Risk of Marijuana Use in Plastic Surgery Patients

The use of cannabis (marijuana) is common among individuals considering plastic surgery and has been associated with higher levels of nicotine in lab tests. "We found that patients who report using marijuana also have increased levels of urine nicotine and cotinine, even if they do not smoke or use other nicotine-containing products," explains ASPS Member Surgeon Joseph A. Ricci of the Hofstra University School of Medicine in Great Neck, NY. This suggests that there may be a connection between undetected nicotine intake and a higher risk of surgical complications(1^✔ ✔Trusted Source
Patterns of Marijuana Use and Nicotine Exposure in Patients Seeking Elective Aesthetic Procedures

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Health Risks of Marijuana and Nicotine

The rising prevalence of marijuana use raises concerns about potential side effects in surgical patients. Marijuana smoke contains carcinogens and irritants that are also found in tobacco smoke, with similar adverse effects on lung health.

Nicotine hinders wound healing, which is particularly worrying for individuals undergoing plastic surgery. Healthcare providers face challenges in identifying patients who are exposed to nicotine due to the increasing popularity of marijuana and modern nicotine delivery technologies, such as vapes, as patients themselves may be unaware of it.

Dr. Ricci and colleagues examined the possible link between marijuana use and nicotine exposure in 135 consecutive patients who consulted a surgeon to discuss cosmetic plastic surgery. 29% of patients were women; the average age was 38 years. The patients were largely Hispanic, reflecting the demographics of the area served by the clinic.

Nicotine Levels in Plastic Surgery Patients

In a survey, 19% of patients reported active nicotine use while 20% reported marijuana use: marijuana alone in 7% of patients and both nicotine and marijuana by 13%. Levels of nicotine and the nicotine metabolite cotinine were compared between groups.

The results showed elevated nicotine and cotinine levels among patients who said they used marijuana. The association was apparent not only in those who reported nicotine-containing products but also in those who denied any type of nicotine use.

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Although marijuana users had elevated nicotine, the levels weren't as high as typically found in patients who smoke or use other forms of nicotine. Most patients who reported marijuana and/or nicotine use on the study survey did not mention these substances during their discussion with the plastic surgeon. For this group, nicotine levels were comparable to those in active cigarette smokers.

"Patients may be hesitant to disclose their substance use history, possibly due to a lack of awareness about the perioperative risks associated with smoking and marijuana use," the researchers write. In 84 patients who went on to have plastic surgery, nicotine levels were lower compared to patients who did not undergo surgery.

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Although the study did not find increased complication rates among marijuana users or those with elevated nicotine levels, the findings raise concern that such risks could occur. The researchers emphasize the need for definitive studies of the effects of marijuana on surgical outcomes. Meanwhile, Dr. Ricci and coauthors conclude: "In real clinical settings, under-reporting of nicotine-containing product use, including marijuana, remains a concern for unrecognized surgical risk and affects the decision on offering elective procedures."

Reference:

1. Patterns of Marijuana Use and Nicotine Exposure in Patients Seeking Elective Aesthetic Procedures - (https:journals.lww.com/plasreconsurg/fulltext/2024/09000/patterns_of_marijuana_use_and_nicotine_exposure_in.19.aspx)

Source-Eurekalert