Tranexamic acid (TXA) is a synthetic lysine analog with antifibrinolytic properties used to reduce bleeding during various surgical procedures. In dermatologic surgery, it is often applied topically (soaked gauze), subcutaneously (intralesional with local anesthesia), and intravenously. We conducted a narrative review on the utility of TXA in dermatologic surgery, both oncologic and aesthetic. Therefore, we conducted a literature search across PubMed and Google Scholar during March 2025, including retrospective and prospective studies, and systematic reviews. We eventually found multiple randomized clinical trials demonstrating a reduction in intra- and postoperative bleeding, ecchymosis, and minor hematomas, especially in Mohs surgery, blepharoplasty, and facial rhytidectomy (facelift), and reduced surgical duration during blepharoplasty and rhytidectomy. The safety profile of TXA is highly favorable, with no observed increase in thromboembolic events. However, optimal dosing and routes of administration have yet to be established.