FPSAM Facial Plastic Surgery and Aesthetic Medicine · 2026

Intravenous Tranexamic Acid in Rhinoplasty: A Randomized Controlled Trial

Longino ES, Desisto NG, Adegboye F, Rebula E, Chowdhury NI, Patel PN, Stephan SJ, Yang SF.

What this paper says

In a randomised trial of 139 septorhinoplasty patients, a 1 gram dose of intravenous tranexamic acid before surgery made no difference to bleeding, swelling, bruising, pain or satisfaction.

Overview

Tranexamic acid reduces bleeding in other operations and existing rhinoplasty data are mixed. Patients having open septorhinoplasty were randomised to 1 gram of the drug intravenously before surgery or to routine medications only. Bleeding was graded during surgery, and swelling and bruising were rated at one week by the patients and by a facial plastic surgeon reviewing photographs.

Sections of note

Randomised controlled trial, registered as NCT05774717.
139 participants, 69 of them given the drug; 73 (53%) female; mean age 42 years; 13% were revision procedures.
Intraoperative bleeding scored with the Boezaart scale and by sponge saturation.
Boezaart scores 2.25 with the drug against 2.41 without, p = 0.3; sponge scores 0.76 against 0.84, p = 0.4.
Patient-rated swelling and bruising at one week were 1.15 and 1.19 out of 4 with the drug, 0.97 and 1.05 without.
Surgeon-graded swelling and bruising were 1.78 and 1.76 with the drug, 1.82 and 1.86 without.
No difference in nosebleeds, pain or satisfaction with appearance.

What it means for a patient

This trial found no benefit from the drug on any measure it recorded, including the bruising patients care about.
It is one of the larger randomised trials in rhinoplasty, so the negative result carries weight against smaller positive studies.
It tested one dose given before surgery; other doses, timings or topical use were not tested here.

Why this paper matters

Tranexamic acid has spread through facial plastic surgery on mixed evidence. A randomised trial of this size reporting no difference is a check on that spread. Whether topical delivery or a different regimen helps remains open.

Terms

Tranexamic acid (TXA): a drug that slows the breakdown of blood clots, used to reduce bleeding.
Boezaart scale: a surgeon-rated scale of how much bleeding obscures the surgical field.
Ecchymosis: bruising.
Periorbital: around the eyes, where rhinoplasty bruising shows.
Randomised controlled trial: patients are assigned to treatment by chance, the strongest single-study design.

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

From the abstract

“Existing data on tranexamic acid (TXA) in rhinoplasty are mixed. Objective: Compare blood loss, edema, and bruising in patients undergoing septorhinoplasty with or without intravenous (IV) TXA, measured by estimated blood loss and photograph review of edema/ecchymosis. Design: Randomized controlled trial…”

Excerpt; the full abstract is on PubMed.