The use of herbals and plastic surgery

By Stephen Daniells

- Last updated on GMT

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Fifty-five per cent of plastic surgery patients take natural
remedies that may lead to post-operative complications, claims a
study, but an industry expert questions the quality of the

More worryingly perhaps is that the plastic surgeons themselves only knew 54 per cent of the herbs by name, and could identify side effects for only ten per cent of them, prompting calls to educate physicians about a market that is worth about $40 billion annually in the US.

The study, published in the journal Plastic and Reconstructive Surgery​ (Vol. 117, pp.436-445), surveyed 100 patients and 100 members of the general public about their use of herbal remedies.

The researchers found that 55 per cent of patients were taking herbal remedies or supplements, with all of these people taking at least two remedies regularly.

The most popular supplements taken were chondroitin (18 per cent), ephedra (18 per cent), Echinacea (14 per cent), and glucosamine (10 per cent).

It should be noted that although the authors class chondroitin and glucosamine as 'herbals' neither is actually from an 'herb'. Chondroitin sulfate is extracted from animal cartilage like shark cartilage, while glucosamine is extracted from the shell of crabs, lobster and shrimps.

According to the authors, in some circumstance there may be complications related to the use of these supplements. For example, some claim a link between chondroitin and bleeding complications during surgery, ephedra and heart attacks, echinacea and suppression of the immune system and infections, and glucosamine and hypoglycemia.

However, knowledge of these potential side effects was not shared by the plastic surgeons.

"For 90 per cent of the herbal remedies listed, side effect profiles were not known, yet physicians admitted that they did not recommend stopping 85 per cent of herbal medications preoperatively or in the perioperative period,"​ wrote lead author Justin Heller, from UCLA.

Responding to the study, Dr Daniel Fabricant, vice president of scientific affairs for the National Nutritional Foods Association (NNFA), told​: "This is not a quality study. The authors talk about problems with glucosamine and chondroitin, for example, but do not cite a single case report of problems caused by this on an operating table."

"We fully support safe use and full disclosure of herbal supplements, but the physicians have to realize that the supplements industry is not going to go away, so it is up to the physicians to educate themselves in this field, to quiz their patients more thoroughly and so be better able to advise and treat their patients,"​ said Fabricant.

According to the American Society of Plastic Surgeons the total number of procedures in the US has increased from 13,600,000 in 2000 to 14,800,000 in 2004, an increase of nine per cent.

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