Aesth Plast Surg (2007) 31:415

DOI 10.1007/s00266-007-0030-6

LETTER TO THE EDITOR

Practice Pearl: A Novel Anesthetic Solution for Decreasing the

Blood Loss at the Recipient Site of Hair Transplantation
(Namazi Solution)
M. R. Namazi

Received: 2 February 2007 / Accepted: 5 March 2007

Ó Springer Science+Business Media, LLC 2007

The tumescent anesthetic technique offers both anesthe-
sia and vasoconstriction. A solution of 0.1% lidocaine,
1:1000,000 epinephrine, and 10 mEq/l of sodium bicar-
bonate is injected into the subcutaneous tissue until it
becomes quite firm. A dual level of tumescent anesthetic
infiltration expedites hair grafting or strip harvesting for
hair transplantation, facilitates the placement of the
correct incisional angle of instruments inserted into the
donor site, reduces bleeding, and increases the exit angle
of the hairs, thereby promoting increased survivorship of
hair shafts and bulbs [2, 3]. However, despite the use of
this technique, bleeding from the recipient sites fre-
quently occurs, which makes transplantation of the har-
vested follicles difficult.
Tranexamic acid is a synthetic derivative of the amino
acid lysine that exerts its antifibrinolytic effect through the
reversible blockade of lysine-binding sites on plasminogen
molecules. Tranexamic acid is useful in a wide range of
hemorrhagic conditions. The drug reduces postoperative
blood loss in a number of surgery types such as cardiac
surgery with cardiopulmonary bypass, orthotopic liver
transplantation, and transurethral prostatic surgery. Tra-
nexamic acid decreases the blood loss from upper gastro-
intestinal bleeding, menorrhagia, placental bleeding,
traumatic hyphema, postpartum hemorrhage, and conisa-
tion of the cervix.
Tranexamic acid significantly reduced mean blood loss
after oral surgery for patients with hemophilia and was
effective as a mouthwash for dental patients receiving oral
anticoagulants. Systemically administered tranexamic acid
is well tolerated. Nausea and diarrhea are the most com-
mon adverse events. Increased risk of thrombosis with the
drug has not been demonstrated in clinical trials [1].
The antifibrinolytic property of tranexamic acid could be
elegantly used for the reduction of bleeding at hair trans-
plantation recipient sites. The addition of one 500-mg
(5 ml) ampule of tranexamic acid to the tumescent anes-
thetic solution can significantly speed and ease the trans-
plantation of the harvested follicles into the recipient sites
while decreasing the stress of the operation.
References
1. Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in
surgery and other indications. Drugs 57:1005–1032
2. Field LM, Namias A (1997) Bilevel tumescent anesthetic infiltra-
tion for hair transplantation. Dermatol Surg 23:289–290
3. Nusbaum BP (2004) Techniques to reduce pain associated with
hair transplantation: Optimizing anesthesia and analgesia. Am J
Clin Dermatol 5:9–15

M. R. Namazi (&)
Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran
e-mail: namazi_mr@yahoo.com

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