Efficacy and Safety of Local Tranexamic Acid in Rhytidectomy: A Systematic Review and Meta-analysis.

BACKGROUND: Rhytidectomy is one of the most performed facial rejuvenation procedures, yet postoperative hematoma remains its most frequent and consequential complication, driving patient morbidity and compromising aesthetic outcomes. Tranexamic acid (TXA), a potent antifibrinolytic agent, has been widely adopted to mitigate surgical bleeding; however, a definitive high-level synthesis of evidence for its local application in rhytidectomy remains limited. We conducted a comprehensive systematic review and meta-analysis to highlight the efficacy and safety profile of local administration of TXA compared with control interventions in patients undergoing rhytidectomy. METHODS: A systematic search of PubMed, Embase, MEDLINE (EBSCO), and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted from database inception through December 2025. Studies comparing the effects of local administration of TXA with a control in adults undergoing rhytidectomy were included. Pooled effect estimates were calculated using a random-effects model; risk of bias was assessed with risk of bias in non-randomized studies-of interventions (ROBINS-I); and the certainty of evidence was appraised using the grading of recommendations assessment, development, and evaluation (GRADE) framework. RESULTS: Seven studies met the inclusion criteria, comprising 1122 patients (596 local TXA and 526 controls). Meta-analysis revealed that local TXA was associated with a significant reduction in estimated blood loss (in milliliters) (standardized mean difference, -4.53; 95% confidence interval [CI], -8.09 to -0.97; P = 0.01), 24-hour postoperative drain output (in milliliters) (standardized mean difference, -1.10; 95% CI, -1.40 to -0.79; P < 0.01), and hematoma rates (odds ratio, 0.35; 95% CI, 0.15-0.81; P = 0.014). CONCLUSIONS: In patients undergoing rhytidectomy, the application of local TXA significantly enhances surgical efficiency and patient safety by reducing blood loss, drain output, and postoperative hematologic complications.