Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Hematoma is the most common complication in facelift surgery. It has a reported incidence ranging from 0.2 to 8%. Tranexamic acid (TXA) is an antifibrinolytic agent capable of minimizing blood loss, and its use in plastic surgery is quite new. The literature review indicates that there are no formal guidelines for dosing and standardization of TXA use. We sought to evaluate the efficacy of intraoperative local irrigation of TXA in reducing the incidence of hematomas in patients undergoing facelift surgery.

Methods

A prospective cohort observational comparative study was conducted between November 2018 and November 2019 with 30 patients undergoing primary facelift surgery at the Ivo Pitanguy Institute in Rio de Janeiro, Brazil. The participants were divided into two groups: group I, patients who underwent facelift with 2.5% topical TXA irrigation as a new routine of the service, and group II, patients who underwent facelift without topical TXA irrigation as a routine.

Results

Drainage output in the first 24 h, hematoma formation, and complication rate were evaluated. It was found that local intraoperative TXA irrigation reduces drainage output in the first 24 h by 71% compared with group II (median 10 ml (8–22 ml) versus 35 ml (19–50 ml); p = 0·009). The rate of postoperative complications (p = 0.1) and hematoma (p = 0.08) was lower in the group with intraoperative local irrigation with TXA. This was not statistically significant.

Conclusion

Local TXA irrigation seems to decrease bleeding and has been shown to be effective in reducing drainage output in the first 24 h postoperatively.

Level of evidence: Level III, risk / prognostic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gonzalez-Ulloa M, Flores ES (1965) Senility of the face: basic study to understand its causes and effects. Plast Reconstr Surg 36:239–246

    Article  CAS  Google Scholar 

  2. Wan D, Small KH, Barton FE (2015) Face lift. Plast Reconstr Surg 136(5):676e–689e

    Article  CAS  Google Scholar 

  3. Cosmetic surgery national data bank statistics (2015) Aesthet Surg J 35(Suppl 2):1–24

  4. Pitanguy I, Machado BH (2012) Facial rejuvenation surgery: a retrospective study of 8788cases. Aesthet Surg J 32:393–412

    Article  Google Scholar 

  5. Butz DR, Geldner PD (May 2016) The use of tranexamic acid in rhytidectomy patients. Plastic Reconstruct Surg Global Open 4(5):E716

    Article  Google Scholar 

  6. Ramanadham SR, Mapula S, Costa CR, Narasimhan K, Coleman JE, Rohrich RJ (2015) Evolution of hypertension management in face lifting in 1089 patients: optimizing safety and outcomes. Plast Reconstr Surg 135(4):1037–1043

    Article  CAS  Google Scholar 

  7. Baker DC, Stefani WA, Chiu ES (2005) Reducing the incidence of hematoma requiring surgical evacuation following male rhytidectomy: a 30-year review of 985 cases. Plast Reconstr Surg 116:1973–1985 Discussion 1986

    Article  CAS  Google Scholar 

  8. Baker TJ, Gordon, H. L. (1967) Complications of rhytidectomy. Plast Reconstr Surg 40:31

    Article  CAS  Google Scholar 

  9. Huang TT, Blackwell SJ, Lewis SR (1987) Routine use of a suction drain in facial rhytidoplasty. Ann Plast Surg 18:30–33

    Article  CAS  Google Scholar 

  10. Jones BM, Grover R, Hamilton S (2007) The efficacy of surgical drainage in cervicofacial rhytidectomy: a prospective, randomized, controlled trial. Plast Reconstr Surg 120:263–270

    Article  CAS  Google Scholar 

  11. Marchac D, Sa’ndor G (1994) Face lifts and sprayed fibrin glue: an outcome analysis of 200 patients. Br J Plast Surg 47:306–309

    Article  CAS  Google Scholar 

  12. Por YC, Shi L, Samuel M, Song C, Yeow VK (2009) Use of tissue sealants in face-lifts: a metaanalysis. Aesthet Plast Surg 33:336–339

    Article  Google Scholar 

  13. Jones BM, Grover R (2004) Reducing complications in cervicofacial rhytidectomy by tumescent infiltration: a comparative trial evaluating 678 consecutive face lifts. Plast Reconstr Surg 113:398–403

    Article  Google Scholar 

  14. Firmin FO, Marchac AC, Lotz NC (2008) Use of the harmonic blade in face lifting: a report based on 420 operations. Plast Reconstr Surg 124:245–255

    Article  Google Scholar 

  15. Auersvald A, Auersvald LA (2014) Hemostatic net in rhytidoplasty: an efficient and safe method for preventing hematoma in 405 consecutive patients. Aesthet Plast Surg 38:1–9

    Article  Google Scholar 

  16. Ker K, Edwards P, Perel P, Shakur H, Roberts I (2012) Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 344:E3054

  17. Henry DA, Carless PA, Moxey AJ, O'connell D, Stokes BJ, Fergusson DA, Ker K (2011) Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 1:CD001886

    Google Scholar 

  18. Evaniew N, Bhandari M (Jan 2017) Cochrane in CORR (R): topical application of tranexamic acid for the reduction of bleeding (review). Clin Orthop Relat Res 475(1):21–26

    Article  Google Scholar 

  19. Ong AA, Farhood Z, Kyle AR, Patel KG (2016) Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 137(5):1448–1462

    Article  CAS  Google Scholar 

  20. McGuire C, Nurmsoo S, Samargandi OA (2019 Jan 3) BEZUHLY M2. Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty a systematic review and meta-analysis, Jama Facial Plast Surg. https://doi.org/10.1001/Jamafacial.2018.1737

    Book  Google Scholar 

  21. Ausen K, Fossmark R, Spigset O, Pleym H (Oct 2015) Randomized clinical trial of topical tranexamic acid after reduction mammoplasty. Br J Surg 102(11):1348–1353

    Article  CAS  Google Scholar 

  22. Rohrich RJ, Cho MJ (2018) The role of tranexamic acid in plastic surgery: review and technical considerations. Plast Reconstr Surg 141:507–515

    Article  CAS  Google Scholar 

  23. Jacono AA, Alemi AS, Russell JL (2019) A meta-analysis of complication rates among different SMAS facelift techniques. Aesthet Surg J 39(9):927–942

    Article  Google Scholar 

  24. Grover R, Jones BM, Waterhouse N (2001) The prevention of hematoma following rhytidectomy: a review of 1,078 consecutive facelifts. Br J Plast Surg 54:481–486

    Article  CAS  Google Scholar 

  25. Beer GM, Goldscheider E, Weber A, Lehmann K (2010) Prevention of acute hematoma after face-lifts. Aesthet Plast Surg 34:502–507

    Article  CAS  Google Scholar 

  26. Beale EW, Rasko Y, Rohrich RJ (2013) A 20-year experience with secondary rhytidectomy: a review of technique, longevity. And Outcomes Plast Reconstr Surg 131:625–634

    Article  CAS  Google Scholar 

  27. Perkins SW, Williams JD, Macdonald K, Robinson EB (1997) Prevention of seromas and hematomas after face-lift surgery with the use of postoperative vacuum drains. Arch Otolaryngol Head Neck Surg 123(7):743–745

    Article  CAS  Google Scholar 

  28. Matarasso A, Elkwood A, Rankin M et al (2000) National plastic surgery survey: face lift techniques and complications. Plast Reconstr Surg 106:1185–1195

    Article  CAS  Google Scholar 

  29. Pitanguy I, Ceravolo MP, Dègand M (1980) Nerve injuries during rhytidectomy: considerations after 3203 cases. Aesthet Plast Surg 4:257–265

    Article  CAS  Google Scholar 

  30. Machado B, Bernacchi A, Vasconcellos C, Pitanguy I (2008) Complicações Nas Intervenções Faciais. In: Resende JH (ed) Tratado De Cirurgia Plástica Na Obesidade. Editora Rúbio, Rio De Janeiro, pp 481–500

    Google Scholar 

  31. Adamson PA, Moran ML (1993) Complications of cervicofacial rhytidectomy. Facial Plastic Surg Clin North Am 1(2):257–271

    Google Scholar 

  32. Ker K, Beecher D, Roberts I (2013) Topical application of tranexamic acid for the reduction of bleeding. Cochrane Database System Rev 23(7):Cd010562

    Google Scholar 

  33. Couto RA, Charafeddine A, Sinclair NR, Nayak LM, Zins JE (2019) Local infiltration of tranexamic acid with local anesthetic reduces intraoperative facelift. A Preliminary Report. Aesthetic Surgery Journal, Bleeding. https://doi.org/10.1093/Asj/Sjz232

    Book  Google Scholar 

  34. Pitanguy I, Cansaçao A, Daher JC. Resultados Desfavoráveis e Cirurgia Plástica II – Hematomas Pós-Ritidectomias Como Evitá-los e Tratá-los. Boletim de cirurgia plástica. Revista oficial do instituto ivo pitanguy e associação de ex-alunos do Prof. Ivo Pitanguy. Setembro / outubro (1971)

  35. Paiva RA, Pitanguy I, Amorim NFG, Berger R, Shdick HA, Landa TA. (2010) Tromboembolismo venoso em Cirurgia Plástica: protocolo de pr venção na Clínica Ivo Pitanguy. Rev Bras Cir Plást 25(4):583–588

  36. Fraval A, Effeney P, Fiddelaers L et al (2017) Obtain A: Outcome benefits of tranexamic acid in hip arthroplasty. A randomized double-blinded controlled trial. J Arthroplast 32(5):1516–1519

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Surgery, Instituto Ivo Pitanguy, Rua Santa Luzia, 206, Rio de Janeiro, Rio de Janeiro, 20020022, Brazil

    Hector Mauricio Serrano Reyes, Joaquin Ramirez, Hugo Aguilar Villa, Juan Pablo Arbelaez, Walter Morrou, Marcelo Aniceto & Francesco Mazzarone

Authors
  1. Hector Mauricio Serrano Reyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joaquin Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hugo Aguilar Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan Pablo Arbelaez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Walter Morrou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marcelo Aniceto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesco Mazzarone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hector Mauricio Serrano Reyes.

Ethics declarations

Conflict of interest

Hector Mauricio Serrano Reyes, Joaquin Ramirez, Juan Pablo arbelaez, Walter Marrou, Marcelo Aniceto, and Francesco Mazzarone declare that they have no conflict of interest.

Ethical approval

This study was approved by the Brazilian Investigation Ethical Committee Board (http://plataformabrasil.saude.gov.br) and conducted in accordance with the Declaration of Helsinki and later amendments.

Informed consent

All participants were invited verbally to be part of this study, and upon acceptance, a written informed consent was obtained. The participants have given written informed consent for publication. An additional informed consent was obtained from all individual participants for whom identifying information and facial images/videos are included in this article.

Funding

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Video. Supplemental Digital Content 1

which demonstrates the irrigation of TXA performed on one side of the face. (MOV 2111 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Serrano Reyes, H.M., Ramirez, J., Aguilar Villa, H. et al. Tranexamic acid: a simple way to reduce drainage and bleeding in rhytidoplasty. Eur J Plast Surg 44, 189–196 (2021). https://doi.org/10.1007/s00238-020-01735-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00238-020-01735-8

Keywords

Search

Navigation