Evaluation of the safety and efficacy of tranexamic acid use in face and neck lift surgery: A systematic review.

[INTRODUCTION] Tranexamic acid (TXA) has been used in various surgical settings to reduce bleeding and improve patient outcomes; however, its efficacy in face and neck lift is underexplored.

[METHODS] Following the PRISMA guidelines, this systematic review identified articles from 4 databases up to October 4, 2024, aiming to assess the efficacy of TXA in reducing the complications in patients undergoing face and/or neck lift.

[RESULTS] Ten articles were included. A total of 592 patients underwent either face or neck lift with TXA administration, among them 534 (90%) were women with a mean age of 62.0 years. TXA dosage ranged from 1 to 25 mg/mL topically and 1 g IV and was administered topically (4 studies), with local injection (5 studies), mixed with tumescence solution (3 studies), or intravenously (4 studies). Three studies showed evidence of reduced intraoperative blood loss with TXA. TXA reduced hematoma incidence in 4 of the 6 studies. Significant reductions in ecchymosis and shorter postoperative ecchymosis duration were reported. Skin flap complications were reported, but none were statistically significant (p > 0.05). TXA significantly reduced postoperative edema in 1 of 2 studies (p < 0.05). Procedure time was either unchanged or reduced. Drainage output and days before drain removal was reduced with TXA in 5 studies. There was no difference in the incidence of infection between groups.

[CONCLUSION] TXA demonstrated promising results in facial surgery by reducing intraoperative bleeding and time, postoperative ecchymosis, edema, and drain output. Although TXA did not increase systemic complications, some wound-related complications were reported.