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Does Tranexamic Acid Use in Facelift Increase Wound Healing Problems? A Retrospective Cohort Study on Matched Patients
Osama Darras, MD, PhD(c); Elad Fraiman, BA, MPH; Alvaro Reategui Via y Rada, MD; Pierce Janssen, MD; James E. Zins, MD.
Cleveland Clinic
2025-01-10
Presenter: Osama Darras, MD, PhD(c);
Affidavit:
Raymond Isakov, MD
Director Name: Raymond Isakov, MD
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Background: A recently published paper described healing problems in facelift patients receiving tranexamic acid (TXA) mixed in their local anesthetic1. Although anecdotal, this raises concerns regarding its use. We therefore compared its incidence between a large TXA and a matched non-TXA group.
Methods: A single-surgeon retrospective cohort study for patients who underwent facelift surgery between 2014 and 2024. Patients were categorized by TXA use. Age, BMI, gender, and hypertension prevalence were matched to minimize bias. All patients received general anesthesia and a subcutaneous injection of 0.5% lidocaine with 1:200,000 epinephrine. Operative time and complications were examined.
Results: Each group included 261 patients. Median Follow-up was 232 days. No significant differences in age (P = 0.221), BMI (P = 0.589), gender (P = 1), hypertension (P = 0.52), secondary facelift (P = 0.19), lipo-grafting (P = 0.66), phenol peel (P = 0.83) were observed. Wound healing problems occurred in 1 patient in the non-TXA group and 2 in the TXA group (P = 0.563). The hematoma occurred in 5 patients in each group (P = 1). All other complications were not significant. Non-TXA group operative time was 20 minutes longer than the TXA group (P < 0.001).
Conclusions
This study challenges previous claims about TXA increasing wound healing problems. Using a large matched cohort, we support the safety of TXA, as complication rates, including healing problems and hematoma, are comparable2. These findings support the use of TXA in facial aesthetic surgery by saving time in the operating room without additional risks.
