{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:52:18Z","timestamp":1788393138730,"version":"build-2803163510"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,17]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Systemic tranexamic acid (TXA) reduces bleeding in nasal surgery but carries theoretical systemic risks. Topical TXA is an alternative, yet its efficacy in rhinoplasty and septoplasty is controversial because of inconsistent findings in individual trials. The aim of the authors of this systematic review and meta-analysis is to synthesize the evidence on the effectiveness of topical TXA in this setting. A systematic literature search was conducted from inception to July 2025 for randomized controlled trials (RCTs) comparing topical TXA to control in adults undergoing rhinoplasty, septoplasty, or septorhinoplasty. Primary outcomes included intraoperative blood loss, postoperative edema, and ecchymosis. Data were pooled using a random-effects model. Seven RCTs comprising 514 patients were included. The use of topical TXA was associated with a significant reduction in intraoperative blood loss (standardized mean difference [SMD] \u22121.20, 95% CI, \u22122.34 to \u22120.07; P = .04), overall postoperative edema (SMD \u22120.87, 95% CI, \u22121.35 to \u22120.39; P &amp;lt; .001), and ecchymosis (SMD \u22121.16, 95% CI, \u22121.63 to \u22120.69; P &amp;lt; .001). Secondary outcomes, such as surgeon satisfaction (SMD 0.74, 95% CI, \u22120.24 to 1.73, P = .14) and operative time (SMD \u22121.03, 95% CI, \u22122.69 to 0.62, P = .22), showed no statistically significant differences between the groups. In patients undergoing rhinoplasty or septoplasty, topical TXA significantly reduces intraoperative blood loss and postoperative edema and ecchymosis. These findings suggest it may serve as an effective adjunct for improving hemostasis and postoperative recovery.<\/jats:p>\n                  <jats:p>Level of Evidence: 3 (Therapeutic) \u00a0<\/jats:p>","DOI":"10.1093\/asj\/sjaf172","type":"journal-article","created":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T11:32:38Z","timestamp":1756035158000},"page":"1220-1226","source":"Crossref","is-referenced-by-count":3,"title":["Local Tranexamic Acid vs Placebo in Patients Undergoing Septorhinoplasty: A Systematic Review and Meta-analysis of Randomized Controlled Trials"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6288-8891","authenticated-orcid":false,"given":"Lorenzo","family":"Di Martino","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Mokhtar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Akbarpoor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2954-0628","authenticated-orcid":false,"given":"Lucas","family":"Kreutz-Rodrigues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna","family":"Vyas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Curtis L","family":"Cetrulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre G","family":"Lellouch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"2025111618522451200_sjaf172-B1","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1089\/fpsam.2019.29007.won","article-title":"Complications in rhinoplasty: a literature review and comparison with a survey of consent forms","volume":"22","author":"Heilbronn","year":"2020","journal-title":"Facial Plast Surg Aesthet Med"},{"key":"2025111618522451200_sjaf172-B2","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.bjps.2025.05.044","article-title":"Dorsal preservation versus dorsal reduction rhinoplasty techniques for aesthetic and functional outcomes: a systematic review and meta-analysis","volume":"107","author":"Ribeiro","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2025111618522451200_sjaf172-B3","doi-asserted-by":"publisher","first-page":"66","DOI":"10.61186\/wjps.13.3.66","article-title":"Impact of topical tranexamic acid on bleeding control in rhinoplasty","volume":"13","author":"Adibparsa","year":"2024","journal-title":"World J Plast Surg"},{"key":"2025111618522451200_sjaf172-B4","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1097\/PRS.0000000000002101","article-title":"Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature","volume":"137","author":"Ong","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"2025111618522451200_sjaf172-B5","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1001\/jamafacial.2018.1716","article-title":"Postoperative ecchymosis and edema after creation of subperiosteal tunnels in rhinoplasty: a randomized clinical trial","volume":"21","author":"Chan","year":"2019","journal-title":"JAMA Facial Plast Surg"},{"key":"2025111618522451200_sjaf172-B6","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.bjps.2024.09.085","article-title":"Role of tranexamic acid (TXA) in plastic and reconstructive surgery: a national perspective","volume":"102","author":"Rohrich","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2025111618522451200_sjaf172-B7","doi-asserted-by":"publisher","first-page":"816","DOI":"10.1001\/jamaoto.2018.1381","article-title":"Preoperative tranexamic acid for treatment of bleeding, edema, and ecchymosis in patients undergoing rhinoplasty: a systematic review and meta-analysis","volume":"144","author":"de Vasconcellos","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025111618522451200_sjaf172-B8","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1001\/jamafacial.2018.1737","article-title":"Role of tranexamic acid in reducing intraoperative blood loss and postoperative edema and ecchymosis in primary elective rhinoplasty: a systematic review and meta-analysis","volume":"21","author":"McGuire","year":"2019","journal-title":"JAMA Facial Plast Surg"},{"key":"2025111618522451200_sjaf172-B9","doi-asserted-by":"publisher","first-page":"2076","DOI":"10.1007\/s00266-023-03768-3","article-title":"Tranexamic acid in patients undergoing rhinoplasty: an updated systematic review and meta-analysis of randomized controlled trials","volume":"48","author":"Gutierrez","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"2025111618522451200_sjaf172-B10","doi-asserted-by":"publisher","first-page":"e210884","DOI":"10.1001\/jamasurg.2021.0884","article-title":"Association of intravenous tranexamic acid with thromboembolic events and mortality: a systematic review, meta-analysis, and meta-regression","volume":"156","author":"Taeuber","year":"2021","journal-title":"JAMA Surg"},{"key":"2025111618522451200_sjaf172-B11","doi-asserted-by":"publisher","first-page":"CD010562","DOI":"10.1002\/14651858.CD010562.pub2","article-title":"Topical application of tranexamic acid for the reduction of bleeding","volume":"2013","author":"Ker","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025111618522451200_sjaf172-B12","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins","year":"2019","edition":"1st ed"},{"key":"2025111618522451200_sjaf172-B13","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"2025111618522451200_sjaf172-B14","doi-asserted-by":"publisher","first-page":"2202","DOI":"10.1097\/00006534-199912000-00041","article-title":"A practical classification of septonasal deviation and an effective guide to septal surgery","volume":"104","author":"Guyuron","year":"1999","journal-title":"Plast Reconstr Surg"},{"key":"2025111618522451200_sjaf172-B15","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1001\/archotol.1991.01870210062009","article-title":"Steroids and rhinoplasty. A double-blind study","volume":"117","author":"Hoffmann","year":"1991","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"2025111618522451200_sjaf172-B16","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1007\/s00266-005-0158-1","article-title":"Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty","volume":"30","author":"Gurlek","year":"2006","journal-title":"Aesthetic Plast Surg"},{"key":"2025111618522451200_sjaf172-B17","doi-asserted-by":"publisher","first-page":"3620","DOI":"10.1007\/978-94-007-0753-5_1654","volume-title":"Encyclopedia of Quality of Life and Well-Being Research","author":"Robinson","year":"2014"},{"key":"2025111618522451200_sjaf172-B18","author":"GRADEpro GDT. [Software]"},{"key":"2025111618522451200_sjaf172-B19","author":"R Core Team"},{"key":"2025111618522451200_sjaf172-B20","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1093\/asj\/sjaf073","article-title":"Topical tranexamic acid and systemic dexamethasone for post-rhinoplasty edema and ecchymosis: first direct comparison","volume":"45","author":"Vural","year":"2025","journal-title":"Aesthet Surg J"},{"key":"2025111618522451200_sjaf172-B21","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1007\/s00266-023-03441-9","article-title":"Evaluating the effect of tranexamic acid local injection on the intraoperative bleeding amount and the postoperative edema and ecchymosis in primary rhinoplasty patients: a randomized clinical trial","volume":"48","author":"Vaghardoost","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"2025111618522451200_sjaf172-B22","doi-asserted-by":"publisher","first-page":"2744","DOI":"10.1016\/j.bjps.2021.03.008","article-title":"Evaluation of local tranexamic acid on septoplastic surgery quality","volume":"74","author":"Hazrati","year":"2021","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2025111618522451200_sjaf172-B23","doi-asserted-by":"publisher","first-page":"3284","DOI":"10.1007\/s00266-024-03951-0","article-title":"Tranexamic acid and rhinoplasty: how do different administration routes affect effectiveness?","volume":"48","author":"Sezen G\u00f6kta\u015f","year":"2024","journal-title":"Aesthetic Plast Surg"},{"key":"2025111618522451200_sjaf172-B24","doi-asserted-by":"publisher","first-page":"103514","DOI":"10.1016\/j.amjoto.2022.103514","article-title":"Evaluation of applying topical tranexamic acid to control septorhinoplasy\u2014induced hemorrhage","volume":"43","author":"Habibi","year":"2022","journal-title":"Am J Otolaryngol"},{"key":"2025111618522451200_sjaf172-B25","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1097\/PRS.0000000000010631","article-title":"The effect of topical tranexamic acid on postrhinoplasty periorbital ecchymosis and eyelid edema","volume":"153","author":"Vural","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"2025111618522451200_sjaf172-B26","doi-asserted-by":"publisher","DOI":"10.1093\/asjof\/ojaa029","article-title":"Tranexamic acid in aesthetic facial plastic surgery: a systematic review of evidence, applications, and outcomes","volume":"2","author":"Locketz","year":"2020","journal-title":"Aesthet Surg J Open Forum"},{"key":"2025111618522451200_sjaf172-B27","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s00238-021-01794-5","article-title":"Tranexamic acid in plastic surgery: routes of administration and dosage considerations","volume":"44","author":"AlGhanim","year":"2021","journal-title":"Eur J Plast Surg"},{"key":"2025111618522451200_sjaf172-B28","doi-asserted-by":"publisher","DOI":"10.1093\/asjof\/ojae105","article-title":"Tranexamic acid application in facial aesthetic surgery: an umbrella review","volume":"6","author":"Ahmed","year":"2024","journal-title":"Aesthet Surg J Open Forum"},{"key":"2025111618522451200_sjaf172-B29","doi-asserted-by":"publisher","first-page":"e6442","DOI":"10.1097\/gox.0000000000006442","article-title":"Is topical tranexamic acid effective in reducing hematoma and seroma in breast surgery? A systematic review and meta-analysis","volume":"13","author":"Hashemi","year":"2025","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025111618522451200_sjaf172-B30","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1530\/EOR-2024-0152","article-title":"Topical tranexamic acid in hip and knee surgery: a meta-analysis of randomized-controlled trials","volume":"10","author":"Tantavisut","year":"2025","journal-title":"EFORT Open Rev"},{"key":"2025111618522451200_sjaf172-B31","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s10143-023-02254-3","article-title":"Topical tranexamic acid (TXA) is non-inferior to intravenous TXA in adult spine surgery: a meta-analysis","volume":"47","author":"Mitha","year":"2024","journal-title":"Neurosurg Rev"},{"key":"2025111618522451200_sjaf172-B32","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1017\/S0022215121003170","article-title":"Tranexamic acid in sinus and nasal surgery: an up-to-date meta-analysis","volume":"136","author":"Yap","year":"2022","journal-title":"J Laryngol Otol"},{"key":"2025111618522451200_sjaf172-B33","doi-asserted-by":"publisher","first-page":"e15202","DOI":"10.1097\/md.0000000000015202","article-title":"Role of tranexamic acid in nasal surgery: a systemic review and meta-analysis of randomized control trial","volume":"98","author":"Ping","year":"2019","journal-title":"Medicine (Baltimore)"},{"key":"2025111618522451200_sjaf172-B34","doi-asserted-by":"publisher","first-page":"e6275","DOI":"10.1097\/gox.0000000000006275","article-title":"Tranexamic acid in rhinoplasty and septoplasty: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"Khajuria","year":"2024","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2025111618522451200_sjaf172-B35","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1186\/s13741-024-00406-7","article-title":"A systematic review and meta-analysis of systematic and topical tranexamic acid administration in aesthetic plastic surgery","volume":"13","author":"Kolasi\u0144ski","year":"2024","journal-title":"Perioper Med"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjaf172\/64295082\/sjaf172.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/45\/12\/1220\/64295082\/sjaf172.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/45\/12\/1220\/64295082\/sjaf172.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,16]],"date-time":"2025-11-16T23:52:28Z","timestamp":1763337148000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/45\/12\/1220\/8256445"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,17]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,9,17]]},"published-print":{"date-parts":[[2025,11,17]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjaf172","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,9,17]]}}}