The Implications of Herbal Medications on Plastic Surgery

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A majority of otherwise healthy individuals currently are regularly taking herbal medications. This may be with multivitamins and or the usual heart or blood pressure etc medications. I myself regularly take glucoseamine and multivitamins. Although many associate these herbs with being more natural with less side effects than pharmaceutically manufactured prescription medications that is not actually true. Especially in the high doses frequently taken these herbs can thin the blood preventing clotting, prevent healing after surgery, have dangerous interactions with medications given at surgery etc. I have personally had to cancel surgery in the middle of an operation because of bleeding that could not be stopped because the patient took goldenseal or high doses of vitamin E within a few days of surgery without telling me. Vitamin E especially in high doses dramatically thins the blood.

Here is a list of commonly used herbal medications and their associated problems:

Free Fat Grafting

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Grafts of small pieces of fat removed from one area of the body and placed in another area was first attempted in the late 1800s and early 1900s. These were used as padding between 2 surfaces in the body, plugs to stop bleeding, to fill out indented areas for cosmetic reasons, etc. The main difficulty was getting the fat to survive as larger blobs of fat would die before any blood vessels could grow into them. More than half of the implanted fat would disappear so early proponents of this would put more fat in place than they needed. That way they would end up with the right amount of fat after blood vessels finished growing into the fat and no more fat would die. In order to make the fat easier to work with (structurally more durable) and add some bulk to the graft a thin layer of deep skin layers were left attached to the fat grafts. These are called dermal fat grafts. Unfortunately this does not make more of the graft survive. Also those grafted tissues that do not survive tend to turn into scar tissue that may be seen and/or felt leading to a poor cosmetic result.

Liposuction and its variants tumescent liposuction, superficial liposuction, smartlipo, power assisted liposuction, microliposculpture, smartlipo

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Liposuction and all its variants tumescent liposuction, large volume liposuction, superficial liposuction, smartlipo, slimlipo, power assisted liposuction, microliposculpture, ultrasound assisted liposuction, superwet liposuction, xerona, Syringe-Assisted Liposuction, liposuction using a laser, water jet assisted liposuction.

Liposuction was first introduced in France in 1977. The technique involved the injection of diluted salt water to break the fat cells followed by stab incisions in less noticeable areas such as the belly button through which hollow metal tubes were inserted to suck out fat under general anesthesia. This was later referred to as dry liposuction because so little fluid was injected. This was temporarily modified in the early 1980s using metal tubes with recessed blades to cut the fat. This did not last as blood vessels and nerves were damaged in the process. The use of the dry technique with either type of metal tube was associated with a high percentage of blood coming out of the tube. This limited the amount of fat that could safely be removed at one time.

Skin Cancer

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Skin cancer is a condition of uncontrolled growth of cells in one or more layers of the skin. It is the most common form of cancer in the United States. They are so common that almost everyone will have some form of skin cancer sometime during the course of their life. The younger the age at which the first one is identified the greater the risk that you will have multiple skin cancers over the course of your life. The primary cause is prolonged and/or intermittent overexposure to ultraviolet radiation from the sun. Therefore most of these skin cancers appear on parts of the body unprotected from/exposed to the sun such as the face or nose. Infrequently the cause is exposure to x-rays or chemicals like arsenic which is found in pesticides. The best way to avoid these conditions is to minimize sun exposure by the use of sunscreen and appropriate clothing.

Suntanning, Tanning, Sunscreens

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During the Victorian era pasty white skin color was in vogue. Tanned bronze skin was popularized by fashion designer Coco Chanel in the 1920s. During World War II troops stationed in the south Pacific suffered from sun exposure and were then issued white skin cream (zinc oxide) for protection from the sun. These early sunscreens were heavy, greasy and opaque (easily visible after application). They also stained clothing. In the 1970s the FDA began to approve specific substances for use by manufacturers in sunscreens. These can be divided into 2 groups:
1-chemical sunscreens that react with sunlight converting it into heat to decrease damage (benzophenone, homosalate, methyl anthranilate, octyl methoxycinnamate, oxybenzone, avobenzone)
2-physical sunscreens that reflect the sunlight (zinc oxide, titanium dioxide, kaolin, ichthammol, iron oxide).

The physical sunscreens are more chemically stable and have less risk of causing skin contact sensitivity.

Mesotherapy, Lipo-Dissolve, or Injection Lipolysis, Lipozap, Kybella

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Mesotherapy involves the injection of medications under the skin. It has been widely used in Europe for years to treat cellulite, psoriasis or spot reduce fat, amid unsubstantiated claims. One subset of this treatment modality is injection lipolysis where a mixture of phosphatidylcholine(lecithin), isoproterenol, deoxycholate, blood vessel dilators, nonsteroidal anti-inflammatory agents, enzymes (such as collagenase or hyaluronidase), aminophylline, caffeine, L-carnitine, buflomedil, calcitonin, vitamins, minerals and hormones in varying combinations are injected into the fat layer under the skin to destroy fat cells. Some of these medications stimulate fat cells to break apart fat molecules contained in the cells. However fat cells in some areas like the thighs and hips are more resistant to this stimulation. The true mechanism of action of some of the medications remains unknown. Multiple injections are made into the treated area per session and sessions are performed a few weeks apart. Some or all of the injected medications are frequently not FDA approved for injection.

Facial Implants - cheeks, chin, jaw

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Breast implants at least in the US come in only 2 forms, a silicone (plastic like shell) containing either salt water or silicone gel (a mollases or jello thick substance). Facial implants for bone augmentation come in greater variety of materials - silicone, goretex and porex medpor. The first 2 do not develop tissue ingrowth by surrounding tissue, thus they are easier to remove at a future date should the need arise. However they can also shift in position at any future date since there is little or no ingrown tissue to keep them in place. Porex Medpor does develop tissue ingrowth or incorporation thus the potential for shifting or infection are much less at a future date. In the absence of infection porex implants are fixed in position within a few weeks after placement by this ingrowth. Those patients with silicone or goretex need to take antibiotics prior to any dental procedure while porex patients do not. This is because the body does not treat incorporated ingrown implants as foreign bodies.

SKIN INFECTIONS

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Over the last 10 to 20 years there have been increasing changes in the bacteria normally present on the skin surface. They are becoming resistant to antibiotics (methicillin resistant Staph Aureus - MRSA) & this resistance as well as the problems they cause are different than what is seen with bacteria that become resistant from exposure to medications in hospitals. You can think of this as an infection from yourself vs. an infection that comes from someone else or some surface contact (door knobs, tables etc). The flesh eating bacteria that has been mentioned in the media is due to bacteria that produce a chemical that kills tissue at deeper as well as superficial levels. These bacteria may or may not be antibiotic resistant. If caught early enough all are easily treated.