Before getting plastic surgery should I stop smoking, smoking marijuana, stop using CBD and what medications should I stop or keep taking?

At Atlantic Coast Aesthetics, we see patients from all walks of life who have all kinds of habits, both good and—less than ideal. Many of our patients are concerned about how various habitual factors such as drinking alcohol, smoking and marijuana or other drug consumption may impact their cosmetic surgery experience. In a recent Instagram Live chat, our Chief Medical Officer and founder, Dr. Thomas A. Pane, took a few minutes to discuss these habits and why it’s better to try to avoid them generally and before or immediately after surgery in particular. Here’s what Dr. Pane had to say about smoking and marijuana before cosmetic surgery.

During the chat, Dr. Pane pulled out an old T-shirt that he described as a “cultural artifact” with the Camel Cigarettes logo on the front and back. This kind of tee was used as advertising by the tobacco giant after sweeping legislation was passed banning “kid-friendly” cigarette advertising, eliminating iconic characters like the Marlboro Man and Joe Camel. Dr. Pane explained that nowadays, that sort of advertising is prohibited by law both for nicotine products and for medications. He pointed out that even having the name of a medication on a pen or a magnet, the kind of gimmicky souvenirs commonly given out by drug manufacturing reps, can influence someone’s decision to use those products or not, which is why that kind of marketing is frowned upon, especially when it is seen as targeted toward children.

Dr. Pane notes while it’s possible to test people for, say, nicotine use, he prefers not to because there’s simply not enough procedures where the presence of tobacco-derived nicotine can cause an issue to make it worth the added time and expense for the patient. If a patient is having a tummy tuck, for example, smoking is not good for the skin or the circulatory system, but the problematic effects can be neutralized to some extent through diligent aftercare practices.

He also points out that this also applies to nicotine vaping, because although cigarette smoke is terrible for you in general, it’s the nicotine which tends to cause the most problems in a surgical context. Nicotine is a vasoconstrictor, which restricts blood flow, especially to the extremities. Because blood flow is an essential part of the healing process, when blood flow is restricted, it conversely impacts the patient’s ability to form a scar and heal properly and as intended. Dr. Pane likens this to an interruption in the supply chain which allows the cells adjacent to the surgical site to work to heal it. If the cells cannot get the nutrients and essential building blocks they need, they can’t do their job as efficiently or effectively.

While marijuana smoke is not known to carry the same risk profile as tobacco or nicotine, largely due to a lack of current research on the subject, it is still generally best avoided. Any form of smoke contains particulates, tiny bits of matter which can infiltrate under bandages and into wounds. While the air you breathe has particulates from car exhaust to pollen to pet dander and dirt, adding unnecessary particulates into your immediate environment can adversely affect your healing process. Dr. Pane says the “golden rule,” if there can be said to be such a thing, is to avoid smoking or cannabis use for at least six weeks after surgery. At that point, the risks of possible problems go way, way down, but if you’ve managed to refrain for six weeks, why stop there?

Dr. Pane was also asked about CBD, a cannabis derivative separate from THC, the psychoactive component in most strains of marijuana which gets people high. This is associated with pain relief, stress relief and is often used to self-medicate for some sleep and anxiety disorders. Dr. Pane says he is not aware of CBD having a net negative or positive effect on wound healing, but as with marijuana and cigarettes, suggests patients who don’t absolutely need it should abstain during the perisurgical period and for the same reason: it’s simply adding a potential negative variable into the equation.

The final point Dr. Pane addressed was prescription medications. In many cases, he observes, people stop medications they don’t actually need to stop or which it could be actively dangerous to stop. Thyroid, blood pressure and diabetes medications were three in particular he noted patients should not stop. If someone recommends they do stop these, it’s a good idea to stop and ask for clarification, especially if the recommendation is coming from someone other than the healthcare provider who prescribed them to begin with. Anticoagulants, or blood thinners, are not usually addressed because of local laws in Miami which state anyone taking them is not a candidate for cosmetic surgery at an ambulatory surgical center. Patients on blood thinners are usually treated at a hospital or extended-care surgical center, and in these cases the medication would be stopped under the care and direction of whoever prescribed it.

Dr. Pane says most plastic surgeons would not consider someone on blood thinners a candidate, regardless of other factors. He says for him, such patients might be candidates depending on what the condition is, what the procedure is and what their primary care physician or the prescribing doctor says. He also stressed that the risk is not zero, as with any other medical procedure, but it can be reduced to a very, very low level if you set everything up the right way beforehand.

As with anything relating to surgery, it is always a good idea to consult with your primary physician and your cosmetic surgeon, so they can work in conjunction to ensure the safest and best possible outcome for your specific situation. You should always ask questions and ensure you’re clear on the risks, tradeoffs and expected outcomes, and educate yourself as to common risk factors for your lifestyle, habitual factors and patient profile. An informed patient is the best possible defense against potential problems arising from substance use, misuse, abuse or in prescription cases termination of use.

If you have a question about anything to do with cosmetic surgery, Dr. Pane and the staff of ACA welcome the opportunity to go over your interests and concerns. Simply call us at (561) 422-4116; email us at acplasticsurg.com/contact-us/; or follow us on Instagram, LinkedIn, Twitter and Facebook. Your question might be the focus of an upcoming Ask Dr. Pane segment, where you get straight answers and real talk about your cosmetic surgery interests. Remember, at ACA, we believe the only bad question is the one you DON’T ask!