Herbal supplements today are as common, if not more common, than prescription medications for many people. In my Indianapolis plastic surgery practice, most of my cosmetic patients are taking at least one herbal supplement. For most, the concept of using herbal supplements is that they can’t hurt and can only help. And since they don’t need a prescription, it is natural to believe that they don’t really pose any health risks. As such, herbal medications are assumed to be safe.

 A recent report in the March/April issue of Aesthetic Surgery Journal finds that almost half of plastic surgery patients have used herbal supplements in the weeks before their upcoming surgery. Many of these include such ginkgo biloba, ginseng, garlic, echinacea, and valerian root. Most patients don’t know that these supplements can have side effects which are very relevant to surgery including interaction with other medications (anesthetic drugs) and alteration of one’s ability to clot properly. Despite the fact that the dangerous side effects of some herbal supplements have been widely publicized, many patients do not fully appreciate the importance of discontinuing these treatments before surgery. Furthermore, the unregulated manufacturing standards and lack of product regulations for the entire supplement industry can produce herbal supplements whose quality and actual contents vary considerably. Most of the time, nobody really knows what is actually inside those tablets.

As a result, I provide my patients prior to surgery a comprehensive list of supplements that must be avoided in the weeks before and after surgery to minimize potential surgical complications. Stopping certain herbal supplements prior to surgery is just as critical as stopping aspirin, ibuprofen, or plavix. One should stop taking them two weeks before and for one week after any major plastic surgery procedure that requires an anesthetic and is more than just a minor operation.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Prevention of complications after plastic surgery, such as bleeding and slow wound healing, can be aided by proper management of a variety of common medications. As an Indianapolis plastic surgeon, this is the medication to-do-list (and not-to-do) that I provide to each of my patients prior to their surgery.

Medications to avoid two weeks prior to surgery:

Discontinue use of any nicotine products. This includes cigarettes, cigars, nicotine gum, and patches. Nicotine reduces the blood flow to the skin and may impair healing; and quitting smoking drastically improves the body’s response to surgery.

Stop using medications containing aspirin and NSAIDS (non-steroidal anti-inflammatory medications, such as ibuprofen, Alleve, Advil) prior to (and following) surgery. Aspirin and NSAIDS thins the blood and can produce excess bleeding and bruising. Be sure to read the labels of any over the counter remedies you regularly take as many commonly-used medications contain aspirin. (e.g., Alka Seltzer) For the same reason, also avoid Vitamin E supplements and red wine prior to surgery.

Stop all herbal medications before surgery. The most common herbs used are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St. John’s Wort, and Valerian. They may adversely effect anesthetic drugs, prolong bleeding and impair healing after surgery.

Medications to start two weeks prior to surgery:

Begin using an Arnica supplement 7 days prior to surgery and continue for two weeks following surgery. Arnica is a naturopathic remedy that not only helps prevent bruising but also aids in clearing bruising that has occurred faster after surgery. We have both orally-taken Arnica tablets and topical Arnica patches and gel tubes available at my OLOGY Spas for this purpose.

Begin a good multivitamin supplement at least two weeks or more ideally one month, prior to surgery. A normal dose of vitamins and minerals combined with a diet high in protein provides the necessary building blocks for wound healing.

Begin high dose Vitamin C supplements. (2 grams per day) both before and after surgery. This well known vitamin is the key nutrient needed for making collagen after surgery, which is what heals your tissues together. Because Vitamin C is water-soluble, there is no risk of overdosing on it. What is not used by your body will be excreted in your urine.

You might also consider adding Vitamin K to your diet. This fat-soluble vitamin plays an important role in blood clotting and can be found in spinach, broccoli, and kiwi.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

What To Do with Your Herbal Medications for Upcoming Plastic Surgery

The past five years has seen the two societal trends come together…..an increase in the number of elective plastic surgery procedures….and….the availability and daily use of herbal medications. Numerous surgical complications have been implicated from certain herbs. The most common herbs implicated are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St. John’s Wort, and Valerian. They may adversely effect anesthetic drugs, prolong bleeding and impair healing after surgery. As a result, I have admonished my plastic surgery patients to stop taking any of these herbs, as well as aspirin-containing drugs and any nicotine products, two weeks before any plastic surgery procedure.

In a recent December 2007 report in our prestigous journal, Plastic and Reconstructive Surgery, a study out of the Division of Plastic Surgery in University of Missouri in Columbia put some hard scientific scrutiny to the effects of certain herbal medications on the effects of platelet function (bleeding) after surgery. Using human volunteers, the effects five herbal medications compared to aspirin were tested by blood samples after two weeks of taking them. Surprisingly, the herbal medications (Ginkgo biloba, garlic, Asian ginseng, St. John’s Wort, and saw palmetto) did not affect platelet function while aspirin did so dramatically. I give kudos to this group for taking the effort to look at a commonly held perception with some factual evdience.

Does this mean I will no longer pay attention to the herbs my patients are on? No…..as the study did not evaluate Echinacea, Ephedra, Kava, and Valerian on my hit list. Only garlic, St. John’s Wort, and Ginkgo biloba were exonerated. Perhaps they will evaluate these herbs in the future. I will still tell my patients to go off any non-essential (aren’t they all?) herbs two weeks prior to surgery. But I will rest easier knowing that some of them are not harmful to their plastic surgery procedure outcome and, even if the patient only stopped a few days before surgery, will likely not be a problem.

Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis