Austin Texas Board Certified Plastic Surgeon

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Electronic Cigarettes and Cosmetic Surgery: Be Safe – Quit Before You Go Under the Knife

Electronic cigarettes are a smoking alternative that generates a vapor that is inhaled into the lungs of the user. The vapor contains many chemicals including nicotine. At present, electronic cigarettes represent a billion dollar industry. This pales in comparison to the tobacco cigarette market, but it is predicted that in the next ten years sales of electronic cigarettes will be equal to those of their tobacco containing counterparts. The increasing use of electronic devises creates the need for more information and discussion about how their use impacts cosmetic surgery and healing from cosmetic surgery. First, it is helpful to understand the effects of smoking traditional tobacco cigarettes.

Smoking traditional tobacco cigarettes has detrimental effects on tissue healing that are well established in the scientific literature. For this reason smoking is discouraged, often prohibited, for up to four weeks prior to, and for up to two weeks following, elective cosmetic surgery by most surgeons. Tobacco contains many chemicals that alter human physiology in a manner that brings about poorer results in wound healing and thus increased risks of complications with elective cosmetic surgery.

One way to categorize these tobacco smoke related chemicals is to think of them in two large categories: 1) toxic smoke and 2) nicotine. The toxic smoke components contribute the general tissue damage and increased risks of cancer associated with smoking tobacco. Furthermore, two toxic substances, carbon monoxide, and hydrogen cyanide, have direct negative effects on the cells and cellular activities needed for wound healing. Nicotine also has a direct negative effect on wound healing by causing vasoconstriction, narrowing of the blood vessels. Thus, nicotine reduces the flow of blood to healing tissues depriving them of the oxygen and nutrients they require to rebuild and regrow.

Electronic cigarettes (aks: e-cigarettes or personal vaporizers) are high-tech elctro-mechanical devises designed to replicate the experience of smoking. They generate at a fine vapor or mist that is inhaled, just as smoke is inhaled. The vapor is created by heating a liquid within the e-cigarette that contains a variety of substances and chemicals. The liquid, and thus the vapor, do not contain the majority of the components found in cigarette tobacco that contribute to toxic smoke. The liquid does, however, contain variable quantities of nicotine. Recall that nicotine causes vasoconstriction of blood vessels headed to healing wounds following surgery.

How does this information apply to the issue of electronic cigarette use and cosmetic surgery? Should electronic cigarettes be avoided prior to elective cosmetic surgery just as traditional tobacco cigarettes use should be discontinued prior to and following surgery? Some point to electronic cigarettes as useful tool in the process of quitting tobacco use and site the absence of toxic smoke as an endorsement of increased safety. There are some in the medical community who stop way short of saying that electronic cigarette use is safe but speculate that it might be safer that tobacco smoking. These comments relate more to the effects on overall health and not directly to healing following surgery.

Electronic cigarette use is very recent phenomenon there is very little direct evidence that sheds light on the effect of electronic cigarette use and cosmetic surgery. To this point, as of June 16, 2013 there were only 3 “direct hits” found on a good search of “electronic cigarettes and wound healing” and only a handful when searching “electronic cigarettes and cosmetic surgery. The newness of electronic cigarettes aside, it is important to point out that The World Health Organization notes there are no rigorous, long-term studies that demonstrate the safety of electronic cigarettes. Given that electronic cigarettes contain nicotine, and nicotine causes a reduction in blood flow to healing wounds, it’s a reasonable hypothesis that there may be a negative effect on healing form cosmetic surgery. It is important to note, that most plastic surgeons regard the use of nicotine gum or patches as approximately, if not equally, harmful to the process of healing as cigarette smoking alone. That sentiment points to how powerful the negative affect of nicotine induced-vasoconstriction actually is on healing after surgery. Furthermore, early FDA analysis of electronic cigarette vapor demonstrated the presence of harmful and even cancer-related chemicals. The significance of these studies has been questioned by the electronic cigarette industry but it suggests the presence and quantities of these substances is worth further investigation.

So in summary, electronic cigarettes are an alternative to traditional tobacco cigarettes which deliver a nicotine containing vapor. The negative effect of nicotine on wound healing and related negative effect on safety and good results in cosmetic surgery is well established and know to be the result of reduced blood flow to healing tissues among other things. Thus, in absence of evidence to the contrary is is likely safest to consider electronic cigarette use should to be hazardous in relationship to cosmetic surgery and should be avoided for four weeks prior to and for a least two weeks following planned surgery. This article is for general educational purposes and should not be construed as direct medical advice. Consult with your plastic surgeon to inquire how you should address the use of electronic cigarettes and cosmetic surgery.

 

Adam Bryce Weinfeld, MD

June 16th, 2013

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