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

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Objectives</jats:title> <jats:p>To prospectively demonstrate that TXA with local anesthesia safely reduces the effects of rebound bleeding, reduces operative time, and decreases postoperative drainage.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>

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

“…Recently, the same group 28 conducted a prospective study to demonstrate that TXA with local anesthesia safely reduced the effects of rebound bleeding and postoperative drainage, and they reached similar conclusions.…”

“…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.…”

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.…”

Assessment of Tranexamic Acid in Reducing Intraoperative Blood Loss During Rhytidectomy

“…The existing literature is lacking. Two prospective cohort studies (level II), 4,5 one retrospective cohort study (level III), 3 and two case series (level IV) 1,2 were evaluated.…”

“…Recently the use of preoperative antifibrinolytic agents in various facial plastic and reconstructive surgeries has been described, but their use in rhytidectomy remains a topic of ongoing discussion. tranexamic acid (TXA) is an antifibrinolytic agent that inhibits clot breakdown and is well described in the literature to reduce intraoperative blood loss in craniofacial, cardiac, trauma, dermatologic, and orthopedic surgeries 2–5 . Despite the potential for TXA to decrease intraoperative blood loss in facelift, no formal guidelines exist for this use.…”