Recurrent Epistaxis Immediate Following Upper Blepharoplasty: Treatment with Tranexamic Acid

Ozkul E., Mangan M. S., ÖZMEN İBİŞ D.

JOURNAL OF CRANIOFACIAL SURGERY, vol.37, no.6, 2026 (SCI-Expanded, Scopus)

Abstract

Upper eyelid blepharoplasty is a widely performed and generally safe oculoplastic procedure. While common complications such as ecchymosis, edema, or hematoma are well-documented, epistaxis has not been reported as a postoperative consequence in the absence of nasal instrumentation. Herein, we present a rare case of recurrent anterior epistaxis following bilateral upper blepharoplasty in a healthy 72-year-old woman with no prior history of nasal pathology, bleeding disorder, or systemic disease. The surgery was performed under local anesthesia with lidocaine and epinephrine, with no intraoperative or immediate postoperative complications. Approximately four hours postoperatively, the patient experienced anterior nasal bleeding from the left nostril, which recurred intermittently over the next few days. Extensive ENT and hematologic evaluations revealed no local or systemic abnormalities. Conservative measures failed to prevent further episodes. On postoperative day 5, oral tranexamic acid (500 mg, three times daily) was initiated, resulting in complete resolution of symptoms by day 13. This case highlights a previously undocumented complication of blepharoplasty and suggests a potential mechanism involving regional vascular interplay and epinephrine-induced rebound vasodilation. Oral tranexamic acid was found to be an effective and well-tolerated adjunctive therapy. Awareness of this rare association may improve postoperative counseling and interdisciplinary management. Precautions such as humidification and nasal care may be considered in selected patients.