Electronic cigarettes (e-cigs) have increased dramatically in awareness and use over the past few years. In plastic surgery, just like in the rest of the society, we are seeing an increasing number of patients presenting in consultations or for surgery who use them. The number still pales in comparison to patients who use tobacco-based cigarettes but the incidence is sure to increase over the next decade.
The fundamental concept of e-cigarettes is that it simulates tobacco smoking but without many of the smoke-related dangers. It essentially uses a battery-powered vaporizer that uses a heating element to turn a liquid solution into water vapor. (hence the term ‘vaping’) The liquid solutions are glycerin and propylene glycol-based with flavorings. Many of the liquid solutions contain nicotine but nicotine-free liquids are also available. Users get the psychological pleasure of smoking by the hand-held device and the creation of a vapor and the taste of the flavorings.
The health benefits of vaping have been touted as being safer than tobacco products due to isolating inhalation down to just nicotine or even no nicotine at all. While logic would suggest that this is very likely, the medical community and the government have yet to weigh in on this issue with clinical studies. But that issue aside, with an estimated 3% of the U.S. population using them, what risk do they pose for a user undergoing plastic surgery?
For those who vape with liquids that contain nicotine, the postsurgical risks are the same as other nicotine replacement therapies such as gum and patches. Nicotine is a potent vasoconstrictor so procedures that raise extended skin flaps that rely on dermal perfusion for viability (e.g., facelifts, tummy tucks, breast reduction/lifts) are at risk. Patients who vape need to switch to non-nicotine containing liquids for their liquid solutions two weeks before and after surgery use. These would be the same recommendations that have been given for tobacco products for years.
Besides counseling our regular smoking patients about the necessity to cease smoking before and after plastic surgery, an alternative suggestion can be to have them switch to e-cigarettes during this period. As long as they use a non-nicotine solution, vaping can be a substitutional habit as a bridging therapy during the perioperative period.
Dr. Barry Eppley
Indianapolis, Indiana