Objective To explore the application effect of tranexamic acid (TXA) combined with lidocaine and epinephrine tumescent solution in patients undergoing large-volume liposuction. Methods A total of 100 patients who underwent large-volume liposuction in Shenzhen Jumei Boyue Medical Beauty Clinic from January 2022 to December 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 50 patients in each group. The control group was treated with lidocaine and epinephrine tumescent solution, and the observation group was supplemented with TXA on the basis of the control group. The surgical indicators, body contouring, hemoglobin (Hb), hematocrit (Hct), total blood loss (TBL), adverse reactions and coagulation function were compared between the two groups. Results There were no signiffcant differences in liposuction volume, incidence of adverse reactions, and prothrombin time (PT), activated partial thromboplastin time (APTT) at 1 and 3 days after surgery between the two groups (P>0.05). Compared with the control group, the observation group had shorter ecchymosis resolution time, lower body contouring score and TBL, and higher levels of Hb and Hct at 1 and 3 days after surgery (P<0.05). Conclusion TXA combined with lidocaine and epinephrine tumescent solution can effectively improve the body contouring of large-volume liposuction, reduce intraoperative blood loss, and promote ecchymosis resolution and improve postoperative Hb and Hct levels, without affecting liposuction efffcacy and coagulation function, which presents favorable safety.