Impact of Tranexamic Acid on Bleeding Outcomes and Complication Rates in Facelift: A Systematic Review and Meta-analysis.

BACKGROUND: Rhytidectomy poses a significant risk of bleeding. Several studies have reported the safety profile and efficacy of tranexamic acid (TXA), an antifibrinolytic agent, in minimizing perioperative sequelae, particularly hematoma and bleeding. OBJECTIVES: The aim of this systematic review was to analyze the effect of TXA administration in facelift surgery, its effect with different routes of administration, and to compare different administration routes in reducing intraoperative blood loss, postoperative edema, and ecchymosis in rhytidectomy. METHODS: A systematic literature search was conducted to identify studies that reported on TXA in facelift surgery. The primary outcomes of interest were intraoperative blood loss, time to achieve hemostasis, operation duration, and postoperative hematoma, edema, ecchymosis, drain output, and major and minor complications. Meta-analyses of hematoma, operation duration, drain output, and major and minor complications were performed, and the risk of bias was assessed with ROBINS-I for nonrandomized studies, and Cochrane's RoB 2.0, a tool for randomized controlled trials. RESULTS: In total, 104 articles were included in the initial screening. Out of 388 participants 170 patients were administered TXA, predominantly female (over 91%), with ages from the late 50s to mid-60s. TXA administration varied, with subcutaneous injection being the most common method. The meta-analysis revealed that the pooled prevalence of minor and major hematoma in TXA recipients was remarkably low, with a significant reduction in the risk of minor hematoma (odds ratio [OR] = 0.18, 95% CI 0.05-0.62, P < .001) and no significant difference in major hematoma risk. Interestingly, TXA significantly reduced postoperative drainage compared to the controls (mean difference = -25.59, 95% CI, -30.4--20.77, P < .01). Additionally, neither minor nor major complications were significantly different between the TXA recipients and controls. Specifically, the pooled odds for the incidence of major complications were not significantly different (OR = 1.47, 95% CI, 0.23-9.19, P = .68), and similar results were found for minor complications (OR = 0.59, 95% CI, 0.23-1.48, P = .26). CONCLUSIONS: TXA significantly reduces postoperative drain output and minor hematomas in facelift surgery without increasing major complications. It also reduces edema, ecchymosis, and intraoperative blood loss. However, further studies are required to explore the efficacy of TXA with different dosages and administration routes.

Surgical Approaches and Outcomes of Short Nose Correction: A Descriptive Systematic Review of the Literature.

OBJECTIVES: The purpose of this study is to describe all published techniques of short nose correction released by surgeons over the years and summarize their outcomes in a descriptive systematic review of the literature. PATIENTS AND METHODS: A computerized literature search was conducted using 5 major databases. All original studies discussing correction methods and/or outcomes of shortened noses were included. The risk of bias was evaluated blindly by 2 reviewers, and the data were descriptively presented. The study protocol was recorded in the International Prospective Register of Systematic Reviews. RESULTS: A total of 24 studies including 1450 patients were included. Lengthening of the nose was performed through a cartilage-only graft in 14 studies, whereas bone graft was used in 3 studies. The mean increase in nasal tip projection in 5 reports ranged from 0.05 to 2.2 mm. The mean nasal length before and after rhinoplasty was reported in 8 studies, with a mean increase ranging from 0.28 to 6.2 mm. Regarding surgical complications, 30 patients had implant deviation or migration, 22 patients experienced postoperative infection, and 12 patients required corrective surgery. CONCLUSIONS: Augmentation of a short nose is a challenging surgical procedure for rhinoplasty. There are several techniques for short nose correction; however, it is difficult to evaluate the outcomes in the absence of a standard tool of assessment. Further analytical studies are warranted to fully evaluate surgical techniques.

Tubed Temporalis Fascia for Nasal Dorsal Contouring: A Novel Technique.

INTRODUCTION: Nasal dorsum irregularities may occur after nasal trauma or as a postrhinoplasty complication. Here, we present a novel technique using temporalis fascia (TF) grafting for primary and revision rhinoplasty to repair the nasal dorsum, hide nasal irregularities, and improve nasal contouring. METHODS: This prospective cohort study was conducted from January 2019 to June 2019 and evaluated nasal dorsal contouring using the TF in a tubed form. The outcome variables were patient satisfaction, dorsal irregularity, and contour definition. The predictor variable was the use of tubed TF for dorsal augmentation. Other associated variables were age, sex, indication for surgery, surgery type, and graft size. Patient satisfaction was evaluated using the Rhinoplasty Outcome Evaluation questionnaire. A rhinoplasty specialist other than the surgeon who performed the procedure evaluated the dorsal augmentation outcomes by inspection and palpation of the dorsum. All statistical analyses were performed using the SPSS software. RESULTS: Seventy-four patients (21.6% men and 78.4% women) were treated with the tubed TF. The mean age was 28.97 years. Thin skin was the most common indication (48.6%) for using TF. The graft size was 2-5 cm; inspection and palpation revealed no irregularities. No reception site complications occurred. One patient had a mild hematoma at the donor site. The mean patient satisfaction score was 10.14 preoperatively and 19.95 postoperatively (p = 0.001). DISCUSSION/CONCLUSIONS: Our novel technique of using the TF graft in a tubed form was easy to perform. Furthermore, the tubed TF covers all irregularities, is good for dorsal augmentation, and improves dorsal contouring and definition.

Evaluation of Scar Outcome After Alar Base Reduction Using Different Surgical Approaches.

PURPOSE: Alar base reduction was first performed in 1892, when Robert Weir began performing surgery to correct nasal flaring. Our study objective was to investigate scar outcomes after alar base reduction with different surgical approaches. MATERIALS AND METHODS: We performed a retrospective cohort study of patients who underwent alar base reduction at King Abdulaziz University Hospital. The primary predictor variable was wound incision in the alar-facial groove; other variables were age, gender, and time interval. The outcome variable, scar status, was assessed subjectively (unnoticeable, noticeable but acceptable, or noticeable and unacceptable) and objectively by rhinoplasty surgeons using Stony Brook Scar Evaluation Scale scores. Paired t tests were used, with P ≤ .05 considered statistically significant. RESULTS: A total of 70 patients were included, with 35 in each of 2 groups. The incision for alar reduction was placed in the alar-facial groove in group 1; the incision was placed 1 to 2 mm anterior to the alar-facial groove in group 2. Group 1 consisted of 14 men (40%) and 21 women (60%); group 2 consisted of 8 men (22.9%) and 27 women (77.1%). The average Stony Brook Scar Evaluation Scale scores for groups 1 and 2 were 4.62 and 4.48, respectively, and did not differ significantly (P = .196). During subjective scar assessment, 85.7% of patients from group 1 reported that their scars were unnoticeable whereas 14.3% reported that they were noticeable but acceptable. In group 2, 82.9% of patients reported unnoticeable scars whereas 17.1% reported noticeable but acceptable scars. Thus, no significant differences were observed in the subjective assessment between the 2 groups (P = .286). CONCLUSIONS: Alar resection along the alar-facial groove ensures better scar outcomes and hides the scar within that groove, especially in patients with a deep facial groove. Future studies should focus on the best method for limiting scarring in patients without deep facial grooves.