Perioperative management of antidepressants and herbal medications in elective plastic surgery.

BACKGROUND: Patients seeking elective aesthetic surgery often use herbal medications and/or antidepressants. As the popularity of these medications grows, the plastic surgeon must become familiar with these drugs and their potentially harmful effects during the perioperative period. METHODS: The authors performed a PubMed search to identify commonly used herbs and antidepressants and their effects on patients during elective cosmetic surgery. RESULTS: Case series, studies, and reviews for 29 of the most common herbs and antidepressant medications were obtained from this search. On the basis of the existing data, the authors established recommendations for the management of these medications before elective cosmetic surgery. CONCLUSIONS: Most commonly used herbs and antidepressant medications have potentially deleterious effects on the patient during surgery, ranging from increased risk of bleeding to fatal interactions. The plastic surgeon must be familiar with these drugs to manage these patients appropriately.