Safety Profile of Standardized Tranexamic Acid (TXA) Dosing in Rhytidectomy: A Retrospective Comparative Cohort Study

Tranexamic acid (TXA) has been associated with reductions in intraoperative blood loss, early postoperative bleeding, time to drain removal, and postoperative ecchymosis in rhytidectomy. However, concerns regarding potential cutaneous and systemic complications persist, and interpretation of the literature is limited by variability in dosing, route of administration, and operative technique. As a result, the safety profile of TXA when mixed with local anesthetic in facelift surgery remains incompletely defined.

To evaluate complications associated with TXA mixed with local anesthetic using a standardized concentration and dosing protocol in patients undergoing combined facial and cervical rhytidectomy.

A retrospective comparative cohort study was conducted of a single surgeon's patients undergoing combined facial and cervical rhytidectomy under intravenous sedation, with and without the use of tranexamic acid (TXA) in local anesthetic infiltration (non-TXA vs TXA cohorts, 2012-2025). TXA was administered at defined concentrations of 9.1 mg/mL for incisional infiltration and 0.8 mg/mL in tumescent solution, with an average total dose of 582.6 mg per case.

A total of 1,036 patients were included (TXA, n = 556; non-TXA, n = 480). TXA use was not associated with an increase in minor or major ischemic events or systemic complications. Distal flap vascular compromise requiring topical nitroglycerin occurred at similar rates providing an additional clinical measure of mild flap vascular stress. No cases of permanent nerve paralysis were observed.

In this single-surgeon cohort using defined dosing, TXA mixed with local anesthetic was not associated with increased ischemic or systemic complications.