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We read with great interest the work by Li et al.[1] The authors hypothesized that red blood cell (RBC) transfusions in orthognathic surgery could be reduced by acute normovolemic hemodilution (ANH); 187 patients were randomly assigned to conventional management or ANH. The authors also referred to a 13% transfusion rate in the study published in 1996; however, due to recently updated transfusion guidelines and practice improvement advisory, many providers now use allogeneic blood transfusion more conservatively. Jozefowicz et al. recently evaluated antifibrinolytic efficacy of tranexamic acid (TXA) in patients ( I n i = 147) undergoing orthognathic surgery.[5] The primary outcome of this prospective randomized study was a cumulative blood loss on the 1st postoperative day. [Extracted from the article]