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. 2025 Nov 13.
doi: 10.1097/SCS.0000000000012140. Online ahead of print.

Trends in Tranexamic Acid Administration Amongst the International Plastic Surgery Community

Nicholas A Mirsky  1 , Sara E Munkwitz  1 , Mahmood J Al Bayati  2 , Mario Samaha  1 , Amanda Spielman  1 , Taylor Smartz  1 , Georges Samaha  1 , Anne-Sophie Lessard  1 , Seth R Thaller  1
Affiliations

Trends in Tranexamic Acid Administration Amongst the International Plastic Surgery Community

Nicholas A Mirsky et al. J Craniofac Surg. .

Abstract

Tranexamic acid (TXA) has gained widespread use across surgical disciplines due to its antifibrinolytic properties and favorable safety profile, yet standardized protocols for its use in aesthetic plastic surgery remain lacking. This study aimed to assess international trends, perceptions, and practices regarding TXA administration among board-certified plastic surgeons. A cross-sectional, anonymous survey was distributed electronically to all active members of The Aesthetic Society. The survey captured demographics, procedural usage, routes of administration, and perceived benefits or barriers associated with TXA. A total of 256 surgeons responded, with 69% reporting active use of TXA. Geographic variability was notable: usage was highest in Australia (100%) and Canada (92%) and lowest in South America and Asia (67%). Intravenous administration was the most common (36%), followed by topical (20%), tumescent (14%), and oral (3%); 27% reported case-dependent variation. TXA was most frequently used in facelifts (79%) and abdominoplasty (54%). Among non-users, 45.6% cited lack of robust data as the main deterrent. Most surgeons believed TXA reduced blood loss (93%), improved surgical field visibility (81%), and minimized ecchymosis (85%) and edema (85%), with 70% noting faster recovery. Importantly, 98% reported no thrombotic events in their practice. This is the first large-scale international survey assessing TXA use in aesthetic plastic surgery. Findings highlight variability in practice patterns and underscore the need for evidence-based guidelines to promote safe and consistent TXA usage across aesthetic procedures worldwide.

Keywords: Aesthetic plastic surgery; Hemostasis; International survey; Surgical outcomes; Tranexamic acid.

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Conflict of interest statement

The authors report no conflicts of interest.

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