Increasing numbers of Western surgeons are embracing complementary medical practices to improve recovery, control pain, and avoid complications
With new therapies inundating the practice of medicine and the continual development of modern technological advances, it is becoming difficult to distinguish between therapies that are beneficial or adjunctive and those that are detrimental and unfounded. Moreover, because many physicians in the United States are trained through allopathic pathways, there is minimal emphasis on alternative treatments that may complement traditional methods.
The juxtaposition of the Western paradigm of medical education with the emergence—and increasing popularization and acceptability—of Eastern and other alternative therapies creates a vortex of confusion. It also provides an opportunity to understand the benefits and limitations of the schools of practice, as well as the differences between them.
Modern physicians find themselves at a crossroads in medical history, standing at a point where they must decide whether to incorporate—and accept, possibly with change—alternative therapies or reject them altogether.
Eastern medicine is a broad term that refers, according to the Complementary Medicine Association in Australia, to “Oriental, Indian, Tibetan, Japanese, and Chinese medicine, all of which share philosophies about the energy system of the human body and the necessity of balance and harmony.”1 This philosophy of medicine encompasses Chinese medicine, massage (shiatsu), and other relaxation techniques2 and is beyond the scope of this article.
A Choice of Philosophies
In the United States, what is commonly understood to be the practice of medicine falls within the realm of traditional, or Western, medicine. This type of practice, generally taught in most US medical schools, is categorized as allopathic, and leads to the MD degree.
Allopathic medicine is seen as modern medicine. It is a method of treating disease using agents that produce effects different from those of the disease being treated.3
In other words, the premise of allopathic medicine is that disease states may be treated by focusing on the particular cause of the illness and directing therapy at that particular cause. It is etiology-specific and targets the eradication of the inciting factors. Allopathic medicine is also known as conventional medicine.
Another type of Western medicine is referred to as osteopathic medicine. Osteopathy is a system of health care based on treating the whole person and is, therefore, a more holistic approach to treating disease. Osteopaths originally considered the musculoskeletal system as primary in the pathophysiology of illness, and used manipulation of this system to correct “somatic abnormalities thought to cause disease.”4
More recently, however, osteopathy has “embraced the full spectrum of medicine, including the use of prescription drugs and surgery, in addition to manipulative techniques.”5 The completion of study in an osteopathic training school leads to the DO degree.
MDs and DOs are being joined, in increasing numbers, by physicians of other kinds, namely homeopaths and naturopaths. These practitioners have varying perspectives on disease and the treatment thereof, and are playing a more significant role in the health of patients who are seeking what they consider to be less toxic treatments.
Homeopathy is a form of medicine developed by Samuel Hahnemann, MD, in the late 18th century. This system of treating illness is based on the law of similars (that like cures like) and seeks to promote health and healing by stimulating the body’s innate defense mechanisms and restoring homeostasis when that natural state is threatened by disease. Homeopathy is a natural form of Western medicine, regulated by the US Food and Drug Administration (FDA) since 1938, that uses minute doses of natural substances to assist the body in self-recovery.
Some of these substances include plant and animal extracts, and may be combined with vitamins and minerals, as well as with small doses of traditional medicinal agents. Moreover, the doses used are highly diluted, ensuring lack of toxicity. The use of minute doses also emphasizes the principle of similars: “These substances would actually cause respective disease if given in a high dose.”6
Homeopathic medicinal dilutions are measured in the Hahnemannian centesimal, abbreviated as C (Figure 1). For example, the original mother tincture found in nature is typically diluted by a factor of 100 with a sterile solvent (70% alcohol or water) to yield a dilution of 1C. This 1C form may then be further diluted by mixing it with 99 parts more solvent, yielding a 2C dilution, and so on.
All homeopathic medicines should be approached with the same care as prescription medications.7 One of the purported advantages of using this type of medication, however, is the unlikelihood of interference by, or adverse drug–drug reactions with, other medications.
Homeopathic preparations are available as single-dose medicines, as a combination of two or three complementary medicines, or as complex formulae that are premixed and readily available from a variety of manufacturers. There are homeopathic medicines for infection, asthma, and eczema, among other disorders. Homeopathy is said to be able to treat any condition for which a patient would ordinarily visit a primary care physician.
Naturopathy shares with homeopathy the goal of treating the causes and effects of illness through naturally occurring mechanisms. Naturopaths, who carry the ND degree, believe in the body’s ability, as a whole, to heal itself. These practitioners use homeopathy, herbs, oral vitamins, massage, physical therapy, and lifestyle counseling on diet and nutrition to repair the body. Their medications are typically administered in oral forms only. Many naturopaths also consider their treatments as complementary to traditional medicine, not as a supplementary or solitary modality.
Both complementary and holistic disciplines are sometimes referred to collectively as integrative medicine. Holistic medicine is an alternative approach to health that focuses on the state of the whole individual, and it explores all aspects of a person’s health: mental, environmental, social, cultural, psychological, and physical. It aims to balance the mind and the body with external forces to help the body heal itself.
Holistic medicine encompasses yoga, biofeedback, megavitamin therapy, acupuncture, and other means to help achieve restoration, wholeness, and greater health. It, too, is often incorporated as an adjunct to traditional medicine and surgery.
Complementary medicine is a general term used to describe any alternative therapy that, like holistic medicine, may use megadose vitamins, spiritual healing, herbal preparations, magnet therapy, and acupuncture—among other therapies—to promote health and recovery from illness or trauma. According to one definition, “The term implies that conventional medicine is used as a primary tool and the noninvasive, nonpharmaceutical techniques are used as a supplement when needed.”8
Complementary and holistic medicines may make use of homeopathy in their approach to health and healing. Proponents of these types of medicine adhere to techniques that are used in conjunction with allopathic medical treatments, such as pharmaceutical drugs and surgery. In light of the increasing numbers of consumers and patients who are turning to alternative therapies, it not difficult to contemplate a role for such therapies as a complement to plastic surgery.
Use in Plastic Surgery
Homeopathic agents have been in use in clinical practice for decades. Modern medicine is seeing a resurgence of these medicines in daily practice, particularly in fields where minimally invasive and surgical procedures are performed. For a list of some of the more common homeopathic agents used and their indications in aesthetic medicine and plastic surgery, see Table 1.
Perhaps the most widely recognized homeopathic agent in use in medicine today is derived from Arnica montana, a perennial species indigenous to the cooler European mountains and plains (Figure 2). Arnica extract is available in pellet or topical forms. It is frequently used preoperatively, in oral form, to help decrease the incidence and extent of swelling and bruising.
Independent studies in the English-language literature have found that arnica is effective in the reduction of ecchymosis after surgery. For example, Seeley et al, in a randomized, double-blind, placebo-controlled trial, investigated the role of arnica after aesthetic surgery.9
The authors sought to determine the effect of arnica on bruising when it was taken perioperatively for a facelift procedure. They concluded that patients who took homeopathic arnica exhibited significantly less ecchymosis than those who did not.
Wilkens and Lüdtke, in a separate study, also found arnica to be useful in reducing postoperative swelling.10
Another well-known homeopathic medication that is familiar in postoperative protocols is calendula, derived from the garden marigold Calendula officinalis (Figure 3, page 50). It is a source of a multitude of compounds, including flavonoids, organic acids, carotenes, manganese, alcohols, and lactones.
Calendula’s activity is hypotensive, antiplatelet, anti-inflammatory, antiseptic, antibacterial, antifungal, and antiviral. It is available orally and topically as a lotion, cream, or ointment. In plastic surgery, calendula is recommended as a local antiseptic in the management of open wounds and burns, and as a healing aid after procedures such as dermabrasion, laser resurfacing, and chemical peels.
A third, less widely used homeopathic preparation is phosphorus. It is sometimes used in treating postoperative nausea and vomiting, conditions that have received much attention in the plastic surgery literature because they may lead to more severe postsurgical complications, including hematoma after breast augmentation, and bleeding and subsequent flap-tissue loss after facelift.
Homeopathic medicines are also applicable for less invasive procedures, such as botulinum toxin and filler injections, mesotherapy, and laser treatments. These agents, such as graphite, may also be used in scar management in conjunction with standard, conventional therapies (and with arnica as well). More commonly, homeopathic medicines are used to help reduce the incidence and duration of swelling and bruising from these less invasive procedures.
Whereas homeopathic medicines may be beneficial during the perioperative period, they must be used with intelligent diligence. Accordingly, an important distinction must be made between homeopathic medicines and herbal remedies.
Homeopathic medicines are prepared in highly diluted forms, whereas herbal remedies are typically found in their natural, full-strength forms. This makes it possible for hypersensitivity or toxicity to develop when using herbal remedies, because these substances are typically concentrated and rely upon the body’s mechanisms to break them down.
Homeopathic medicines are not known to cause allergic reactions or other complications as long as they are used in dilutions of 4C or greater, according to Ronald Boyer, MD, president of the Center for Education and Development of Clinical Homeopathy in Edgemont, Pa. Nonetheless, vigilance is paramount: Recently, deaths during aesthetic surgery have been partly attributed to the undisclosed use of herbal medications that might have interfered with the administered anesthetic drugs.
Unlike herbal preparations, homeopathic medicines are regulated by the FDA as drugs. This regulation ensures that homeopathic substances adhere to strict guidelines, as defined by the Homeopathic Pharmacopoeia of the United States, and to the FDA’s drug-labeling specifications.
Herbal remedies, in contrast, are categorized as foods under the Dietary Supplement Health and Education Act and are, therefore, not subject to stringent labeling and packaging rules and oversight. Homeopathic medicines should not be confused with vitamins, herbs, minerals, or enzymes.
Even so, as in prescribing any medication, a thorough history must be elicited from the prospective patient. In addition, a complete physical examination is essential before surgery. During this overall health investigation, it is important to obtain the patient’s medication history (past and current; over-the-counter, herbal, and prescription), and to discern whether the patient has any allergies or contraindications to homeopathic medicines, although this is rare.
Know What Medications to Avoid
Moreover, it is critical to inform patients about which medications, herbal or conventional, must be avoided to prevent anesthetic-related and surgical complications (Table 2). It is recommended that a list of medications to avoid, as well as a list of recommended medications, be provided to the patient. These should be reviewed several weeks before surgery to ensure that the patient understands the instructions and is compliant with them.
The incorporation of homeopathy into one’s medical practice comes with responsibilities. It behooves the interested physician to obtain appropriate knowledge and education in homeopathy. It is also imperative that the physician uses homeopathic medicines to do no harm, understanding the critical differences between medications to permit and those to avoid.
The philosophy of homeopathy is not suitable for all physicians, nor is the practice suited to all patients. The future of homeopathy in conventional medicine and plastic surgery is yet to be written. It appears, however, that homeopathic medicines and concepts will gain increasing acceptance among patients and plastic surgeons alike, as a complement to surgery, in a laudable effort to treat illnesses and conditions from a more holistic perspective.
Shirley Madhère, MD, PC, is a plastic surgeon in private practice in New York City and an associate adjunct surgeon at the New York Eye and Ear Infirmary. She can be reached at (212) 941-1571.
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9. Seeley BM, Denton AB, Ahn MS, et al. Effect of homeopathic arnica montana on bruising in face-lifts. Arch Facial Plast Surg. 2006;8: 54–59.
10. Wilkens J, Lüdtke R. Arnica 30x after knee surgery. Br Homeopathic J. 2000;89(suppl 1):S72.