Evaluating Tranexamic Acid's Role in Upper Eyelid Blepharoplasty: A Systematic Review and Meta-Analysis.

[INTRODUCTION] To evaluate the efficacy of tranexamic acid (TXA) in blepharoplasty surgery.

[METHODS] A meta-analysis was conducted following PRISMA guidelines. PubMed, Web of Science, Cochrane Library, and Scopus databases were searched for randomized controlled trials (RCTs). Data extraction focused on outcomes, such as ecchymosis scores, time to recovery, intraoperative pain, operative time, and hemostasis quality. The risk of bias was assessed using the ROB 2 tool. RevMan 5.4 software was used for meta-analysis with mean differences (MD) and standardized MD (SMD) calculated for various outcomes.

[RESULTS] Five RCTs comprising 594 participants (1154 eyes) met the inclusion criteria. Overall, TXA significantly reduced postoperative ecchymosis on postoperative days (POD) 1 and 7 (SMD = - 0.54, 95% CI: [- 0.71 to - 0.38], p < 0.00001) with moderate heterogeneity (I = 50%). TXA significantly shortened patient-reported recovery time (MD = - 0.72 days, 95% CI: [- 1.02 to - 0.42], p < 0.00001) with homogeneity (I = 0%). Also, TXA significantly reduced operative time (MD = - 1.20 minutes, 95% CI: [- 2.39 to - 0.01], p < 0.05). On the other hand there was no significant difference in intraoperative pain scores or surgeon-assessed hemostasis quality for SC TXA; however, IV TXA improved hemostasis assessment (MD = - 0.70, 95% CI: [- 1.02 to - 0.38], p < 0.0001).

[CONCLUSION] TXA significantly reduces ecchymosis, expedites recovery, and enhances operative time and hemostasis in blepharoplasty. These findings support TXA's use as an effective adjunct to improve blepharoplasty recovery, although further studies are warranted to optimize dosing and minimize thromboembolic risks.

[LEVEL OF EVIDENCE I] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .