Over the past 5 years, the number of people seeking nonsurgical cosmetic procedures has increased by 44% (American Society of Aesthetic Plastic Surgery, 2015). Patient-provider communication is essential when taking a heath history because patients may present with a personal history of medications or medical conditions that have the capacity to negatively influence their nonsurgical cosmetic outcomes (De Boulle & Heydenrych, 2015). Health care providers also need to be aware of the various herbal substances that their patients may be taking on a daily basis (Ismail, 2009). Obtaining a complete health history, which includes prescription and herbal drugs/spices prior to treatment, becomes essential for ensuring patient safety and satisfaction (Hussain, 2011). Although herbs/spices also have the capacity to affect surgical outcomes, this article focuses solely on the potential negative effects of herbs/spices on nonsurgical cosmetic procedures.

BACKGROUND

Over the last few years, there has been an overwhelming increase of herbal consumption noted in the United States (Pradhan & Pradhan, 2011, p. 334). Yet, only a very small percentage of patients have been shown to initiate conversations with their health care providers regarding their herbal usage (Kennedy, Wang, & Wu, 2008). As defined by Merriam-Webster Dictionary (n.d.-a), "An herb is a plant or plant part valued for its medicinal, savory, or aromatic qualities," whereas a spice is defined as "a seasoning (as pepper or nutmeg) that comes from a dried plant part and that is usually a powder or seed" (Merriam-Webster Dictionary, n.d.-b). Because the Food and Drug Administration does not regulate herbs by the same standards used to evaluate prescription medications, and herbs can interact with medications and affect body functions, it becomes just as important for health care providers to be aware of the herbs their patients may be taking on a daily basis (Anastasi, Chang, & Capili, 2011).

Herbal agents alone or in combination with certain medications may have the ability to affect the efficacy of nonsurgical cosmetic outcomes, thus underscoring the need for clinicians to educate their patients prior to treatment (Emer & Waldorf, 2011). Many patients have been shown to mix their prescription and herbal medications together without truly understanding how this can result in complications (Hussain, 2011).

HERBAL SUPPLEMENTS/SPICES

Salicylates and Coumarin

There are many herbs and/or spices that contain substances such as salicylates and coumarin that prevent or inhibit the formation of blood clots. Salicylates (Table 1) not only are found in medications but are also incorporated into certain spices, foods, and beverages (Waldron & Moll, 2013, p. 5). In addition, there are a number of herbs that contain coumarin, which has anticoagulant properties (Waldron & Moll, 2013, p. 6). Again, the importance of clinicians taking a thorough patient health history cannot be emphasized enough, as ingesting certain herbs/spices prior to treatment may affect nonsurgical cosmetic outcomes (Brennan, 2014). In addition, consumption of herbs/spices in combination with certain medications may contribute to increased risk of excessive bleeding and bruising (Waldron & Moll, 2013).

TABLE 1 Spices Containing Salicylates

As a result, knowledge of spices that contain natural salicylates becomes invaluable by providing clinicians significant information to make appropriate decisions during their patient selections and treatments.

There are a number of herbal supplements that have been found to contain coumarin (Table 2). As discussed by Waldron and Moll (2013), "Since natural coumarins have anticoagulant properties, caution may be warranted by persons taking prescription anticoagulants to avoid excessive bleeding risk" (p. 6). For these reasons, it is once again important for a health care provider to be aware of these potential blood thinners so that patients may be properly prepared for their nonsurgical cosmetic procedures by educating them on the potential consequences of ingesting certain medications, herbs, and spices.

TABLE 2 Herbal Supplements Containing Coumarin

Evidence has shown that there are a number of herbs and spices that may affect platelets, thus potentially promoting bleeding and/or bruising (Table 3; Nutescu et al., 2006). Moreover, because many people think that all herbs are safe and natural (Hussain, 2011), it is possible that they may be mixing certain medications with herbs and creating an opportunity for their body to bruise or bleed more than normal if they were to have any nonsurgical cosmetic treatments (Nutescu et al., 2006; Samuels, 2005).

TABLE 3 Herbal Supplements That May Affect Platelets and Coagulation

Anecdotally, many patients that I have interviewed during their first office visit acknowledged taking one or all of these mentioned herbs and/or spices: fish oils, the three G's: garlic, ginkgo, and ginger, onion, and turmeric, with a small percentage also taking blood thinners. Knowing this type of information prior to an actual treatment enabled me to properly educate those patients regarding possible negative outcomes from the herbs/spices being consumed, potential increased bleeding and bruising, in addition to providing them with realistic expectations. Although a patient taking blood thinners, herbs, spices, or a combination of all three may be injected, depending on age, diet, exercise schedule, skin thickness, turgor, and skin elasticity, a clinician might decide that some patients are not desirable candidates for nonsurgical cosmetic treatments at their initial office visit (Brennan, 2014; Samuels, 2005).

PRACTICE TIPS FOR CLINICIANS

All patients should be given a thorough, good faith, or appropriate examination. This verbal examination will provide clinicians with in-depth health history information so they may determine whether this potential patient is a good candidate to receive any nonsurgical cosmetic treatments on the same day as his or her initial consult. This examination should be performed by the MD or advanced practice registered nurse prior to treatment. In addition, all returning patients should be questioned whether anything in their medical history has changed since their last visit.

Upon questioning, if patients acknowledge that they have been taking a number of herbs/spices on a daily basis that their health care provider believes might negatively affect the procedures outcome, the patients should be given the opportunity to decide if they want to proceed knowing that their chances of bleeding and/or bruising may significantly increase. There are varied articles addressing how many days prior to treatment a patient should stop his or her herbal/spice intake to achieve the best nonsurgical cosmetic outcomes. Evidence has suggested anywhere from right before and after the treatment (Brennan, 2014) to 1 week prior to any treatment (Anastasi et al., 2011).

CONCLUSION

The number of people taking herbs/spices continues to increase (Hussain, 2011). As reflected in the literature, many individuals consuming these products are not aware of their potency or potential effects (Ismail, 2009). Also, many are mixing their herbs with medications unaware of how these interactions might affect their health (Hussain, 2011). This article has attempted to present the importance of including herb/spice intake in patients' health histories, knowing about these products and how they may impact the results of a nonsurgical cosmetic procedure, and the importance of educating patients about their herbal/spice regimens to maximize outcomes.

REFERENCES