Background Tranexamic acid (TXA) is an antifibrinolytic that significantly reduces perioperative blood loss. Topical use of TXA, as opposed to traditional systemic administration, has proven to be effective in recent literature. This study assesses the benefit of topical TXA in plastic surgery in a systematic review and meta-analysis of randomised controlled trials. Methods PubMed, Web of Science, Embase and the Cochrane Library, were searched concerning the effect of topical TXA . Outcomes evaluated included blood loss volume (BLV), operation time, postoperative bruising, length of stay, duration of drain tube and postoperative complications. Results 20 articles were included, consisting of 12 randomized controlled trials and 8 retrospective case, while 8 studies were included in the meta-analysis. Compared with the control group, the topical TXA group showed a reduction in blood loss volume from 23.6% to 60% (p < 0.05), significantly reduced rate of postoperative ecchymosis (p = 0.01), shorter operating times (p = 0.016), reductions in transfusion, better surgical field quality (p < 0.001), shorter length of stay in hospital (p = 0.03) and less drain output in 24 hours (p =0.011). Specifically topical TXA was noted to be more effective in reducing bleeding in anticoagulated patients. Conclusions Topical TXA in plastic surgery can improve surgical outcome by reducing perioperative blood loss, ecchymosis, improving surgical field and shortening operation and admission time.