To true devotees of the pursuit of beauty, the recipe for retaining youth and gorgeousness appears to involve tinkering with what's inside as well as what's outside.

A newly published survey has found that 55 percent of cosmetic surgery patients take herbal supplements, compared with only 24 percent of similar people not undergoing surgery.

University of California, Los Angeles, researchers said they worried that these supplements, in rare cases, might add to the complications of surgery.

Published in February's issue of the journal Plastic and Reconstructive Surgery, the report also found surgeons performing such surgeries are frequently unaware of the supplements' effects, or even that their patients are taking them.

The study compared 100 adults (95 women and five men) older than 40 who went to UCLA for cosmetic plastic surgery treatments with 100 adults of a similar gender distribution who were not getting cosmetic surgery.

Subjects were asked about 13 herbs and supplements that are either top sellers or have the greatest potential to cause complications after surgery.

The researchers found that the most commonly used herbs and supplements were ephedra (18 percent), chondroitin (18 percent), echinacea (14 percent) and glucosamine (10 percent). All 55 of the surgery patients taking herbs used at least two supplements, at least one every day.

"In one sense, it seems ironic that something like taking a natural substance is being used by people getting plastic surgery," said Dr. James Bradley, associate professor of surgery at UCLA, and one of the study's authors. "But when you look at it carefully, that population is looking for self-improvement. They are using both herbs and plastic surgery to rejuvenate themselves."

Bradley said he and his colleagues undertook the survey because they found that many of their plastic surgery patients took herbs and supplements but neglected to inform their surgeons before having facelifts, breast augmentations and abdominoplasties.

Bradley said he had only anecdotal evidence of any dangerous side effects from herbal ingestion during or after plastic surgery. For example, one plastic surgeon in the study said he had a patient who bled heavily after her facelift and found the only medication she had taken was garlic.

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