Local Tranexamic Acid in Facelift Surgery Is Not Associated With Wound Healing Complications: A Matched, Single-Surgeon Cohort Study.

Background: Recent anecdotal reports from respected surgeons suggest a potential link between tranexamic acid (TXA) in local anesthetic solutions and wound healing complications during facelift procedures.

Objectives: This study evaluates outcomes in patients undergoing facelift with and without local TXA injection.

Methods: A single-surgeon retrospective cohort study was conducted on patients who underwent facelift surgery under general anesthesia between 2014 and 2024. All received subcutaneous injections of 0.5% lidocaine with 1:200,000 epinephrine, with or without TXA. Patients were matched for age, BMI, sex, and hypertension. Operative time and postoperative complications were assessed.

Results: Each group had 261 patients with a median follow-up of 232 days. No significant differences were observed in age (p=0.22), BMI (p=0.59), sex (p=1.00), hypertension (p=0.52), primary vs. secondary facelifts (p=0.19), fat grafting (p=0.66), or chemical peels (p=0.83). Minor wound healing complications were similar (p=0.16). Delayed healing occurred in 4.6% (non-TXA) vs. 2.3% (TXA) (p=0.15). Minor skin necrosis was noted in one non-TXA patient (0.4%) and two TXA patients (0.8%) (p=1.00). Two major complications, major skin necrosis, were reported in the non-TXA group, none in TXA (p=0.5). Hematoma rates were comparable (p=1.00).

Conclusions: This large-scale, single-surgeon, retrospective cohort study of matched patients study challenges previous claims associating TXA use with wound healing complications. Local administration of tranexamic acid (TXA) in a concentration of 1-2mg/mL is not associated with increased risk for minor or major wound healing complications in patients undergoing facelift procedures with wide skin undermining. TXA appears safe when used with appropriate dosing, screening, and technique.