Route Matters: Topically Applied Versus Locally Injected Tranexamic Acid for the Reduction of Post-rhinoplasty Edema and Ecchymosis.

[BACKGROUND] Tranexamic acid (TXA) is widely used to reduce postoperative edema and ecchymosis; however, evidence comparing topically applied and locally injected routes following rhinoplasty remains limited and inconsistent.

[OBJECTIVES] To compare the efficacy of topically applied versus locally injected TXA in reducing periorbital edema and ecchymosis after primary rhinoplasty and to explore whether route of administration influences clinical outcomes.

[METHODS] In this triple-blind, randomized, controlled clinical trial, 75 patients undergoing primary open rhinoplasty were allocated into three groups: topical TXA (2.5 mL of 100 mg/mL applied via soaked pad for 5 minutes after osteotomy), locally injected TXA (2.5 mL of 100 mg/mL injected just before surgery), and saline control. A single surgeon performed all procedures using standardized piezo-assisted osteotomies. Postoperative edema and ecchymosis were evaluated on postoperative days 1, 3, and 7 by a blinded assessor using validated photographic grading scales. Statistical analyses were performed using the Kruskal-Wallis and Mann-Whitney U tests with Bonferroni correction.

[RESULTS] Both TXA groups demonstrated significantly reduced edema and ecchymosis compared with the control at all time points (P < 0.05). The topical TXA group exhibited greater reductions than the injection group on days 1 and 3, though differences were not statistically significant by day 7. No adverse events were observed.

[CONCLUSIONS] Compared with locally injected TXA, topically applied TXA administered immediately after osteotomy achieved greater early reduction in postoperative periorbital edema and ecchymosis. These findings underscore the importance of the administration route in optimizing aesthetic recovery after rhinoplasty.