor areas were infiltrated with either an adrenaline-only tumescent solution or a combination of adrenaline and TXA (50 mg/mL). Approximately 20 grafts were harvested from each area. Intraoperative bleeding was assessed immediately after graft excision using a validated 10-point visual bleeding scale. Paired comparisons were performed using the Wilcoxon signed-rank test.

Bleeding scores were significantly lower in the adrenaline-only control areas compared with TXA-treated areas (median [IQR] 2 [2-3] vs. 3 [2-4]; p < 0.001), with a large effect size (r = 0.56).

Within the specific protocol applied in this study, adrenaline-based tumescence demonstrated more effective immediate intraoperative hemostasis. However, given the difference in total adrenaline exposure between groups, the independent contribution of tranexamic acid cannot be conclusively determined.

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