Do you recommend taking anything like arnica before upper and lower blepharoplasty?

Hi @alm751. You can start taking arnica pills 2 days prior to surgery. Best of luck to you, Dr. Nima!

While the anecdotal evidence regarding the benefits of arnica is compelling, the clinical evidence is less convincing. However, the supplement is safe for most patients, so there is no real reason not to take it if you think it might help. It is also essential to avoid some medications that can exacerbate bruising, such as ibuprofen, naproxen and aspirin. I encourage you to schedule a consultation with a board-certified plastic surgeon. During this meeting, you can discuss your surgical history including your concerns about bruising. Your surgeon can place you on a pre-surgery protocol to minimize these side effects in anticipation of your procedure.

I perform most of my blepharoplasties in the office setting using local anesthesia. We place cold gauze on the eyes as soon as we finish with that side and then change the gauze regularly for the rest of the procedure. We recommend that patients take arnica and consider arnica gel as well. They are to keep the eyelids cool for the rest of the first day and then sleep with the head elevated. An antihistamine can be taken for any itching. We usually remove the sutures in 3-4 days and let the patient wear makeup at that time. Bruising is usually mild and is gone within a week.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa

Thanks for your question.  Yes, it is very customary to start arnica tablets before surgery and extend them into the postop period.  We usually start bromelain about 3 days prior to surgery and anica, the day of surgery and continue both for 10 days postop.  Arnica gel or cream can also be applied to bruised areas to help resolve bruising. I find that Vitamin C and also Zinc can help with postop healing. Best!

Arnica is helpful for swelling and bruising reduction after facial surgery.  I have not seen the same benefit for body procedures.

Arnica Montana is a homeopathic drug that is claimed to reduce bruising and swelling. Anecdotally, many patients and plastic surgeons feel that Arnica does have a benefit. There are, however, conflicting reports in the valid scientific literature about these claims. Bromelin (Bromelain), another homeopathic medication, is a mixture of enzymes found naturally in the juice and stems of pineapples and also purported to reduce swelling, bruising, inflammation and pain after surgery. This supplement, which is often taken along with Arnica, is also controversial with regard to efficacy. We do have patients take Arnica and Bromelain in our practice.
I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS)  that you trust and are comfortable with. You should discuss your concerns with that surgeon in person. It is critical that he or she should be aware of all medications, supplements, minerals, vitamins, and herbs that you are taking, because they may interfere with normal blood coagulation, healing, and anesthesia.

Robert Singer, MD  FACS

La Jolla, California

We do not recommend it routinely, but it is acceptable to take it. Revision  eyelid surgery procedures tend to swell and bruise less the second time than the first time.

Hi.  Arnica alone or in combination with bromelain is often prescribed prior to surgery.  While bromelain has been shown to be clinically effective, the data around arnica is less convincing.We have found that perioperative supplementation with a product called Vivanta Surgical Recovery System works extremely well and has been clinically proven to reduce pain, swelling and opioid use.  Vivanta has become part of our clinics standard ERAS protocol.

The combination of arnica/bromelain tablets before and after surgery, topical arnica creme for bruising after surgery and a Medrol dospak for after surgery swelling is a broad spectrum approach to lessening the unavoidable swelling and bruising effects after any facial surgery.

Preparation for surgery is important in determining the time taken for the healing process, hence the popularity of Arnica. Although, contrary to popular thought, the evidence from collective studies is that the use of arnica, does not make a difference to bruising and therefor swelling, However, psychologically it may be beneficial as its use gets the patient to consider the healing process ahead of the surgery and be to be actively involved. More important is what you do not take that is contributing to unnecessary bruising! Although considered harmless, aspirin and anti inflammatory medication in particular, which are so commonly used for pain control in headaches and arthritis  must be completely avoided for a minimum of 10 days prior to the surgery. Surgeons usually advise 2 weeks to be on the safe side. Even one tablet taken in this time will result in avoidable bruising. Instead use paracetamol, which does not affect the platelets necessary for blood clotting.Patients are also advised to discontinue all supplements including fish oil, as many of these  thin the blood, meaning greater bruising, just when you expected these to be beneficial. Obviously blood thinner medication prescribed for certain medical conditions have to be discontinued under specialist medical supervision.Compared to surgery performed 10 years ago, you should expect considerably less bruising,  due to refinements in surgical knowledge and applicationYour surgeon would be using a local anaesthetic mixture  containing adrenaline, which is taken advantage of as the adrenaline shrinks the blood vessels (vasoconstriction) . The adrenaline mixture is injected into the tissues, before the surgery is commenced, even when a general anaesthetic is used.                                                                                                                                                                                                                                                                                                                                                                                                   The vasoconstriction process dramatically reduces  the tendency to bleeding during the procedure and therefore bruising afterwards, Over recent years surgeons have better  appreciated the importance of the vasoconstriction and the fact that the process takes time to work. Whereas diligent surgeons would allow 10 minutes for the vasoconstriction, it is now known the process reaches its peak benefit in 30 minutes!  A surgeon who prioritises quick, and therefore inexpensive surgery, is unlikely to wait the time needed for best vasoconstriction.Also significant in reducing bleeding and bruising  is control of the  the patients blood pressure during the procedure. Keeping  the pressure at low normal, ie at a lower than usual with the  systolic at or just below 100mm. makes a major difference. When the surgeon notes the amount of bleeding is more than expected, a new use of the medication, tranexamic acid, given intravenously or directly into the surgical site, dramatically reduces oozing and effectively changes the bruising profile.The fact is, if concern about bruising is inhibiting a person from having the benefit of brighter looking eyes, you should discuss this topic with your intended surgeon. The fact that such bruising did not occur with other facial surgery suggests it was not you, but technique related.