Self-Administered Dietary Supplements, Herbal Products, and Ergogenic Aids Before Plastic Surgery: A Narrative Review and the PLASTIC-S Perioperative Management Framework.

The autonomous consumption of dietary supplements, high-dose vitamins, herbal products, ergogenic aids, and "natural" weight-loss preparations has increased substantially among candidates for plastic surgery. In Brazil, this pattern is amplified by a large market of compounded (manipulado) formulas that may contain undeclared active ingredients, by gym-oriented prohormones and selective androgen receptor modulators, and by the expanding access to cannabidiol products since the regulatory changes introduced by the Brazilian Health Regulatory Agency (ANVISA) in 2019 and 2022. These substances are frequently omitted during the preoperative interview because patients do not perceive them as medications, yet several of them have been associated, to varying degrees, with perioperative concerns such as increased bleeding, hemodynamic instability under anesthesia, cytochrome P450-mediated interactions, and impaired wound healing. This narrative review synthesizes the available evidence and proposes a plastic-surgery-specific, clinically applicable framework built on two elements: the PLASTIC-S structured anamnesis mnemonic, which organizes self-administered substances into eight categories mapped to perioperative risk mechanisms, and a two-dimensional Procedure × Supplement Risk Matrix, which translates that assessment into individualized, graduated suspension intervals rather than a single flat recommendation. Procedures are stratified into four risk tiers and supplements into four risk tiers, whose intersection yields suggested suspension intervals ranging from none to about three weeks, together with a group of substances that are best avoided altogether. The framework is intended to move everyday practice beyond the generic "suspend two weeks before" advice toward a more individualized and reproducible approach, and it can be incorporated as a low-cost component of the preoperative safety routine in contemporary Brazilian plastic surgery. As a narrative review, its recommendations rest largely on pharmacological reasoning, case reports, and consensus rather than on prospectively validated evidence, and the PLASTIC-S framework should therefore be regarded as a proposed clinical tool requiring prospective validation.