Dr. Hermine WarrenIt turns out that asking a simple question while taking patients’ histories could prevent unanticipated bleeding and bruising after fillers, neurotoxin injections and more.
That question? It goes beyond asking about medications to inquire about patient use of specific supplements, herbs and spices, according to one expert.
Hermine Warren, D.N.P., A.P.R.N., C.A.N.S., C.N.M., who has practiced in the nonsurgical cosmetic subspecialty since 2004 and recently published an article on the topic, says it’s not only aspirin and prescribed blood thinners that can result in less-than-optimal cosmetic procedure experiences; it’s also certain herbs and spices.
“Whether somebody is going in for a dermal filler injection, a neurotoxin injection, permanent makeup, microneedling, or they’re going in for something more significant, like a surgical treatment…, it’s important to be aware that certain things will affect the integrity of the area that you’re working on,” Dr. Warren says.
While most healthcare providers take a medical history before performing cosmetic procedures, many might not ask about seemingly benign herbs and spices that could impact bleeding and healing, Dr. Warren says.
“… it’s very important to note what herbs and spices might have a blood thinning activity, which could potentiate medications people are on or just be the cause of an environment that would create more bleeding, Doing so, would create an opportunity for providers to intervene and say, prior to your surgery, you should be off this particular herb for at least two weeks. Otherwise, it could create a situation where you may have an amount of increased bleeding and difficulty with the healing process,” Dr. Warren says.
Culprits include:
·      Fish oil
·      Turmeric, if taken daily
·      Ginkgo biloba
·      Garlic
·      Bromaline (pineapple enzyme)
·      Vitamin E
Patients taking considerable amounts of these, who are also on aspirin therapy or blood thinners, could be at significant risk for increased bleeding, which could lead to hematomas, according to Dr. Warren.
Patients often take the supplements, herbs or spices in the name of health, and have no idea that large doses of any one of these could affect the way they bleed and, subsequently, influence their aesthetic outcomes. Dr. Warren says she learned early in her career, the hard way.
“Years ago, I was going to do permanent makeup procedure on a patient. I had done a thorough medical history, which was negative, including questioning her regarding all prescription medications. However I did not ask if she was taking any herbs or spices. I started doing her lip procedure, and she started gushing with blood. I couldn’t even see her lip line. I naturally stopped the procedure to assess what was going on. I stopped the bleeding and re-questioned the patient regarding intake of any meds. I suddenly thought to ask her if she was on any fish oils; as she was a trainer. And she said, oh yes, I take six to eight [fish oil supplements] a day,” Dr. Warren says. “Had I included questioning her regarding all medications and herbs/spices in her initial intake prior to her treatment, I would never have started the procedure that day. I would have counseled the patient to go off of her fish oils for at least two weeks so that her chances of increased bleeding would be decreased.”
