What supplements should I stop before cosmetic surgery?
⚠️ Contact your surgeon right away if:
You notice unusual bruising, prolonged bleeding from a small cut, or swelling after starting or stopping any supplement close to your surgery date. If you experience heavy bleeding that does not stop, chest pain, or difficulty breathing after your procedure, call emergency services (911) immediately.
Short answer
Several herbal supplements and vitamins can affect bleeding, anesthesia, and healing around the time of surgery. Telling your surgeon about every supplement you take is the most important step, ideally at least two weeks before your procedure. The evidence on exactly which ones to stop is based mostly on case reports and expert review rather than large clinical trials.
What the research shows
A practical review written specifically for plastic surgery patients found that many commonly used herbal supplements can cause problems in the perioperative period, including increased bleeding, interactions with anesthesia medications, and effects on wound healing. [5] The review covers supplements such as garlic, ginkgo, ginseng, St. John's Wort, vitamin E, and others, noting that most of what is known comes from case reports rather than rigorous clinical trials. [5]
Interestingly, fish oil is one supplement where better evidence exists. A large randomized controlled trial of over 1,500 patients found that fish oil did not increase perioperative bleeding and actually reduced the need for blood transfusions. [3] This challenges older routine advice to stop fish oil before all surgeries, though that guidance came from cardiac surgery patients and may not apply to every cosmetic procedure.
On the other hand, some supplements may be helpful before surgery. Preoperative nutritional supplements (proteins and immune-supporting nutrients) were associated with a roughly 50% reduction in surgical site infections in a meta-analysis of elective surgery patients. [1] Iron supplementation before surgery has also been shown to improve hemoglobin levels and reduce the need for blood transfusions. [7]
Supplements most often flagged as concerns
Based on the plastic surgery literature, the supplements most commonly discussed as potential risks before cosmetic procedures include: [5]
- Garlic, ginkgo biloba, ginseng: May increase bleeding risk.
- St. John's Wort: Can interfere with anesthesia and other medications.
- High-dose vitamin E: May impair blood clotting.
- Ephedra (ma huang): Can cause dangerous heart rate and blood pressure changes under anesthesia.
- Kava: May prolong the effects of sedation.
The evidence behind these warnings is largely based on case reports and theoretical mechanisms rather than large controlled studies, so the quality of data is limited. [5] Expert consensus for procedures like laser resurfacing also emphasizes careful preoperative assessment as a key part of patient safety. [2]
What this means for you
The most important action you can take is to give your surgeon a complete list of every supplement, vitamin, and herbal product you use, including ones that seem harmless or "natural." Most surgeons recommend stopping flagged supplements at least two weeks before elective surgery. [5]
Do not stop any supplement without checking with your surgical team first. Some, like iron or nutritional protein supplements, may actually be encouraged before surgery to support healing and reduce other risks. [1] [7] Your surgeon will guide you on what to continue, what to pause, and when it is safe to restart.
Caveats
Much of the specific guidance on herbal supplements and surgery is based on case reports and expert opinion rather than randomized trials, so the evidence grade for this topic is low. [5] Recommendations may also differ depending on the type of cosmetic procedure you are having. This page provides general education only. Always follow the specific instructions your own surgical team gives you.