Research: HELLER and co-workers,

Listed in Issue 138


HELLER and co-workers, Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California 90069, USA, have compiled a top-ten list of Herbal medicines and Supplements used by patients presenting for cosmetic surgery.


Widespread use of herbal medications/supplements among the population may have a negative effect on perioperative patient care. The aim of this study was to identify the prevalence of such use in a cosmetic surgery patient population compared with use among the general public; to assess physician awareness of proper management of these herbal medications/supplements; and to review the literature to provide rational strategies for managing perioperative patients taking these remedies.


To assess patient (n = 100) and general public (n = 100) usage rates, open-ended lists of (1) the most common herbal medications/supplements and (2) homeopathic treatments were compiled. 20 plastic surgeons were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects.


The usage rate for cosmetic versus public surveys for Herbal Medicines/Supplements was 55% versus 24% (p < 0.001), with 35% versus 8% (p < 0.001) using Homeopathic preparations. Cosmetic patients’ top four herbal/supplements of usage were chondroitin (18%), ephedra (18%), echinacea (14%), and glucosamine (10%). The top four used by the general public were Echinacea (8%), garlic (6%), ginseng (4%), and ginger (4%). The physician survey demonstrated awareness of 54% of the listed Supplements/Herbal medicines, 85% of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100% discontinuation preoperatively.


Herbal medicines and supplements displayed greater prevalence in the cosmetic surgery population than in the population at large. Furthermore, side effects and potential complications warrant addressing these remedies as pharmaceuticals rather than as safe and ‘natural’. Thus, a descriptive “top-10” list with perioperative recommendations was compiled for the plastic surgeon.


Heller J, Gabbay JS, Ghadjar K, Jourabchi M, O’Hara C, Heller M, Bradley JP. Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know.  Plastic & Reconstructive Surgery 117 (2): 436-445, Feb 2006.

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