For my research class at the Canadian College of Naturopathic Medicine, I wanted to find out if the homeopathic remedy Arnica Montana really did work to decrease swelling and bruising after rhinoplasty (more commonly known as a nose job). I became interested in this topic because I had reconstructive rhinoplasty a few years ago and was instructed to take the homeopathic Arnica Montana by my plastic surgeon before and after surgery to reduce the amount of time I had bruising and swelling. Personally, I had incredible results and only had bruising for a few days, which is remarkable after such major trauma to the face. Although it worked for me, I wanted to do further research to see what the research studies out there said and how Arnica faired in healing post-rhinoplasty when compared to corticosteroids. After all, it’s good to be skeptical and do your own research!
What is Arnica montana and how does it work?
Arnica montana is a homeopathic remedy made from the beautiful flowering plant
known as Leopard’s bane or Mountain Daisy. When used at maximum strength, the plant is toxic. However, when the plant is prepared through a homeopathic method, it is safe and very effective. Arnica is commonly used to treat bruises and reduce muscle pain, swelling, and joint stiffness, among other things.
Homeopathy, founded by Samuel Hahnemann in the 1800s, is a type of medicine based on the Law of Similars and the premise of Like Cures Like. This means that when a substance is given to a healthy person it creates a specific set of symptoms and when it is given to a sick person, it heals those same symptoms.
Homeopathic remedies, made from plants, minerals, animals and other substances, are diluted in a series of succussions where the active substance is placed in a vial with water and shaken vigorously a set number of times, also known as potentization. Then, a portion of the water is diluted and shaken in the same way. This procedure is repeated with a number of dilutions and succussions until there is no active substance (the toxic portion) left in the vial. The remaining medicine is the energetic portion that has been brought out from the original substance (Organon 353). The higher the number of succussions and dilutions the stronger the remedy is. Often you will see a C or M next to a number like 6C or 30C. “C” indicates a 100-fold serial dilution and “M” is a 1,000 fold serial dilution. The method commonly used today is that the final substance is added to pellets that are quickly dissolved under the tongue and the medicine is absorbed.
Why is Arnica Use in Post-Rhinoplasty Treatment Important?
The use of Arnica is important since ecchymosis (bruising around the eyes) and edema (swelling) are the most common side effects during the recovery period post-rhinoplasty. The cause of ecchymosis, according to Golger, is osteotomy, or breaking of nasal bones, which is often required during a closed rhinoplasty. According to the Canadian Society of Plastic Surgeons website, bruising is typically diminished after a week, however, swelling post-surgery can last multiple weeks or months.
This topic is also important because cosmetic surgery, including rhinoplasty, is very prevalent across the globe. In fact, in 2015 there were 21 million surgical and non-surgical procedures performed on both men and women. Further, there were 730,287 rhinoplasty surgeries performed in 2015, 7.6% of the total plastic surgeries performed globally. That’s a lot of people who could benefit from faster healing and less down time, making them more satisfied patients.
What are Other Treatments for Rhinoplasty?
There are other effective alternatives to reducing ecchymosis and edema post-rhinoplasty, such as steroid use and placebo. However, according to the Mayo Clinic, there are multiple side effects with steroids, such as prednisone and corticosteroids. Some of the side effects of oral steroid use include: “elevated pressure in the eyes (glaucoma), fluid retention, causing swelling in your lower legs, high blood pressure, problems with mood, memory, behavior and other psychological effects, and weight gain, with fat deposits in your abdomen, face and the back of your neck.” Injected steroids may cause side effects such as “skin thinning, loss of color in the skin, facial flushing, insomnia and high blood sugar.”
Although there are a wide variety of side effects from corticosteroids, there are many benefits as well such as relieving “inflammation, pain and discomfort of many different diseases and conditions.” The health care provider weighs the safety and risk analysis when using steroids. In the case of placebo, there is no risk in safety by allowing the body to heal itself post-rhinoplasty. Often, cold packs are suggested as a way to decrease edema, which have minimal risk.
What Does the Research Say?
For my research assignment, I looked at several research studies that used the homeopathic remedy Arnica Montana perioperatively, or before, during, and after rhinoplasty. I also narrowed my search results to using only those studies that used Arnica for rhinoplasty and not other cosmetic procedures, among other research criteria. I found that the most common formula that was used in some of the studies was SinEcch A. montana formula from Alpine Pharmaceuticals. After reviewing all of the random controlled trials (RCTs), here’s what the research showed:
- Arnica reduced swelling and bruising post-rhinoplasty when compared to steroids
- Arnica is safe and effective to take since it doesn’t interact with any medications
- Steroids actually increased bruising post-rhinoplasty (Totonchi and Guyuron)
- When the dose of Arnica was increased after surgery by having the patient take 2 V500 mg of A. montana 1M, and then having the patient take the 12C formulation for 3 times a day for the next 3 days, a difference was seen in the reduction of the intensity and extent of ecchymosis
- Contrasting evidence showed that some of the studies were poorly done and the amount of arnica used was very low or the potency was not listed at all.
Overall, Arnica is safe and effective to be taken in a clinical setting to reduce swelling and bruising post-rhinoplasty. It’s no wonder that many surgeons recommend and trust Arnica because it works compared to steroids!
To see my entire paper, click –> Progressive Research Assignment_FINAL_Kremer.
Naturopathic Chronicles 
Well, this blog entry can not be left uncommented. A look at the only study cited, namely Totonchi et al, reveals severe flaws in this study. First, a score is an ordinal measure. Ordinal measures are *not* tested with a conventional ANOVA, since ordinal data violate the requirement of gaussian distribution, which is a core requirement for both ANOVA and the t-test. I.o.W. the p-values are likely invalid.
Second, the power of the study is relatively weak, which increases the probability of false positives. It would be interesting to look at other studies you reviewed.
More generally, there seems to be a non-understanding of what a p-value really measures. It measures the probability that my observed data fit to the null hypothesis that there is no effect. A p-value of < 0.05 does NOT mean that a particular treatment works. There are at least three alternative hypotheses, namely (a) "the treatment works", (b) "there is some unknown convoluting factor", and (c) "the result is a false positive". The assessment which of these alternative hypotheses is true is a matter of prior probability. Since homeopathy violates not only one, but several scientific theories (a scientific theory being an extremely well supported model whose change is extremely unlikely), the prior probability of (a) is near zero. That in turn means that it is more likely that the p values below 0.05 are due to (b) or (c).
In summary, the data you present do *not* support your conclusions. Indeed, the authors themselves say that the results in other studies are inconclusive. Given the size of the effect they reported, a comparatively large number of inconclusive studies is a further sign of a false positive.
PS: I am a computational biologist, staff scientist at a large European Medical University with 20+ years experience in doing exactly such analyses.
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Thomas,
Thank you so much for your expertise and leaving such a detailed comment. I greatly appreciate it. Also, thank you for the incredible work you do. I wanted to take the time to address your points:
1.) The other studies I looked at were:
Hettige, R. “Limiting oedema, ecchymosis and haemorrhage in septorhinoplasty with ice
cooled swabs.” Royal Berkshire NHS Foundation Trust, UK, 2014. Annals of The Royal
College of Surgeons of England. 2014 Jul; 96(5): 395–396. Epub.
Hwang, SH. “The efficacy of steroids for edema and ecchymosis after rhinoplasty: a
meta-analysis.” The Catholic University of Korea, College of Medicine, 2014.
Laryngoscope. 2015 Jan.; 125(1): 92-8. Epub.
Totonchi A., Guyuron, B. A Randomized, Controlled Comparison between Arnica and
Steroids in the Management of Postrhinoplasty Ecchymosis and Edema. Plastic and
Reconstructive Surgery Journal. 2005 Dec. 6. July 2007, 271-274.
Ernst E., Pittler, M.H. Efficacy of homeopathic arnica: a systematic review of placebo-
controlled clinical trials. Arch Surg. 1998 Nov;133(11):1187-90.
Kargi E, Hosnuter, M, Babucc, O, Altunkaya, H, Altinyazar, C. Effect of Steroids on
Edema, Ecchymosis, and Intraoperative Bleeding in Rhinoplasty. Annals of Plastic
Surgery. 2003, Dec. Volume 51, Number 6, 570-574.
Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren A. Effects of Different
Corticosteroids on Edema and Ecchymosis in Open Rhinoplasty. Aesthetic Plastic
Surgery. 2006. 30,150-154.
Chaiet S, Marcus B. Perioperative Arnica montana for Reduction of Ecchymosis in
Rhinoplasty Surgery. Annals of Plastic Surgery. 2016 May. Volume 76, Number 5, 477-
482.
Hatef D, Ellsworth W, Allen J, Bullocks J, Hollier L, Stal S. Perioperative Steroids for
Minimizing Edema and Ecchymosis After Rhinoplasty: A Meta-Analysis. Aesthetic
Surgery Journal. 2011 Aug. Volume 31, Number 6, 648–657.
Ho D, Jagdeo J, Waldorf H. Is There a Role for Arnica and Bromelain in Prevention of
Post-Procedure Ecchymosis or Edema? A Systematic Review of the Literature. The
American Society for Dertmatologic Surgery. 2016 Apr. Volume 42, Number 4, 445-63.
Seeley B, Denton A, Ahn M, Maas C. Effect of Homeopathic Arnica montana on Bruising
in Face-lifts: Results of a Randomized, Double-blind, Placebo-Controlled Clinical Trial.
Archives of Facial Plastic Surgery. 2006 Jan./Feb. Volume 8, 54-59.
2.) In response to the P values, you are correct stating that if there is a P value of less than 0.05 that it is not statistically relevant and could be achieved by chance alone. Also, the Totonchi et al researchers would agree with you since they found: that the 51% was not statistically significant because the p value was < 0.05, which indicates that 5% could have been caused by chance. They also found that when looking at the difference between day 2 and day 8 after surgery, the arnica group and control group had greater decreases of intensity of ecchymosis than the steroid group (both by 55%). (9) One could argue that it's not statistically relevant since it's not that much. However, it's interesting to note that the arnica and control group both healed better than steroid group alone.
I did find that the Chaiet and Marcus study (2016) contradicts the Totonchi and Guyuron (2005) study in its findings. The Chaiet and Marcus study finds that the homeopathic Arnica montana is effective in decreasing the extent and the intensity of ecchymosis after osteotomies in rhinoplasty surgery, which may dramatically affect patient satisfaction.
3.) I also gave the Totonchi et al study a C (Unclear of Conflicting Scientific Evidence) based on CAP standards.
Overall, there is both supportive and conflicting information with regards to the use of the homeopathic A. montana to reduce ecchymosis and edema post-rhinoplasty. It is clear that more research needs to be done to detect the most effective dose and time schedule for patients to take it. A few of the studies did find that corticosteroids were not a great option because of increased bruising post-rhinoplasty, which is an undesirable effect. It is interesting to note that many of the studies did work to build on each other by using the same SinEcch17 formula.
I appreciate your feedback because our program teaches us to think critically and be skeptical. Obviously I am a (now) second year medical student and do not have the years of experience as you in research analysis but I aim to be able to analyze the research further with better studies. Sometimes the problem with analyzing studies done on homeopathy or herbs is that they are done poorly and you are comparing apples to a piece of an apple or another fruit entirely. I hope that in the future we will have better studies to be able to compare. But at the same time, it's helpful to know that arnica is a better alternative to corticosteroids post-rhinoplasty and do not have any side effects.
I am glad to share my experience in med school and use it as a tool to start a conversation with experts such as yourself in the field. Thanks again! Have a great weekend. – With Gratitude, Valerie
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Well, the p-value does *not* tell that there is a 5% chance of a false positive. The false positive rate is determined by study design and other factors and can be as high as 100% if a factor is overlooked. The p-value tells you that there is a 5% chance that your data fit to the assumption that there is no difference, nothing more. Apparently you are not aware how homeopathy came into being. Hahnemann’s description of the Cinchona bark experiment matches exactly a hypersensitivity reaction, i.o.W. homeopathy is a result of Hahnemanns personal pathology. You also do not seem to be aware how homeopathic treatments are discovered and developed. Dig a bit into it, you will be astonished.
Finally, if homeopathy works, we would have to rewrite Physiology, Chemistry, and Biology. Possibly even Physics. Given modern knowledge this is extremely unlikely. That in turn means that the prior probability of homeopathy is extremely low. For the effect of prior probability on the likelihood of a particular alternative hypothesis, see here: http://www.nature.com/news/scientific-method-statistical-errors-1.14700. Essentially he prior probability combines with the p-value by multiplication. That in turn means that the probability of a confounding factor or a false positive is much higher than the probability of homeopathy to work.
BTW, if several studies are controversial and the prior probability is practically non existent, this is a sure sign that we are dealing with badly designed studies and/or false positives.
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Thomas, Thanks for your comments. I am aware of how homeopathy came into being since we have been studying homeopathy extensively. I am not sure how you jumped to the conclusion that I don’t understand homeopathy or how it was discovered since I mention how it started it in my blog as well as how homeopathic remedies are made. I am also aware of the Cinchona bark experiment.
I don’t think we would have to rewrite physiology, chemistry and biology since it’s a widely accepted concept that water has memory as seen in the work of Luc Montagnier:
https://familyhomeopath.ca/water-memory-documentary-of-2014-about-nobel-prize-laureate-luc-montagnier/
And from the work of Dr. Masaru Emoto: http://www.collective-evolution.com/2015/12/20/study-shows-water-has-memory-german-scientists-expand-on-dr-emotos-work/
Homeopathy works in the same way, using this water memory, to bring about healing results in the body. -Valerie
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Just a quick reply. If you are familiar with the Cinchona bark experiment, you are surely aware that normally Cinchona bark does not produce *any* of the symptoms Hahnemann reported, except in hypersensitive individuals. Hahnemann was aware of that, yet held on to his theory. Do you seriously think this is the way to discover something ?
As for the water memory, you are correct, this is widely accepted. However, one has to work darn fast, because the lasting of this effect is in the femtosecond realm. *This* and *not* Beneviste or Emoto’s theses is widely accepted. A water memory according to Beneviste and Emoto violates the laws of thermodynamics, which in turn would require a rewriting of Physics, Biology, Chemistry, etc.
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Interesting comment about the hypersensitivity reaction in Hahnemann. No, that’s not the best way to test a theory or discover something, I would agree. However, sometimes many scientific discoveries are found in the most peculiar ways. Also all of the results from different homeopathic remedies were recorded in the Synthesis Materia Medica which does show the best homeopathic remedies used for certain conditions based on many case studies. All of these were not tested on Hahnemann alone.
It will be interesting what scientists find out in the future with water memory and if the laws of thermodynamics will have to be changed in the future. We shall see!
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Quote: “It will be interesting what scientists find out in the future with water memory and if the laws of thermodynamics will have to be changed in the future. We shall see! ”
Again, a theory (like the law of thermodynamics) is a scientific model that is extremely well established, so that a change is extremely unlikely. Indeed many “findings” with water-memory can not be replicated. Water memory as presented by Beneviste is pseudoscience.
Aside that, what you are presenting here is not even homeopathy. In homeopathy, a diagnosis does not count, only the totality symptoms. Therefore the statement to use arnica against some pathology does not make sense. In fact, Hahnemann himself rejected diagnoses. That has grave consequences. Assume two patients present with the same symptoms, one with a large polyp and the other with an early stage adenocarcinoma of the colon. These diseases cause largely the same symptoms. The homeopathic treatment of the first will be harmless, the one of the second will result in death. Think about it.
As for your case descriptions. I have read some of them. They are fraught with observational bias and post hoc ergo propter hoc fallacies. The false positive rate here approaches 100%. Within case descriptions are extremely strong sources of errors, therefore in medicine case descriptions are only a starting point, but almost never the proof.
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Excellent analyses Homeopthy works and works beautifully without side effects. Like this article to know Arnica.
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Thanks so much for your comment Narendra! It works incredibly! And without side effects so that’s a great plus!
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You are doing incredible work and I appreciate. Homoeopathy is a total cure of mind, body and soul. It is a contemporary therapy and it needs to be adopted for better health.
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Nice to read comments. I am a nurse and so have used conventional medicines. i have also used homeopathic remedies too. In my private practice in facial aesthetics, Arnica is one of the first things I recommend my patients take to reduce swelling and bruising and promote a quick healing response. High potency 200c immediately after treatment then 2hrly – 4hrly -6 hrly for 1 – 2 days depending on symptoms. Some pts only need a few doses.
I find Arnica especially important for reduction in swelling post lip enhancement when initial swelling could cause vascular compromise. A few pt’s I didn’t give Arnica to, as I thought they would be alright, ended up calling me 1st day post procedure worried about swelling and tightness of tissues. After review and having Arnica these pt’s phoned to say after 1st dose they noticed symptoms start to settle. But if a pt’s was not responding as quickly, as I would expect, when taking Arnica, then I would know there may be a more serious problem. For example an allergic reaction or potential vascular occlusion with dermal filler.
Despite my great first hand results, some colleagues don’t want to try homeopathy due to lack to documented research and due to the ‘bad press’ homeopathic medicine has been receiving.
On case reviews I often feel some of their pt’s would have benefited from treatment with Arnica.
I have suggested to these colleagues just to try Arnica on themselves to see how they themselves feel it helps in the healing process post treatment. Often those who are anti – homeopathy have just read about it and made a decision it doesn’t work despite never actually even trying it for themselves. Not even to be inquisitive and explore the new possibilities of it. If it really is little more than a placebo effect, then trying it won’t cause any problems. But the fact is that it does work and thats why so many people, especially in the aesthetics industry are really happy with its results and continue to use and recommend it.
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Tonya,
Thanks so much for sharing your story and experience with Arnica! It is very effective. Also, there are no drug interactions since it’s an energetic medicine, which is a great thing. Glad you have patients that also respond to it well.
Thanks so much again for sharing your experience and encouraging others to see homeopathy in a different light. I love the fact that a lot of people in the aesthetics industry use Arnica and have seen great success. Thanks again! – Valerie
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Lovely just what I was searching for.
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It’s exhausting to seek out knowledgeable folks on this topic, however you sound like you know what you’re talking about! Thanks
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