BACKGROUND: Tranexamic acid (TXA) has emerged as a lifesaving antifibrinolytic agent for treating traumatic hemorrhage. Despite its great popularity in other surgical specialties, published reports on TXA use in plastic surgery, especially in esthetic surgery, are limited and an optimal dosing regimen has not been yet described. The aim of this study was to evaluate the efficacy and safety profile of TXA in rhinoplasty.
METHODS: All study patients underwent rhinoplasty by a single surgeon using an intravenous bolus dose of 1 g TXA before skin incision. TXA was also added to local anesthesia (0.5 mg TXA in 5-ml saline 0.9% and 0.5 mg epinephrine in 10-ml lidocaine and 10-ml Marcaine) and injected locally before skin incision. The authors’ TXA administration protocols and techniques in rhinoplasty will be illustrated and described in detail.
RESULTS: Hospital records were reviewed for patient demographics, preoperative and postoperative hemoglobin and hematocrit, operative times, and Visual Analog Scale for pain at discharge. Postoperative periorbital ecchymoses and edema and day of return to social activity were also recorded. Neither thrombotic events nor other TXA-related complications were recorded.
CONCLUSIONS: TXA’s anti-inflammatory properties are cardinal in its role in esthetic surgery, in addition to its antifibrinolytic effects. Intravenous and local administration of TXA has a substantial effect in decreasing pain, periorbital edema, and ecchymosis and achieving a faster return to social activity in rhinoplasty patients. These findings may be enormously beneficial in rhinoplasty where postoperative edema may mask results and influence patient and surgeon perception of surgical outcome for several months after surgery.