BACKGROUND: Tranexamic acid (TXA) is an antifibrinolytic that is regularly used to reduce bleeding in surgical specialties. OBJECTIVES: To assess the effects of subcutaneous TXA in oculofacial plastic surgeries, with the hypothesis that TXA reduces postoperative ecchymosis and edema. METHODS: A prospective, randomized, double-blind, split-face study. The sides of the face were randomized to local anesthetic (bupivacaine with epinephrine) mixed with TXA or sodium chloride (placebo). Photographs were taken immediately post-operatively and on post-operative day 7. Photographs were graded by two masked investigators using the Surgeon Periorbital Rating of Edema and Ecchymosis criteria. Patients selected the side that they subjectively determined to have less ecchymosis and edema. As a secondary outcome, patients rated pain on each side of their face using the Wong-Baker FACES pain scale. RESULTS: Twenty-four patients undergoing bilateral, symmetric oculofacial surgery were included in the study. There was a statistically significant difference in postoperative periocular ecchymosis on POD7 (with TXA 0.91 ± 0.73 versus placebo 1.61 ± 1.03
p = 0.020) and in periocular edema on POD1 (with TXA 1.30 ± 0.76 versus placebo 2.00 ± 0.85
p = 0.028). All patients selected the side of the face receiving TXA as having less periocular ecchymosis and edema. There was no statistically significant difference in subjective pain level between the side receiving TXA versus placebo. There were no intraoperative or postoperative complications. CONCLUSIONS: Subcutaneous TXA was safe and reduced periocular ecchymosis and edema compared to contralateral placebo injections in this series of patients undergoing bilateral oculofacial plastic surgeries.