Prospective Study Assessing the Effect of Local Infiltration of Tranexamic Acid on Facelift Bleeding

Background: Rebound bleeding during facelift surgery is a major cause of facelift hematomas. Subcutaneous infiltration of tranexamic acid combined with lidocaine and epinephrine was recently retrospectively shown to decrease rebound bleeding. No study has prospectively examined the effect of subcutaneous TXA on intraoperative and postoperative bleeding during facelift surgery.

Objectives: To prospectively demonstrate that TXA with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage.

Methods: Prospective, single surgeon, case control study from July 2019 to March 2020. Thirty-nine patients underwent facelift surgery alone or in combination with facial rejuvenation procedures. All patients were injected subcutaneously with 1-2mg/mL TXA + 0.5% Lidocaine/1:200,000 Epinephrine. Patient demographics, TXA dose, time to hemostasis, drain output, minor and major complications were examined.

Results: Thirty-nine patients (35 female and 4 male; mean age, 64.9 years; age range, 49-80 years). Mean time to hemostasis was 6.4 min for the left and right sides each. Average POD 0 drain outputs were 13.9cc (left) and 10.1cc (right). Average POD 1 drain outputs were 15.1cc (left) and 15.6cc (right). Drains were removed on POD 1 or 2 for all patients. Complications included 2 minor (flap necrosis + infection and marginal mandibular neuropraxia) and 0 major.

Conclusions: Rebound bleeding associated with epinephrine is a problematic occurrence in facelift surgery. TXA safely and effectively decreased bleeding, OR time, and drain output compared to traditional local anesthetic techniques. Future goal is to determine if epinephrine can be completely removed from the local anesthetic and replaced with TXA for facelift surgery.