Quantitative Analysis of Tranexamic Acid Effects on Ecchymosis in Rhinoplasty

Cristel RT, Demesh D, Patel MJ, Shah AR.

What this paper says

Comparing 50 rhinoplasty patients given tranexamic acid against 50 controls, computer measurement of bruising at day 7 found no significant difference on any colour scale.

Overview

Many methods have been proposed to reduce bruising after rhinoplasty, and tranexamic acid, a drug that slows the breakdown of blood clots, remains contested. The authors note it can carry serious side effects including seizures, blood clots and vision changes. This prospective study ran from March to June 2019 in primary rhinoplasty patients, using image analysis software to quantify bruising objectively.

Sections of note

Prospective study of 100 subjects: 50 given tranexamic acid and 50 controls.
Eighty four subjects were female and 16 male.
Photographs were taken on postoperative day 7.
Adobe Photoshop was used to quantify bruising using multiple objective colour scales.
There were no significant differences on any of the red, green and blue or L a b colour subgroups, all P greater than 0.05.
There were no adverse events related to tranexamic acid.
The authors conclude the drug did not reduce bruising when given both intravenously and by injection during surgery.

What it means for a patient

Tranexamic acid did not reduce visible bruising a week after surgery in this study.
Bruising was measured by colour analysis of photographs rather than by eye, which removes rater bias.
No side effects occurred in this group, but 50 patients is far too few to detect the rare serious effects the authors list.
Assessment was at a single time point, day 7, so earlier or later differences would not be captured.

Why this paper matters

Tranexamic acid is used routinely by some rhinoplasty surgeons on the assumption it reduces bruising, and the evidence has been mixed. This study applies objective measurement rather than subjective grading. Whether the drug affects bruising at other time points or in different doses is not addressed.

Terms

Tranexamic acid: a drug that slows the breakdown of blood clots, used to reduce bleeding.
Ecchymosis: bruising, meaning blood collected under the skin.
Intravenous: given into a vein.
RGB and L a b: numerical colour scales used to quantify image colour.
Primary rhinoplasty: a first operation on a nose with no previous surgery.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

From the abstract

“Many methods have been described to reduce postoperative ecchymosis in rhinoplasty with tranexamic acid (TXA) remaining controversial. TXA remains a consideration for surgeons, however, may have serious side effects, including seizures, blood clots, and vision changes. Methods: A prospective study of primary…”

Excerpt; the full abstract is on PubMed.