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Topic 31 - 5
Arnica for Eyelid Surgery:
Miracle or Money-Maker?
blood pressure and blepharoplasty Experiencing morning before blepharoplasty

arnica pills

Arnica montana has received considerable press claiming almost miraculous powers when taken before and/or after eyelid or other forms of plastic surgery. Proponents claim that arnica decreases swelling and bruising after surgery. While the supposed mechanism is not at all understood, the preparation is said to "work on the blood vessels." Ingestion of the herb in homeopathic dosages is claimed to be free of side effects.

Arnica montana is a perennial herb found in the woods of Central Europe, although it may also be cultivated in North America and elsewhere. Also known as leopard's bane and mountain tobacco, its fresh or dried flower heads have been used on the skin by European doctors for centuries. In Germany, for instance, over one hundred drug preparations contain this herb.

In the United States, arnica is not regulated and is available without prescription. It comes in a variety of forms including creams, gels, oils, tinctures, pills to be placed under the tongue, pills to be swallowed, teas, mouthwashes, and even as an injectable liquid. Used topically as a cream or gel, arnica is said to benefit a wide range of conditions, such as bruises, sprains, muscle injury, joint pain, acne, and even phlebitis.

Sound like a miracle? It isn't, not that this has prevented arnica from becoming extremely popular.

Pure arnica taken orally is highly poisonous and may cause cardiac arrythmias, gastrointestinal problems, kidney and liver damage, or death. The FDA classifies it as an unsafe herb, and it should not be taken by women who are pregnant or breast-feeding. Homeopathic preparations, however, are so dilute that blood levels of the drug are all but undetectable (which means little or none is getting to the target tissues anyway).

In regards to eyelid surgery, homeopathic pills taken orally have become somewhat "the rage" among advocates ranging from health food activists to many cosmetic surgeons. Regimens and dosages are not at all standardized. Some patients begin using the herb as long as ten days before surgery, while others begin the day of surgery and continue for four days or more after.

The typical cost for a one day supply of arnica is around $5-15.

Expense aside, does it work?

Despite patient testimonials found on sites selling the product (including some belonging to physicians), there is no sound evidence to support any benefit (warning: favorable so-called "trials" are tiny, cherry-picked, and statistically meaningless). In well-controlled double-blind studies on patients undergoing eyelid surgery or facial plastic surgery treated with either oral arnica or a placebo, there repeatedly has been no subjective or objective difference in postoperative bruising noted by either the patients themselves or the staff members who evaluated them.

The same holds for arnica gel. A recent controlled study on over 130 patients undergoing upper blepharoplasty demonstrated no beneficial effect on any measured parameter, including swelling, bruising, pain, and patient satisfaction with recovery or outcome.

All eyelid surgeons have patients who experience little or even no bruising after extensive surgery. Those on arnica always attribute this outcome to the herb; those not on arnica tend to compliment their surgeon's gentle touch. We have also seen plenty of patients on arnica develop above average bruising. In several such cases, the patients - still firm believers -- commented that they should have taken their doses earlier, longer, and so on.

Undeterred by medical and scientific evidence, patients and many cosmetic surgeons continue their blind love affair with this homeopathic money-maker. Our own three-decade experience with patients using arnica and other botanicals to prevent bruising or accelerate healing is that they make no noticeable difference. However, none of this seems to convince thousands of consumers each year to stop wasting resources on an unproven folk remedy.

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