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Integrative Medicine in Plastic Surgery

A Systematic Review of Our Literature

Ruan, Qing Zhao, MD*; Chen, Austin D.*; Tran, Bao Ngoc N., MD*; Epstein, Sherise, BA*†; Fukudome, Eugene Y., MD*; Tobias, Adam M., MD*; Lin, Samuel J., MD, MBA*; Lee, Bernard T., MD, MBA, MPH*; Yeh, Gloria Y., MD, MPH; Singhal, Dhruv, MD*

doi: 10.1097/SAP.0000000000001676
Review Paper
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Background Surveys have reported that as high as 80% of plastic surgery patients utilize integrative medicine approaches including natural products (NPs) and mind-body practices (MBPs). Little is known regarding the evidence of benefit of these integrative therapies specifically in a plastic surgery patient population.

Methods We conducted a systematic review of studies in MEDLINE, PubMed, and EMBASE (inception through December 2016) evaluating integrative medicine among plastic surgery patients. Search terms included 76 separate NP and MBP interventions as listed in the 2013 American Board of Integrative Health Medicine Curriculum. Two independent reviewers extracted data from each study, including study type, population, intervention, outcomes, conclusions (beneficial, harmful, or neutral), year of publication, and journal type. Level of evidence was assessed according to the American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations.

Results Of 29 studies analyzed, 13 studies (45%) evaluated NPs and 16 (55%) studied MBPs. Level II reproducible evidence supports use of arnica to decrease postoperative edema after rhinoplasty, onion extract to improve scar pigmentation, hypnosis to alleviate perioperative anxiety, and acupuncture to improve perioperative nausea. Level V evidence reports on the risk of bleeding in gingko and kelp use and the risk of infection in acupuncture use. After year 2000, 92% of NP studies versus 44% of MBP studies were published (P = 0.008).

Conclusions High-level evidence studies demonstrate promising results for the use of both NPs and MBPs in the care of plastic surgery patients. Further study in this field is warranted.

From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School;

Harvard T. H. Chan School of Public Health; and

Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Received May 27, 2018, and accepted for publication, after revision August 30, 2018.

Conflicts of interest and sources of funding: none declared.

Presented at the Society of Asian Academic Surgeons 2017 meeting in Birmingham, AL, on September 21 to 22, 2017.

Reprints: Dhruv Singhal, MD, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Suite 5A Boston, MA 02215. E-mail: dsinghal@bidmc.harvard.edu.

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