Impact of tranexamic acid on postoperative complications and bleeding in facial aesthetic surgery: A systematic review and meta-analysis

Abstract

Background: Tranexamic acid (TXA) is a synthetic antifibrinolytic agent originally developed for hemostasis, which is now widely used in aesthetic and reconstructive surgery. Its application in facial cosmetic procedures is aimed at reducing bleeding, swelling, and bruising. This systematic review assesses the impact of TXA on postoperative outcomes in facial cosmetic surgery, focusing on blood loss, surgical time, edema, and ecchymosis.

Methods: This review followed the preferred reporting items for systematic reviews and meta-analyses guidelines and synthesized data from randomized controlled trials, cohort studies, and case-control studies published between 2004 and 2024. Eligible studies examined TXA in aesthetic facial surgeries (e.g., rhinoplasty, rhytidectomy, and blepharoplasty). Outcomes included intraoperative bleeding, surgical time, postoperative edema, ecchymosis, and patient satisfaction. A comprehensive search was conducted across the PubMed, Embase, Cochrane Library, and Google Scholar databases.

Results: Twenty-two studies involving 9005 patients were included. TXA significantly reduced blood loss, postoperative edema, and ecchymosis. The average surgical time was 122.17 (SD: 34.44) min, with mean blood loss of 86.63 (SD: 56.93) cc. TXA use consistently decreased drain output and postoperative complications, particularly in rhinoplasty and rhytidectomy. Various administration routes (intravenous, topical, or local infiltration) showed no significant systemic complications. Combining TXA with local anesthetics improved hemostatic and anesthetic efficacy.

Conclusion: TXA is an effective adjunct in facial cosmetic surgery that reduces intraoperative bleeding, surgical time, and postoperative sequelae such as edema and ecchymosis. Further studies are needed to establish standardized dosing and objective outcome grading. TXA demonstrated safety and efficacy indicating that it should become a standard practice in facial aesthetic procedures.

Keywords: Aesthetic Surgery; Blood Loss Reduction; Facial Cosmetic Procedures; Postoperative Edema; Tranexamic Acid.