Background <p>Tranexamic Acid(TXA) has been shown to improve melasma treatment or help homeostatic in the past decade, but no report on improving surgical scars. Given that early intervention may enhance surgical scar outcomes, this split-scar study investigates whether immediate postoperative administration of TXA around the incision site can help prevent scar formation.</p> Methods <p>In this prospective trial, 30 consecutive patients who underwent surgery from January 2022 to January 2024 were enrolled. TXA was injected randomly into half of each surgical wound closure immediately after surgery by plastic surgeons. The scars were assessed independently using the visual analogue scale (VAS) and the modified Stony Brook Scar Evaluation Scale (mSBSES) at follow-ups. The occurrence of complications or adverse events was also recorded.</p> Results <p>In total, 30 patients who completed the study were analyzed. The TXA-treated side achieved significantly improved VAS scores and better mSBSES scores (<i>p</i>&lt; 0.05, respectively), which revealed a significant improvement in appearance and narrower scars. No severe complications were reported.</p> Conclusion <p>This study demonstrates that immediate postsurgical TXA injections can improve the appearance of postoperative scar.</p> Level of Evidence II <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>