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Supplements in the perioperative period around and just after surgery can increase the risk for hypertension as well as excess bleeding. Many patients fail to notify their surgeons that they are taking supplements as they don’t consider them as medication and often are unaware of the side-effects they may cause. Arnica montana has arguably been recommended just prior to surgery and then for a few days after surgery. Unfortunately, Arnica montana can also increase blood pressure, which can lead to increased bleeding problems. Bromelain, another supplement, has been recommended to speed bruising resolution, but it can also increase the risk of bleeding. Bleeding during eyelid and facial surgery can lead to more swelling, postop bruising, infection risk, and potential for hematoma (localized blood clot) formation. Once a hematoma occurs it can either be watched as most will resolve on their own or if large and causing problems can required reopening the surgical site, which is a second operation and carries more risks than the original surgery.

Many popular supplements that can increase bleeding can include but is not limited to: omega oils (fish oils); garlic; gingko; vitamin E; flax seed/oil; St John’s wort; glucosamine; and others. Some of these supplements seem to take weeks to clear out in terms of their effect on bleeding. Daily alcohol consumption also can increase bleeding risks as well.

In summary, Dr. Burroughs advises all patients to stop all non-essential prescribed medications and supplements prior to surgery by up to a few weeks to ensure a safer surgery with fewer bleeding related complications. Severe orbital bleeding from eyelid surgery has been reported to rarely cause blindness. Prescribed blood thinners (e.g., aspirin, coumadin and alternatives; plavix etc) should only be stopped by the recommendation of the prescribing primary physician or cardiologist.