Tranexamic Acid in Rhytidectomy: A Split-Face Multi-Institutional Study

Background: Tranexamic acid (TXA) has the ability to reduce intraoperative bleeding and facilitate hemostasis in addition to its anti-inflammatory properties that can potentially aid in recovery among patients who underwent rhytidectomy. Objective: To compare postoperative ecchymosis in patients who underwent rhytidectomy with TXA added to the tumescent anesthetic. Methods: A multi-institutional, single-blind study was performed on patients who underwent rhytidectomy. The sidedness of the face was randomized to receive either local anesthetic with TXA or without, prior to incision for rhytidectomy. The primary outcome was postoperative ecchymosis that was graded by the surgeons at the 1 week postoperative time frame in standard photograph review. Results: A total of 70 patients, mean age 62.1, were enrolled in the study. The surface area of postoperative ecchymosis at 1 week was shown to be significantly less on the side of the face that received local anesthetic infiltration prior to incision with TXA than the side that had local anesthetic without TXA ( p < 0.001). These results were consistent with subjective measurements of postoperative ecchymosis graded at 1 week with two blinded investigators to the sidedness of the face that received TXA ( p < 0.001). Conclusions: TXA may potentially facilitate a reduction in postoperative ecchymosis in patients undergoing rhytidectomy.