Some supplements can increase surgical risks — especially bleeding, bruising, swelling, and reactions to anesthesia — even when they are otherwise safe and beneficial. To reduce these risks, please stop the supplements listed below at least two weeks before surgery, and do not resume them until two weeks after surgery, unless Dr. Batniji tells you otherwise.
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SCOPE — This list covers supplements only. Prescription medications — including aspirin, NSAIDs, anticoagulants (Coumadin, Plavix, Eliquis, Xarelto), and hormonal therapies — are managed separately. Please follow the individualized pre-operative instructions provided to you by Dr. Batniji and your other physicians. |
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IMPORTANT — GLP-1 medications and peptide therapies. If you are taking a GLP-1 medication (semaglutide, tirzepatide, Ozempic, Wegovy, Zepbound, Mounjaro) or any compounded peptide therapy, please inform us at your preoperative appointment. These medications slow gastric emptying and typically require a specific hold period — discontinue GLP-1 medication one week before surgery and you may resume it one week after surgery— to reduce the risk of aspiration during anesthesia. Peptides other than GLP-1 may increase the risk of bleeding and, as such, should be discontinued 2 weeks prior to surgery and not resumed until 2 weeks after surgery. |
Not listed here? This list covers the most common concerns but is not exhaustive. If you take any supplement, herbal product, protein powder, pre-workout blend, energy drink, or “natural” remedy not named below, please bring the bottle to your pre-operative visit so we can review it. When in doubt, stop it 2 weeks before surgery and do not resume until 2 weeks after surgery.
| Supplement | Common Use | Surgical Concern |
|---|---|---|
| Ashwagandha (Withania somnifera) | Stress, energy, sleep | May potentiate sedatives and anesthesia; can affect thyroid function and blood pressure. |
| Cannabis / CBD | Pain, anxiety, sleep (edibles, vapes, tinctures, topicals) | Can alter anesthesia requirements, increase airway irritation, and interact with sedation and pain medications. See the cannabis note below for timing. |
| Cayenne (Capsicum frutescens) | Circulation, metabolism | May affect platelet function and increase bleeding risk. |
| Dong Quai (Angelica sinensis) | Female hormone balance, energy | Contains coumarin-like compounds that can enhance the effect of blood thinners. |
| Echinacea (Echinacea angustifolia) | Immune support, cold and flu | May affect liver function and interact with anesthesia medications. |
| Feverfew | Migraine prevention | Inhibits platelet aggregation; increases bleeding risk. |
| Fish Oil / Omega-3 | Heart, cholesterol, joint health | Has blood-thinning properties that can increase bleeding and bruising during facial surgery. Discontinue even if recommended by another physician, unless Dr. Batniji directs otherwise. |
| Garlic (Allium sativum) | Cardiovascular health, cholesterol | At supplement doses, can enhance blood thinners and NSAIDs and prolong bleeding time. Culinary garlic is fine. |
| Ginger (Zingiber officinale) | Nausea, digestion | May affect bleeding time and interact with anticoagulant and cardiac medications. |
| Ginkgo Biloba | Circulation, memory | Strong antiplatelet activity — one of the most significant bleeding risks among common supplements. |
| Ginseng (Panax ginseng / quinquefolium) | Energy, stress, cognition | Acts as an anticoagulant and may interact with blood pressure, diabetes, and cardiac medications. |
| Green Tea Extract (EGCG) | Weight loss, antioxidant (concentrated capsules) | At supplement doses, may affect bleeding and interact with anticoagulants. Drinking green tea as a beverage is fine. |
| Kava | Anxiety, sleep | Potentiates sedatives and anesthesia; associated with liver toxicity. |
| Kratom | Pain, energy, mood | Opioid-like effects that complicate anesthesia and post-operative pain management; carries withdrawal risk. |
| Licorice Root (Glycyrrhiza glabra) | Cough, digestion, adrenal support | Can raise blood pressure, lower potassium, and increase tissue swelling. Note: Deglycyrrhizinated licorice (DGL) does not carry these risks. |
| Melatonin | Sleep, jet lag | May enhance the sedative effects of anesthesia medications. |
| Nattokinase / Serrapeptase | “Circulation support,” clot prevention (biohacker enzymes) | Potent fibrinolytic and anticoagulant activity; can significantly increase surgical bleeding. |
| Supplement | Common Use | Surgical Concern |
|---|---|---|
| Ashwagandha (Withania somnifera) | Stress, energy, sleep | May potentiate sedatives and anesthesia; can affect thyroid function and blood pressure. |
| Cannabis / CBD | Pain, anxiety, sleep (edibles, vapes, tinctures, topicals) | Can alter anesthesia requirements, increase airway irritation, and interact with sedation and pain medications. See the cannabis note below for timing. |
| Cayenne (Capsicum frutescens) | Circulation, metabolism | May affect platelet function and increase bleeding risk. |
| Dong Quai (Angelica sinensis) | Female hormone balance, energy | Contains coumarin-like compounds that can enhance the effect of blood thinners. |
| Echinacea (Echinacea angustifolia) | Immune support, cold and flu | May affect liver function and interact with anesthesia medications. |
| Feverfew | Migraine prevention | Inhibits platelet aggregation; increases bleeding risk. |
| Fish Oil / Omega-3 | Heart, cholesterol, joint health | Has blood-thinning properties that can increase bleeding and bruising during facial surgery. Discontinue even if recommended by another physician, unless Dr. Batniji directs otherwise. |
| Garlic (Allium sativum) | Cardiovascular health, cholesterol | At supplement doses, can enhance blood thinners and NSAIDs and prolong bleeding time. Culinary garlic is fine. |
| Ginger (Zingiber officinale) | Nausea, digestion | May affect bleeding time and interact with anticoagulant and cardiac medications. |
| Ginkgo Biloba | Circulation, memory | Strong antiplatelet activity — one of the most significant bleeding risks among common supplements. |
| Ginseng (Panax ginseng / quinquefolium) | Energy, stress, cognition | Acts as an anticoagulant and may interact with blood pressure, diabetes, and cardiac medications. |
| Green Tea Extract (EGCG) | Weight loss, antioxidant (concentrated capsules) | At supplement doses, may affect bleeding and interact with anticoagulants. Drinking green tea as a beverage is fine. |
| Kava | Anxiety, sleep | Potentiates sedatives and anesthesia; associated with liver toxicity. |
| Kratom | Pain, energy, mood | Opioid-like effects that complicate anesthesia and post-operative pain management; carries withdrawal risk. |
| Licorice Root (Glycyrrhiza glabra) | Cough, digestion, adrenal support | Can raise blood pressure, lower potassium, and increase tissue swelling. Note: Deglycyrrhizinated licorice (DGL) does not carry these risks. |
| Melatonin | Sleep, jet lag | May enhance the sedative effects of anesthesia medications. |
| Nattokinase / Serrapeptase | “Circulation support,” clot prevention (biohacker enzymes) | Potent fibrinolytic and anticoagulant activity; can significantly increase surgical bleeding. |
| Pre-Workout / Performance Blends | Energy, workout performance | Often contain hidden stimulants, vasodilators, or herbal anticoagulants (yohimbine, synephrine, nitric oxide boosters, ginseng). Stop all pre-workout powders and performance capsules. |
| Resveratrol | Anti-aging, cardiovascular | Antiplatelet effects that increase bleeding and bruising risk. |
| Saw Palmetto | Prostate health | Mild antiplatelet and hormonal effects. |
| St. John’s Wort (Hypericum perforatum) | Depression, mood | Numerous drug interactions; affects the metabolism of anesthesia and many other medications. |
| Turmeric / Curcumin | Inflammation, joint pain | Antiplatelet effects that increase bleeding and bruising risk. Culinary use in food is fine. |
| Valerian Root | Sleep, anxiety | Potentiates sedatives and anesthesia; long-term use can cause withdrawal-like effects. |
| Vitamin C (high-dose, above 1,000 mg/day) | Immune support | At gram-level doses may affect bleeding and wound healing. Standard multivitamin doses are fine. |
| Vitamin E (above 100 IU/day) | Antioxidant, skin health | Antiplatelet activity prolongs bleeding time. The multivitamin we recommend is Vitamin E–free for this reason. |
| Yohimbe (Corynanthe yohimbe) | Sexual function, energy | Raises heart rate and blood pressure; can increase the potency of anesthetics. |
Regardless of legal status, all cannabis use — smoked, vaped, edibles, tinctures, topicals, and CBD — should be disclosed to Dr. Batniji and the anesthesia team. Cannabis can change how much anesthetic you need, affect your airway, and interact with pain medications.
Timing: Stop all cannabis use at least 72 hours before surgery unless otherwise directed. If you use cannabis daily or multiple times per day, please tell us in advance so we can plan for potential withdrawal effects (irritability, nausea, poor sleep) that could complicate your recovery.
Disclosure is confidential and will not affect your care — it is a safety matter.
Contact Batniji Facial Plastic Surgery at 949.650.8882 (Newport Beach) or 310.467.2180 (Beverly Hills), or email info@drbatniji.com.
