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The safety of Tranexamic acid

Published on March 15, 2024

Tranexamic acid (TXA) has gained considerable attention in the field of facial plastic surgery for its potential to reduce bleeding and improve outcomes. This blog post aims to provide an in-depth look at the pros and cons of using tranexamic acid in facial plastic surgery, exploring its benefits, limitations, and overall impact on patient care.

Pros of Using Tranexamic Acid in Facial Plastic Surgery

  1. Reduced Bleeding

One of the most significant benefits of TXA is its ability to minimize bleeding during and after surgery. Tranexamic acid works by inhibiting plasminogen activation, which in turn reduces fibrinolysis and stabilizes blood clots. This property is particularly beneficial in facial plastic surgery, where precise control of bleeding can enhance surgical visibility and outcomes.

  1. Decreased Need for Blood Transfusions

By effectively reducing intraoperative bleeding, TXA decreases the likelihood of patients requiring blood transfusions. This not only lowers the risks associated with blood transfusions, such as infections and allergic reactions but also contributes to more efficient use of healthcare resources.

  1. Improved Surgical Outcomes

Reduced bleeding and swelling can lead to clearer surgical fields, allowing for more precise and meticulous work. This can enhance the accuracy of the surgical procedure, potentially leading to better aesthetic and functional outcomes for patients.

  1. Shorter Operation Times

With the use of TXA, surgeons may experience less time dealing with bleeding, which can lead to shorter overall operation times. This efficiency benefits both the surgical team and the patient, reducing the time under anesthesia and potentially lowering the risk of complications.

  1. Reduction in Postoperative Complications

Studies have shown that TXA can reduce the incidence of postoperative complications, such as hematomas, which are common concerns in facial plastic surgery. By minimizing these complications, TXA can contribute to a smoother recovery process and higher patient satisfaction.

Cons of Using Tranexamic Acid in Facial Plastic Surgery

  1. Flap necrosis. Recently, there have been growing reports of tissue necrosis (skin death) in unusual locations in surgeries using TXA. This is causing surgeons to reevaluate the safety of using TXA for cosmetic facial surgery.
  2. Risk of Thromboembolic Events

One of the primary concerns with TXA use is the potential increased risk of thromboembolic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE). While this risk is generally low, it is a critical consideration for patients with a history of thrombosis or other risk factors.

  1. Allergic Reactions

Although rare, there is a possibility of allergic reactions to tranexamic acid, ranging from mild to severe. Patients with known allergies to TXA or its components should avoid its use.

  1. Limited Research in Specific Surgical Contexts

While the benefits of TXA in reducing bleeding are well-documented, research on its use in specific types of facial plastic surgery is still evolving. Further studies are needed to fully understand its effectiveness and safety across different surgical procedures.

  1. Potential Drug Interactions

TXA can interact with other medications, potentially altering their effects. It is important for patients to disclose all medications and supplements they are taking to their surgeon and anesthesiologist to avoid adverse interactions.

  1. Cost Considerations

While not significantly expensive, the cost of TXA can add to the overall expense of surgery. Patients and healthcare providers should consider the cost-benefit ratio, especially in settings where healthcare resources are limited.


Tranexamic acid represented a promising adjunct in facial plastic surgery, offering several benefits, including reduced bleeding, shorter operation times, and improved outcomes. However, the emergence of unusual flap necrosis is causing surgeons to reassess the potential benefits of using this products. It is clear now that much more research is needed before this product can be safely employed for facial plastic surgery. Patients considering facial plastic surgery should discuss the use of tranexamic acid with their surgeon to make an informed decision based the emergence of these new complicaitons that have caused facial surgeons to reassess the safety of Tranexamic acid.

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About Dr. Steinsapir

Dr. Steinsapir is a board-certified eye surgeon and fellowship trained in oculoplastic surgery and cosmetic surgery in Los Angeles and Beverly Hills where he specializes in balanced facial cosmetic surgery for natural results with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice in Beverly Hills and also serves as a volunteer faculty at the Jules Stein Eye Institute, David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s can make a difference for you.