Local Infiltration of Tranexamic Acid With Local Anesthetic Reduces Intraoperative Facelift Bleeding: A Preliminary Report

Abstract

Background Rebound bleeding as a result of loss of epinephrine effect is a common problem encountered during facelift surgery. Tranexamic acid (TXA) is an anti-fibrinolytic agent whose safety and efficacy in reducing bleeding are well documented. We have found that local infiltration of TXA combined with a lidocaine with epinephrine solution during facelift surgery has been effective in decreasing rebound bleeding and the time required to gain hemostasis. Objectives The authors sought to share their local infiltration protocol of TXA combined with epinephrine solution in facelift. Methods Patients who underwent facelift received subcutaneous injection of TXA-lidocaine 0.5% solution following the authors’ protocol. After completing both sides of the facelift and the submental platysmaplasty, the first and second sides were sequentially closed. The time to gain hemostasis on each side prior to closure was prospectively measured. Results Twenty-seven consecutive patients who underwent facelift surgery received local infiltration of TXA-lidocaine solution. In 23 of the 27 patients, the time required for hemostasis was prospectively recorded. The mean age was 62.1 years (±9.3) and all were females. The average time spent achieving hemostasis on the right, left, and both sides of the face was 6.5 (±2.7), 6.3 (±2.1), and 12.9 (±4.2) minutes, respectively. The total surgical time saving is approximately 25 to 60 minutes. Although primary facelift [13.6 (± 4.3)] exhibited a longer time of hemostasis compared with the secondary group [10.2 (± 2.8)], this was not statistically significant (P = 0.09). Conclusions Local infiltration of TXA with local anesthetic prior to a facelift appears to decrease bleeding, operative time, and postoperative facelift drainage output. Level of Evidence: 4

Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty

“…Previous studies have shown that systemic use of TXA affects the reduction of hematoma rates in rhytidoplasty or intraoperative bleeding [5,33]. In this study, there was a statistically significant difference trend (p 0.084) in the hematoma rate in patients who had irrigation with tranexamic acid versus those who did not.…”

“…We put forward that TXA due to its low cost, its safety in use, and its effectiveness in results [5,20,33] should be considered a fundamental tool in the prevention of complications in rhytidoplasty.…”

A Systematic Review of Tranexamic Acid in Plastic Surgery: What’s New?

“…One case series, 25 2 retrospective cohort studies, 26 , 27 1 prospective cohort, 28 and 1 RCT29 were identified regarding the use of TXA in facelift procedures involving 194 patients with an average age of 61.8 years. Of these patients, 94 underwent an extended deep plane facelift, 61 had a face lift with SMAS plication.…”

“…In 2019, Couto et al 27 conducted a study on 27 patients who underwent a facelift and received a subcutaneous injection of TXA-lidocaine 0.5% solution before skin flap dissection. The time to gain hemostasis on each side before closure was prospectively measured in 23 of the 27 patients.…”

How to Prevent and Treat Complications in Facelift Surgery, Part 1: Short-Term Complications

“…Recent studies have suggested that tranexamic acid (TXA) may be beneficial in reducing facelift bleeding intraoperatively and decreasing surgical time by inhibiting fibrinolysis and clot dissolution. 15 , 16 However, evidence that it reduces hematoma rate is currently sparse. The ideal route—intravenous, topical, or subcutaneous infiltration combined with local anesthetic—remains unclear.…”