The Impact of Local Tranexamic Acid Infiltration on Periorbital Ecchymosis and Edema in Rhinoplasty: A Triple-Blinded Randomized Controlled Trial

Abstract Background Rhinoplasty is acknowledged as one of the most commonly conducted facial plastic surgical procedures worldwide. Periorbital ecchymosis and edema pose considerable postoperative complications that influence patient satisfaction and recovery duration. Objectives This study aimed to examine the impact of local tranexamic acid (TXA) infiltration on periorbital ecchymosis and edema in patients undergoing rhinoplasty. Methods A randomized, triple-blind, controlled trial was conducted involving 80 patients scheduled for primary open septorhinoplasty at our university hospital between 2021 and 2022. Participants were randomly allocated to receive either local infiltration consisting of TXA (1 mg/mL) combined with lidocaine and epinephrine (n = 40) or a control solution containing identical components, except TXA (n = 40). Periorbital ecchymosis and edema were evaluated at 24 h and 1 week postoperatively, utilizing a standardized scale. Results No significant differences were observed between the TXA and control groups regarding periorbital edema at 24 h (P = .965) and 1 week (P = 1.000) postoperatively. Additionally, periorbital ecchymosis showed no substantial difference between the groups at 24 h (P = .597) or 1 week (P = .063). Intraoperative bleeding was marginally reduced in the TXA group (39.38 ± 23.699 vs 43.13 ± 26.435 mL), although this difference did not achieve statistical significance (P = .506). Conclusions The local infiltration of TXA did not lead to a statistically significant reduction in periorbital edema, ecchymosis, or intraoperative bleeding among rhinoplasty patients compared with a placebo. These findings suggest that local infiltration may not provide the same benefits in rhinoplasty procedures as those documented with systemic administration routes. Level of Evidence: 2 (Therapeutic)