Preoperative evaluations before facial cosmetic surgery have found that approximately half of patients are taking herbal and other supplements, reports a study in the July issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

‘It is extremely important to investigate the use of herbal medicines, as many of these supplements can put the surgical patient at risk,’ writes ASPS Member Surgeon Dr Bahman Guyuron and colleagues of Case Western Reserve University, Cleveland. They advise patients to stop taking supplements at least 2 weeks before cosmetic plastic surgery.

The researchers analysed 200 patients undergoing cosmetic facial surgery, such as facelift surgery or rhinoplasty. The patients’ preoperative medication lists were reviewed to determine how many patients were taking herbal supplements and what types they were using. More than 80% of patients were women; the average age was 45 years.

A total of 49% of patients were using at least one type of supplement. Vitamin and mineral supplements only were used by 25% of patients. Animal- and plant-based supplements, most commonly fish oil, in addition to vitamins and minerals were taken by 22% of patients.

Overall, patients reported taking 53 different types of supplements. The average number of supplements was 2.8 per patient, although one patient was taking 28 different supplements.

Many supplements linked to bleeding or other risks

Of those surveyed, 35 patients were taking supplements that have been linked to an increased risk of bleeding, such as bilberry, bromelain, and fish oil. In Dr Guyuron’s practice, patients were advised to stop taking supplements 2 to 3 weeks before surgery.

The researchers write, ‘Therefore, 17.5% of all patients … would have been at risk of bleeding’ if they had not discontinued supplement use.

Dietary supplements are widely used in the United States. Since supplements are not regulated, there is a ‘severe lack’ of data on their safety and effectiveness, according to Dr Guyuron and colleagues. Because patients regard supplements as safe, ‘natural’ products, they may not tell doctors about supplements when asked what medications they are taking.

However, many of these products have side‑effects that could lead to problems in surgical patients. In addition to the supplements potentially related to bleeding risk mentioned above, other popular supplements with potential adverse effects include echinacea, ephedra (ma huang), ginkgo, ginseng, kava, St John’s wort, valerian, feverfew, and ginger.

‘These high risk supplements … are quite commonly used and the surgeon must elicit a complete history in order to avoid the known adverse consequences of supplement use on surgical outcome,’ Dr Guyuron and co-authors write. They emphasise their policy of advising patients to stop taking supplements is consistent with current recommendations for preoperative patient evaluation.