Is Local Tranexamic Acid Worth Using in Hair Transplantation? An Intrapatient Comparison.

BACKGROUND

Excessive bleeding during donor area harvesting may impair surgical control and graft quality in hair transplantation. While adrenaline-based tumescent solutions are routinely used, the additional value of local tranexamic acid (TXA) in this setting remains unclear.

OBJECTIVE

To evaluate whether local TXA provides additional benefit compared with standard adrenaline-based tumescence during donor area follicular unit excision (FUE).

METHODS

This intrapatient-controlled, single-blinded study included 57 male patients undergoing FUE. In each patient, two adjacent 4 cm2 donor areas were infiltrated with either an adrenaline-only tumescent solution or a combination of adrenaline and TXA (50 mg/mL). Approximately 20 grafts were harvested from each area. Intraoperative bleeding was assessed immediately after graft excision using a validated 10-point visual bleeding scale. Paired comparisons were performed using the Wilcoxon signed-rank test.

RESULTS

Bleeding scores were significantly lower in the adrenaline-only control areas compared with TXA-treated areas (median [IQR] 2 [2-3] vs. 3 [2-4]; p < 0.001), with a large effect size (r = 0.56).

CONCLUSION

Within the specific protocol applied in this study, adrenaline-based tumescence demonstrated more effective immediate intraoperative hemostasis. However, given the difference in total adrenaline exposure between groups, the independent contribution of tranexamic acid cannot be conclusively determined.

LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .