Most healthy patients who undergo elective surgery do not need to add any additional supplements to promote healing after a surgical procedure. Certain medications are prescribed during your recovery, and they should taken according to instructions without risking drug interactions or bleeding problems associated with many over the counter and herbal supplements. Keep things simple and uncomplicated. Here is some advice regarding vitamins and supplements that may optimize healing:
First of all, good nutrition is necessary for healing, both before and after your procedure. Patients should take a daily multivitamin, which provides the recommended daily allowance of vitamins and minerals.
Iron-deficiency anemia is a common nutritional problem in the United States. In our patient population, we see women with heavy menstrual periods, or patients with a history of gastric bypass and massive weight loss, being anemic. It is much less common in postmenopausal women. In general, your multivitamin will supply adequate iron to reverse iron deficiency anemia. Individuals with documented anemia should take iron supplements when prescribed by your primary care physician. Otherwise do not take supplemental iron because of the greater risk of iron overload.
Vitamin C is needed to make collagen. It is also an antioxidant and strengthens the connective tissue in skin, muscle, and blood vessels. Normal daily recommendation is 60 mg/day and is present in a multivitamin. Certain populations are more likely to be deficient in vitamin C, to include the elderly, alcoholics, drug abusers and people who are malnourished. Humans lack the ability to store vitamin C, so it is important to continually replenish this vitamin through dietary means or by supplementation. Though it is appropriate to prescribe vitamin C for patients deficient in this vitamin, some practitioners feel it is important to give large doses to non-deficient individuals for optimal wound healing. One study recommended supplementing 1-2 grams (1,000-2,000 mg) daily from wound onset until the healing is complete. The metabolic requirement of vitamin C for collagen synthesis during wound healing makes this important even for those who are not deficient in vitamin C. So I would recommend a daily vitamin C supplement as you are healing from your surgical procedure, as there is no danger or risk associated with a daily dose of 1000 mg per day in addition to your prescribed medications.
Vitamin A is required for skin healing and collagen production. It enhances the early inflammatory response and increases the tensile strength of the healed wound. Vitamin A supplementation has been shown to reduce the inhibitory effects of corticosteroids. The recommended daily intake for vitamin A is 3000 IU and is present in a multivitamin. This amount is sufficient for healthy patients undergoing elective surgery. In those individuals with a history of recent oral steroid usage, high doses of 15,000 international units per day for one week are recommended to help with wound healing and to counteract the anti-inflammatory effects of the steroids.
Zinc helps maintain the integrity of skin and mucosal membranes. Healthy individuals receive all the Zinc they need from their diet and do not need to supplement. As a matter of fact, Zinc supplementation in individuals without a deficiency does not improve wound healing and risks zinc toxicity causing gastrointestinal problems, impaired immunity, and delayed wound healing. So a healthy diet, in combination with a multivitamin is sufficient. Whole grains and milk products are good sources of zinc. Many ready-to-eat breakfast cereals are fortified with zinc. Oysters, red meat, and poultry are excellent sources of zinc. Baked beans, chickpeas, and nuts (such as cashews and almonds) also contain zinc.
Nutrient deficiencies impact all aspects of wound healing, as we’ve seen. Protein and protein-calorie malnutrition result in decreased synthesis of protein and cell production, reduced immune function, and delayed progression of all phases of wound healing. Vitamin and mineral deficiencies impair tissue synthesis, energy production, oxygen transportation, immune function, and all phases of wound healing.
For more information on what constitutes a healthy diet, visit http://www.cnpp.usda.gov/dietaryguidelines.htm
With the increased prevalence of gastric bypass surgery for obesity, we have many massive weight loss patients presenting to our office for body contouring. These patients are a high risk for nutritional deficiencies. We recommend that all massive weight loss patients are evaluated with a comprehensive medical examination and bloodwork, and have all nutritional deficiencies corrected, prior to undergoing cosmetic surgery.
Antibiotics are indispensable to modern health care and are prophylactically prescribed for our cosmetic surgery patients. They are especially important in patients receiving breast implants or patients who will have drainage tubes for a short time after surgery. Unfortunately, they are not without side effects. Antibiotics wipe out your body’s good bacteria, they cause yeast infections and diarrhea, and they generally weaken the immune system. Probiotics, in contrast, restore your body’s natural flora and strengthen the immune system. Taking probiotics with antibiotics helps ensure that you prevent unpleasant side effects at the same time that you heal from surgery. Get your probiotics from the food you eat. Foods like yogurt, fermented and unfermented milk, miso, tempeh, some juices, and soy beverages. Or, take your probiotics in supplement form. Your local health food store and drug stores has a variety of probiotic compounds in pill, capsule, or powder form that you can take daily while you are under antibiotic treatment to increase the amount of beneficial flora in your intestinal tract.
Bromelain is a protein-digesting enzyme complex found in the stem of pineapples. Bromelain was approved in Europe as an effective remedy for swelling and inflammation after surgery. However, more research (especially high-quality research) is needed before it can be said conclusively that bromelain works for these uses. Because dietary supplements, including bromelain, do not require FDA approval, there are no clearly established dosing guidelines that are both safe and effective. As a result, dosing information comes from bromelain’s use in other countries or from practical experience with the supplement. As there is no standard dosage of bromelain, it is reasonable to follow the dosing instructions provided on the label of your particular product.
Arnica Montana comes in oral or topical forms. The U.S. Food and Drug Administration (FDA) has declared arnica an unsafe herb due to adverse effects reported when taken by mouth. The topical preparation (in cream or gel form) is commonly used on unbroken skin as an anti-inflammatory and pain-relieving agent that may help bruising and swelling.
Patients can apply this product to the affected area of skin as directed on the package. Do not apply to scraped skin or open wounds. Do not use long-term. As with bromelain and other herbal supplements, arnica does not require FDA approval, and it is unclear if arnica really works. Short-term topical use may help speed the resolution of bruising and swelling. I generally recommend Arnica cream after facial procedures or injectables, where it can be lightly massaged into areas of bruising along the cheeks or lower eyelids, or around the mouth. It may also be used during the healing phase from liposuction, where the cream is massaged into areas of bruising, swelling, or scar tissue for 5-7 days.
The mind is an equally important player when it comes to healing. Studies have shown that patients who are more relaxed and better informed about upcoming surgery are more likely to enjoy a successful outcome.
Dr. Hayley Brown MD, FACS
Plastic Surgeon Las Vegas
Desert Hills Plastic Surgery Center, Henderson and Las Vegas, Nevada