There is an interesting article in the March issue of the Aesthetic Surgery Journal (www.aestheticsurgeryjournal.com) from Drs. Wong, Gabriel, Maxwell, and Gupta of Loma Linda University in California. This review article which was titled: Bleeding Risks of Herbal, Homeopathic, and Dietary Supplements: A Hidden Nightmare for Plastic Surgeons? (Aesthetic Surgery Journal 32:332-348)

 

Soon after I moved into my current office, I took care of the mother of one of the nurses that I work with at the New York Presbyterian Hospital. This woman desired a facelift and during her consultation her daughter and I both reviewed all her medications. We made sure that she stopped all the common medications that are known to cause bleeding during surgery. Just before we were scheduled to do her facelift, she developed a pigmented lesion on her leg about which we were all concerned and a decision was made to biopsy this lesion before the facelift.

 

During the removal of this lesion (which fortunately turned out to be benign), we encountered an inordinate amount of bleeding. The patient insisted she had stopped all the medications which are known to interfere with normal blood clotting and I insisted on a hematology consult.  The blood tests ordered by the hematologist turned out to be abnormal. We went over all her medications again and could not find anything to account for this abnormality. The patient finally added as an aside that she also took garlic supplements.

 

Garlic supplements are known to cause bleeding and once stopped in this patient, her blood tests all reverted to normal. The next month we performed her facelift without, fortunately, any bleeding problems. The patient was very happy with her result and I was very happy that we had stopped her garlic supplements.

 

The authors of the above mentioned article divided these alternatives and “natural” remedies into 3 categories: Herbal supplements and herbal extracts, herbal teas, and homeopathic medicines and other dietary supplements. Some of the more popular of the herbal medications covered in this article included bromelain, garlic, Ginger, ginkgo, ginseng, licorice, read chili pepper, and saw palmetto. The herbal teas were seasonal tonic and te gastronol. The homeopathic medicines included: chondroitin, glucosamine, fish oil, Arnica Montana, and vitamin E. All of these agents as well as those not listed here are known to increase the risk of bleeding and hematoma both pre-and postoperatively.

 

The authors stress the importance of careful screening of patient’s for all these medications and recommend stopping them as long as 3 weeks prior to any surgical procedure and not resuming them for the equal than time afterwards.  Thus, it is extremely important that you inform your doctor of everything you are taking including all prescription medications, vitamins, herbal medications, herbal teas, and homeopathic medicines. Failure to do so, may result in many complications both during the surgery and afterwards.