When "natural" remedies mean danger for cosmetic surgery

New review details herbal, homeopathic and dietary supplements that increase bleeding risk; provides plastic surgeons with screening and supplement management recommendations

March 12, 2012
American Society for Aesthetic Plastic Surgery (ASAPS)

Herbal products, homeopathic medicines and dietary supplements are popular, but many cosmetic surgery patients are not aware that some of these supplements put them at risk for serious bleeding complications during and after surgery. Physicians from Loma Linda University conducted a comprehensive review to identify the herbal supplements, teas, homeopathic medicines and dietary supplements that are most likely to increase the risk and duration of perioperative or postoperative bleeding.

They also provide perioperative recommendations to guide plastic surgeons as they counsel patients around supplement discontinuation prior to and after surgery. "Bleeding Risks of Herbal, Homeopathic, and Dietary Supplements: A Hidden Nightmare for Plastic Surgeons?" appears in the March issue of Aesthetic Surgery Journal.

"It is essential that plastic surgeons be aware of the popular "natural" products that have potentially dangerous bleeding effects. We conducted this review to help surgeons educate, screen and counsel their patients on herbal foods, supplements, teas, and other homeopathic remedies that can compromise patient safety," said lead author Subhas C. Gupta, M.D., Chairman of the Department of Plastic Surgery at Loma Linda University School of Medicine. "Questions surgeons may want to ask their patients include whether the patient is taking any vitamins, herbs or supplements; what vegetables or plant products the patient has been eating in the past month; what types of teas the patient has been drinking recently; and whether the patient has ever taken any herbs or supplements in the past."

The review focuses on 19 herbs, three herbal formulas, two herbal teas, and several other supplements that can preoperatively and postoperatively cause intrinsic bleeding, potentially resulting in serious side effects such as development of hematoma. Some of the most popular herbs and supplements with potentially dangerous bleeding effects include Chinese peony, garlic, ginger, ginko, ginseng, Oil of wintergreen (methyl salicylate), and Saw palmetto (Serenoa repens, Salbalserrulata). The authors strongly recommend that physicians carefully screen patients for supplement use and advise complete cessation of supplements two to three weeks before surgery, as well as postponement of supplement use after surgery.

"Many patients don't disclose their intake of herbs or supplements, and they are often not aware of the risk of complications, which can seriously compromise surgical outcomes and patient safety," said Foad Nahai, M.D., Editor-in-Chief of Aesthetic Surgery Journal. "This review will help plastic surgeons appropriately counsel their patients. It provides an excellent overview of our current knowledge about many popular supplements, recommendations for discussing supplement consumption with patients, and recommendations for managing supplement use in the preoperative and postoperative setting."