Arnica montana has received a considerable amount of press claiming almost miraculous powers for this herb when taken before and/or after 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. The fresh or dried flower heads have been used by European doctors for centuries to prevent swelling and bruising after injuries of almost any sort.

Sound like a miracle? Maybe it is, maybe it isn't, not that this has prevented Arnica from becoming extremely popular. In Germany, for instance, over 100 drug preparations contain this herb. In the United States, Arnica is not regulated by the FDA 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. Homeopathic preparations are generally quite dilute.

Used topically, Arnica is said to benefit a wide range of conditions, such as bruises, sprains, muscle injury, joint pain, acne, and even phlebitis. Some European doctors use more concentrated preparations to treat angina and coronary artery heart disease.

In regards to cosmetic eyelid surgery, pills taken orally have become somewhat "the rage" among patients ranging from health food activists to physicians themselves. Regimens and dosages are not 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 about $10.

Expense aside, does it work?

Despite patient testimonials found on sites selling the product, there is no medical consensus regarding benefit. In a 2006 randomized, double-blind clinical trial on patients undergoing face lift treated with either Arnica or a placebo, there was no subjective difference in postoperative bruising noted by either the patients or the staff.

Our own experience with patients using Arnica for eyelid surgery is that it doesn't make a difference.

All eyelid surgeons have patients who experience little or even no bruising after extensive surgery. Those patients 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 patients on Arnica develop more than average bruising. In several such cases, the patients--still firm believers-- commented that they should have taken their doses earlier, longer, and so on. So what do all those patient testimonials really mean to you? Probably not very much.

Okay, but if it may or may not work, what is there to lose (except for your money)? The answer depends on this: Is it safe?

Homeopathic advocates claim that the herb is free of all side effects and does not interfere with the use of more mainstream medications. This is generally (but not entirely) true. Taken orally in high enough doses, Arnica is known to induce substantial medical problems including dizziness, tremors, and heart irregularities. It may also irritate the intestines and cause vomiting. The topical formulations (creams, gels, etc.) are not safe to be used on open wounds and so have no application after delicate eyelid surgery. Some patients may also be allergic to the herb and break out in a rash.

The saving grace here is that most homeopathic preparations are extremely dilute. Still, for anyone with heart, stomach, or intestinal problems, it seems advisable to first check with a general physician before use.

Finally, if you're serious about minimizing bruising, don't forget to do the things that are known to help in a big way: stop medications prolong bleeding (such as aspirin, ibuprofen, and Vitamin E), cut back on any smoking, and get your blood pressure under good control. For a further discussion on such precautions, refer to the Insider's Guide to Blepharoplasty.

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