Is it safe to take anti-bruising supplements prior to surgery?

Question

I am getting lower blepharoplasty done and wanted to mitigate the bruising as much as possible. Can I take arnica or bromelain (or both) tablets prior to having surgery done and would that prevent bruising better than just taking it post surgery?

Jonathan Kulbersh, MD · Answer

Reviews tend to be mixed on whether these supplements actually do reduce bruising, but they certainly can’t hurt. There is no reason not to start taking them before your surgery - in fact, some surgeons recommend it as a part of their pre-op protocol. At the same time, make sure you avoid medications and supplements that might increase bleeding and subsequent bruising, such as aspirin, nonsteroidal anti-inflammatories like Advil, and blood thinners.

Nima Shemirani, MD · Answer

Hi @siwo! I recommend starting Arnica pills two days prior to surgery and continuing until completion of the bottle. Best of luck, Dr. Nima!

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. Yes, it is probably safe to take these supplements. It is not clear if there is any true benefit though. It is more important to choose an experienced eyelid surgeon to perform your treatment. Good luck!

Richard Karoo, FRCS(Plast) · Answer

This is a very interesting question, some patients are convinced Arnica helps and personally do not believe there is any harm caused by taking these supplements orally however, objectively, it is extremely difficult to create a controlled trial inducing an identical surgical event on two separate occasions one with and the other without arnica.....
Hence the research papers differ in opinion. (see below)
Whats most important is to avoid medication or herbal supplements which we know can Increase the risks of bleeding. It's important to let your Plastic Surgeon know about all supplements taken as well as prescription medications as this can have a dramatic effect on your outcome. 
Hope this was of some help, best wishes

ref:
Perioperative Homeopathic Arnica and Bromelain: Current Results and Future Directions.
Ann Plast Surg. 2020 Mar;84(3):e10-e15
vs
Is There a Role for Arnica and Bromelain in Prevention of Post-Procedure Ecchymosis or Edema? A Systematic Review of the Literature.
Dermatol Surg. 2016 Apr;42(4):445-63

Kenneth D. Steinsapir, MD · Answer

Arnica is ineffective at reducing bruising. Since the food supplement business is so poorly regulated, you sometime get exposed to products that actually increase your risk of bruising. In particular Bromelain is not intended to reduce bruising. It is touted to reduce swelling. The effect is unsubstantiated. What is clear is that the pineapple in the bromelain will actually inhibit your platelets and increase bruising. That bruising will harm your surgical outcome. Don't do this to yourself.

James Shire, MD · Answer

This question is for your surgeon. Every doctor has their own protocol. In my practice, all patients must be off of anything that prevents or interferes with blood clotting, such as aspirin, anti-inflammatories (ibuprofen or NSAID), Vitamin E, Fish Oil, many herbal supplements and even alcohol for at least 14-21 days prior to surgery. This will decrease the risk of bleeding and dramatically reduce post-op bruising. Arnica and bromelain have more of a placebo effect and the effectiveness to limit bruising is limited at best. The surgeons techniques and how they handle the tissues is probably the most important factor.

Matthew Bridges, MD, FACS · Answer

We use these routinely for surgery, but anything like this should not be taken unless approved by your surgeon.  Don't take medical advice from strangers in the internet.  Talk to your doctor.

Philip S. Schoenfeld, MD, FACS · Answer

I am a big fan of both Bromelain and Arnica prior to surgery.  All of my patients are placed on this pre operative and post operative regimen and I have been quite pleased with the effects for the past 20 years.

William Portuese, MD · Answer

In our practice, we do not recommend taking  anti-bruising supplements since they are a little to no benefit.  More importantly is tobe off any aspirin, herbal supplements, and any other medication that increases bleeding time

Robert T. Buchanan, MD (retired) · Answer

Not only is it safe to use Bromalain and Arnica before and after surgery, we give it to all our patients before their surgery to reduce their bruising and speed resorption of what does occur.