Many patients have a don???t ask-don???t tell philosophy when it comes to disclosing the herbal supplements they take, but surgeons and anesthesia providers should be concerned because many herbs can cause complications when taken before surgery, says David J. Rowe, MD, an assistant professor of plastic surgery at University Hospitals Case Medical Center in Lyndhurst, Ohio.

St. John???s wort, for example, induces photosensitivity, which can become an issue if a patient is undergoing a procedure in which a laser or intense pulsed light will be used. Ginkgo biloba and garlic have blood-thinning properties that can cause excessive bleeding, which is a concern with facelifts. "It???s like having a patient who has taken a lot of aspirin," says Dr. Rowe, co-author of an article on the perioperative risks and benefits of herbal supplements published in the March/April issue of Aesthetic Surgery Journal.

Between 40 percent and 70 percent of patients don???t tell their doctors about herbal supplements and other remedies they???re taking, according to data cited in the article. In one survey cited, nearly 43 percent of patients took alternative medicine in the 2 weeks before surgery. Getting patients to stop herbal supplements 2 weeks before surgery can head off potential problems.

Patients often don???t tell their physicians about herbal supplements because they believe doctors won???t approve or don???t understand complementary medicine. Dr. Rowe says it???s important for surgeons and other healthcare providers to let patients know they???re aware of the popular herbal supplements and ask if patients are taking anything as soon as surgery is scheduled. If you avoid the subject, patients will notice, says Dr. Rowe. "If you have puddles of blood after a facelift, you aren???t going to be happy."

—Kent Steinriede