title: Top-10 list of herbal and supplemental medicines used by cosmetic patients: what the plastic surgeon needs to know.
abstract: BACKGROUND
  Widespread use of herbal medications/supplements among the presurgical population may have a negative effect on perioperative patient care. Thus, the authors' goal 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.
  
  
  METHODS
  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. Board-certified plastic surgeons (n = 20) were then given the same list of herbs/supplements and surveyed on their awareness of these treatments and perioperative side effects.
  
  
  RESULTS
  The usage rate for cosmetic versus public surveys for herbal medicines/supplements was 55 percent versus 24 percent (p < 0.001), with 35 percent versus 8 percent (p < 0.001) engaging in homeopathic practices, respectively. Cosmetic patients' top four herbal/supplements of usage were chondroitin (18 percent), ephedra (18 percent), echinacea (14 percent), and glucosamine (10 percent). The top four used by the general public were echinacea (8 percent), garlic (6 percent), ginseng (4 percent), and ginger (4 percent). The physician survey demonstrated awareness of 54 percent of the listed supplements/herbal medicines, 85 percent of which were not suggested to be discontinued preoperatively, with only ephedra achieving 100 percent physician discontinuation preoperatively.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, California 90069, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Heller
authors.forename: Joubin S
authors.initials: JS
authors.lastname: Gabbay
authors.forename: Kiu
authors.initials: K
authors.lastname: Ghadjar
authors.forename: Mickel
authors.initials: M
authors.lastname: Jourabchi
authors.forename: Catherine
authors.initials: C
authors.lastname: O'Hara
authors.forename: Misha
authors.initials: M
authors.lastname: Heller
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000328:Adult; D002807:Chondroitin; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D004363:Drug Utilization; D004365:Drugs, Chinese Herbal; D029790:Ephedra sinica; D005260:Female; D005737:Garlic; D020441:Ginkgo biloba; D005944:Glucosamine; D006801:Humans; D039321:Hydrastis; D020901:Kava; D008297:Male; D008875:Middle Aged; D020944:Silybum marianum; D005894:Panax; D008517:Phytotherapy / Q000706:statistics & numerical data*; D028321:Plant Preparations; D010946:Plants, Medicinal; D019651:Plastic Surgery Procedures; D013518:Surgery, Plastic; D014632:Valerian; D014810:Vitamin E; D029789:Ephedra
chemical_list: D004365:Drugs, Chinese Herbal; D028321:Plant Preparations; D014810:Vitamin E; C099950:Ephedrae herba; D002807:Chondroitin; D005944:Glucosamine