Journal Review

Study identifies top 10 herbals used by patients

Surgeons not aware of potential side effects

Cosmetic surgery patients use herbal and supplemental medicines at a higher rate than the general public, but physicians are not always aware of the use or of the effect of the supplement on perioperative care, according to a recent study published in Plastic and Reconstructive Surgery.1

The study surveyed 100 cosmetic surgery patients, plus 100 randomly selected adults from the same geographic area, to assess use of herbal and supplemental medicines. An additional survey of 20 plastic surgeons was conducted to assess physicians’ awareness of herbal medicines and supplements, knowledge of perioperative complications associated with the medicines, and recommendations they make to discontinue medicines preoperatively.

Of the cosmetic patients, 55% reported using herbal medicines and supplements, with 100% of those patients taking at least two medicines. This group of patients reported taking at least one of their medicines every day. Of the participants in the general population survey, 24% reported using herbal medicines and supplements, with only 33% reporting use two remedies, and only 50% reporting use of at least one herbal medicine every day.

Physicians were aware of 54% of the herbal medicines and supplements identified in their survey, but they only knew of the side effects of one herbal medicine, ephedra. Only 30% of the physicians identified chondroitin, the most frequently used herbal medicine used by patients in the survey, as associated with bleeding. The side effects of other herbal medicines were not correctly identified by any survey participants. Physicians reported that they did not recommend stopping 85% of the herbal medicines listed in the survey preoperatively or perioperatively.

Because the prevalence of herbal medicines and supplements is growing, and information on their side effects is necessary to ensure patient safety, study authors compiled a list of the 10 most frequently used herbal medicines and supplements by cosmetic surgery patients, the most common uses, and potential surgical complications. The herbal medicines/supplements and their potential complications are:

  • chondroitin — surgical bleeding;
  • ephedra — hypertension and cardiac instability with anesthetics;
  • echinacea — potential barbiturate and halothane toxicity, allergic reaction, and immunosuppression;
  • glucosamine – hypoglycemia;
  • ginkgo biloba — postoperative sedation and perioperative bleeding;
  • goldenseal — volume depletion, postoperative sedation, and photosensitization;
  • milk thistle — volume depletion;
  • ginseng — perioperative bleeding;
  • kava — postoperative sedation;
  • garlic — perioperative bleeding.


  1. Heller, JBS, Gabbay, JS, Ghadjar, K, et al. Top-10 list of herbal and supplemental medicines used by cosmetic patients: What the plastic surgeon needs to know. Plast Reconstr Surg 2006; 117:436-445.