With medical and recreational marijuana becoming more widely available, more people are smoking than ever before. However, when it’s time for surgery, marijuana use is often downplayed or not mentioned at all. A recent study in Plastic and Reconstructive Surgery highlights the importance of being honest with your plastic surgeon about your marijuana use. Conducted at Montefiore Medical Center, the study found that many marijuana users had higher levels of nicotine in their systems than they disclosed during consultations. These findings raised concerns about potential surgical risks, like delayed healing and other complications.
Featured Experts
- George Sanders, MD is a board-certified plastic surgeon based in Encino, CA
- Mokhtar Asaadi, MD is a board-certified plastic surgeon in New York, NY
- Bradley Bengtson, MD is a board-certified plastic surgeon based in Grand Rapids, MI
The Marijuana Nicotine Overlap
The study surveyed 135 patients seeking elective surgery and found a clear connection between marijuana and nicotine use. Half of the patients reported no substance use, while 19 percent were nicotine users and 7 percent used marijuana. Interestingly, 13 percent said they used both, and 11 percent were former users. The most surprising finding came from urine tests. Marijuana users who said they didn’t use nicotine had higher levels of nicotine in their systems. This finding suggests that some patients may not be willing to share their nicotine use during consultations.
Why Honesty with Your Surgeon Matters
As reported by Physician’s Weekly, less than a third of patients who were actively using marijuana or nicotine reported their usage before surgery. Although the study found no direct link between elevated nicotine levels and bad surgical outcomes, the researchers concluded that underreporting can still be risky. Smoking cigarettes has long been associated with delayed wound healing.
“In clinical settings, underreporting of nicotine-containing product use, including marijuana, remains a concern for unrecognized surgical risk, and affects the decision on offering elective procedures,” wrote the study authors. “Despite that, a correlation between a positive urine test result and negative surgical outcome has not been demonstrated.”
Grand Rapids, MI, plastic surgeon Bradley Bengtson, MD, says he and his staff are very clear with their patients. “We ask specifically about tobacco use separately from marijuana and vaping,” he says. “We ask patients to stop smoking for a minimum of six weeks before and after surgery. We also confirm this on the day of surgery, although we do not conduct testing. If a patient is undergoing a skin flap-based surgery like a facelift or mastopexy, I limit skin elevation and tension, and I inform them that the outcome may be compromised. I place the responsibility on them as much as possible and ensure the team documents these discussions.”
“We ask all of our patients to discontinue any CBD, marijuana, or nicotine-containing products for two weeks before and two weeks after surgery,” adds Encino, CA plastic surgeon George Sanders, MD. “Although we could perform a nicotine test to discover whether people are really telling the truth about nicotine usage, that is rather distasteful to me since doing that implies that we don’t take patients at their word. This is not the type of doctor-patient relationship that I wish to have.”
The Bottom Line: Trust is Key
Being open with your plastic surgeon about any substance use—whether it’s nicotine, marijuana or vaping—is essential for your safety and the success of your procedure. While sharing might feel uncomfortable, your surgeon’s priority is to provide the best possible care and outcomes. By being honest, you help them make informed decisions, minimize risks and take the necessary precautions for a smooth recovery.
“Nicotine has many harmful effects, impacting the cardiovascular system, contributing to cancer, gum disease, and other conditions,” says New York plastic surgeon Mokhtar Asaadi, MD. Even though the study found no direct correlation between elevated nicotine levels and poor surgical outcomes, hiding this information could jeopardize your health. “The vasoconstrictive effects are particularly harmful, especially when performing procedures like facelifts where we lift the skin, such as behind the ears,” he adds.
Your surgeon is there to guide you through the process. Transparency builds trust and ensures you’re both on the same page so you can safely and confidently achieve the best results from your surgery.
