Background: Hematoma is the most common complication in facelift surgery. It has a reported incidence ranging from 0.2 to 8%. Tranexamic acid (TXA) is an antifibrinolytic agent capable of minimizing blood loss, and its use in plastic surgery is quite new. The literature review indicates that there are no formal guidelines for dosing and standardization of TXA use. We sought to evaluate the efficacy of intraoperative local irrigation of TXA in reducing the incidence of hematomas in patients undergoing facelift surgery. Methods: A prospective cohort observational comparative study was conducted between November 2018 and November 2019 with 30 patients undergoing primary facelift surgery at the Ivo Pitanguy Institute in Rio de Janeiro, Brazil. The participants were divided into two groups: group I, patients who underwent facelift with 2.5% topical TXA irrigation as a new routine of the service, and group II, patients who underwent facelift without topical TXA irrigation as a routine. Results: Drainage output in the first 24 h, hematoma formation, and complication rate were evaluated. It was found that local intraoperative TXA irrigation reduces drainage output in the first 24 h by 71% compared with group II (median 10 ml (8–22 ml) versus 35 ml (19–50 ml); p = 0·009). The rate of postoperative complications (p = 0.1) and hematoma (p = 0.08) was lower in the group with intraoperative local irrigation with TXA. This was not statistically significant. Conclusion: Local TXA irrigation seems to decrease bleeding and has been shown to be effective in reducing drainage output in the first 24 h postoperatively. Level of evidence: Level III, risk / prognostic study. [ABSTRACT FROM AUTHOR]