A recent American Society for Aesthetic Plastic Surgery article warns of possible effects such as bleeding and complications with drug interactions for patients going in for cosmetic surgery. For many people, “natural” or “herbal” are virtually synonymous with safety and purity; however, products available over-the-counter without a doctor’s prescription are often mistakenly believed to be free of significant risks, according to a Tampa plastic surgeon we recently spoke with. A report in the March/April issue of Aesthetic Surgery Journal warns that more than 40% of plastic surgery patients use herbal supplements in the two weeks prior to undergoing surgery. And, while some herbal supplements may provide benefits during recovery, commonly used herbal medications such as ginkgo biloba, ginseng, garlic, echinacea, valerian root and others can have deleterious effects when combined with surgery.

When undergoing plastic surgery, the most significant and potentially dangerous effects of alternative medicines occur during the operative and immediate postoperative periods. With such a wide array of supplements available, the main concerns of the plastic surgeon are interaction with other medications, cardiovascular effects, alteration of coagulation [bleeding] and sedative effects, according to an experienced Phoenix plastic surgeon.

As many as 70% of patients unfortunately may not disclose the use of alternative medications to their surgeon or conventional health care provider, sometimes because they feel these physicians have little knowledge or interest in naturopathic medicine, or they feel physicians may disapprove of such treatments. Some patients simply fail to recognize the relevance of supplement usage to their current medical or surgical care. Newport Beach plastic surgeons remind patients that full disclosure of all medications – both those that are prescribed and those that are obtained over-the-counter – is extremely important to their health and safety. They should also understand that inconsistent and unregulated manufacturing standards and lack of regulation for many herbal supplements mean that quality and dosage may vary considerably among products.

The authors recommend that patients be provided with a comprehensive list of supplements that must be avoided in the perioperative period to minimize potential surgical complications.
Herbal Medications to Avoid Within 2 Weeks of Surgery

Bleeding effects
- Gingko biloba
- Garlic
- Fish oils (omega-3 fatty acids)
- Dong Quai
- Feverfew

Drug interations
- Echinacea
- Goldenseal
- Licorice
- St. John’s wort
- Kava
- Valerian root

Cardiovascular Effects
- Ephedra (tachycardia, hypertension and palpitations)
- Garlic (hypotension)

Anesthetic effects
- Valerian root
- St. John’s wort
- Kava

Other
- St. John’s wort and Dong Quai (photosensitivity)
- Ginseng (hypoglycemia)

Although the dangerous side effects of some herbal supplements have been widely publicized, San Diego plastic surgeons still find that many patients do not fully appreciate the importance of discontinuing these treatments before surgery. Physicians must have at least fundamental knowledge of the common herbal medications and their effects, and then be very proactive in discussing patients’ use of herbal supplements during the history, consultation and informed consent process. Stopping certain herbal supplements prior to surgery is just as critical as stopping aspirin, ibuprofen and many other common drugs.”

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