Virginia Center for Plastic Surgery

Herbal medicines are medicinal products that contain plant materials as their pharmacologically active components. Herbal sales in the United States exceed $5 billion annually. Many herbal remedies possess significant pharmacological activity and, consequently, potential adverse effects and drug interactions.

This is an area of medicine that physicians have traditionally received little education and therefore have given little attention. Perhaps in response to that, up to 70% of patients do not reveal their use of herbal medicines to their physicians and pharmacists. You can improve your chances for an optimal outcome by communicating your usage of these medications with the Virginia Center for Plastic Surgery.

You should know that the US Food and Drug Administration has not evaluated products labeled as supplements and that no guarantee of product quality could be made. For most herbal medicines, the specific ingredients that determine the pharmacological activity of the product are poorly characterized. All extracts are not the same, and commercially available extracts vary greatly in their quality and potency. We recommend that you stop all herbal supplements 14 days prior to any surgical procedure.


Bleeding: All surgery carries some risk of problems with bleeding. The following common herbal remedies may increase the risk of bleeding during surgical procedures: feverfew, garlic, ginger, St. John’s Wort, ginkgo, and Asian ginseng.


Photsensitivity: St John's wort poses a risk of photosensitivity reaction attributed to its hypericin component. Thus, this should not be used in conjunction with retinoids like Renova. Concomitant use with other photosensitizing agents, such as tetracycline hydrochloride, fluoroquinolones, and sulfonamides, should also be avoided. Angelica root and fruit, celery, dill, fennel, agrimony, bergamot peel and others may also increase photosensitivity.

Surgery: The interaction of herbal medicines with anesthetic medicines is now only partially understood. Ephedra is one agent well documented to increase blood pressure and heart rate. There have been over 1,000 reported adverse reactions related to the use of ephedra and anesthesia. Stress from surgery normally tends to lower blood sugar to some degree (hypoglycemia). Ginseng can further lower blood sugar to a dangerous level. Kava and valerian can interact with many anesthetics to unpredictably increase the sedation effects of the anesthesia medications. St. John’s Wort can increase metabolism of many drugs used in the perioperative period, thus decreasing the effectiveness of the anesthesia medications.

Skin Care: Numerous herbal medicines may profoundly affect the skin and thereby adversely interact with efforts to improve skin quality through resurfacing techniques. Kava (Piper methysticum) preparations are used as natural anxiolytics and can result in classic skin problems that include reddened eyes, scaly skin eruptions, and yellowish discoloration of the skin, hair, and nails.

Phytoestrogens may potentiate or antagonize estrogen effects. Among the more commonly used phytoestrogen-containing herbs are dong quai (Angelica sinensis), red clover (Trifolium pratense), alfalfa (Medicago sativa var italica), licorice (Glycyrrhiza glabra), and black cohosh. These compounds may contribute to changes in skin pigmentation following resurfacing procedures such as laser resurfacing or chemical peel resurfacing. Other estrogenic implications should be discussed with your primary care physician.

Wound Healing: Several herbal medicines, such as aloe vera gel, contain pharmacologically active ingredients that may aid in wound healing.

Comfrey should be avoided in wound healing because of the herb's constituent pyrrolizidine alkaloids, which have shown hepatotoxic, carcinogenic, and mutagenic properties in rats.

In vitro studies have demonstrated anti-inflammatory and antimicrobial effects attributable to arnica's helenalin component. However, the claim that homeopathic arnica is efficacious beyond a placebo effect is not supported by rigorous clinical trials. Despite this, we frequently recommend the use of homeopathic arnica supplements as there is good anectdotal evidence of its efficacy.

Numerous botanical remedies formulated as essential oils have been shown to have antimicrobial and anesthetic effects, including tea tree oil (Melaleuca alternifolia), peppermint oil (Mentha piperita), and various conifer-derived oils. Aloe vera (Aloe vera) gel is very commonly used.