Tranexamic acid (TXA) may reduce postoperative bleeding and drainage after abdominoplasty, but the evidence for combined intravenous and topical administration remains limited. This Letter to the Editor critically appraises a recent pilot study of TXA in Scarpa fascia-preserving abdominoplasty. Important concerns include its retrospective, non-randomized design; potential temporal and indication-related confounding; absence of separate route-specific comparator groups; limited generalizability; inadequate power to detect rare thromboembolic events; and uncertain clinical relevance of the reported drainage reduction. Potential circularity in the analysis of drain duration is also discussed. Larger randomized trials with standardized protocols and patient-reported outcomes are needed before routine adoption.Level of Evidence V 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 www.springer.com/00266 .

Leonardo da Vinci's ability to capture subtle human nuances enabled observations that modern medicine has only recently identified. While the Mona Lisa has been evaluated across many medical disciplines, this paper introduces a fresh perspective from aesthetic surgery by examining the portrait's facial morphology-specifically identifying temporal and masseter muscle hypertrophy-offering a novel explanation for her distinct facial structure and enigmatic smile.'Level of Evidence V 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 www.springer.com/00266 .