CBD & Plastic Surgery: Is it Safe?

From vape-able oils and edible gummies to topical salves and smokable flowers, CBD seems to be everywhere you look. It does not have psychoactive effects and thus is often seen as a “safe” option for managing pain and other concerns—but CBD users still need to understand how it can affect the body when it comes to having plastic surgery, as it can potentially compromise your safety and results.

To clear up any misconceptions you may have around the use of CBD, board certified Fairfax plastic surgeon Dr. Christopher Hess is answering your top 5 questions about CBD and plastic surgery.

1. What is CBD?

Cannabidiol (CBD) is one of over 100 cannabinoids found naturally within the Cannabis sativa plant. Unlike cannabis’ sister cannabinoid, THC, CBD is non-psychoactive, meaning there is no “high” or altered state associated with its use. While numerous studies suggest that CBD can improve a range of ailments including epilepsy, insomnia, and mental health disorders, research on CBD is still in its infancy, and the development and promotion of CBD products have far outpaced medical studies on the drug.

2. Is CBD safe to use before and after plastic surgery?

While CBD does appear to have potential benefits for some people due to its anti-inflammatory and antioxidative properties, I advise my patients not to use CBD products in any manner in the weeks before or after undergoing plastic surgery. There are many reasons for this:

• CBD is not regulated by the federal government, except for a prescription drug approved to treat seizures. In fact, the FDA states that limited data on CBD indicates “real risks that need to be considered.”
• CBD may contain potentially harmful contaminants. Since CBD is most often derived from commercially-farmed hemp plants that have been exposed to a range of pesticides and herbicides, many products routinely test positive for potentially-harmful chemicals, heavy metals, bacteria, and fungi. (In 2018, the FDA found that many synthetic cannabinoid products had been contaminated with an ingredient used in rat poison.)
• CBD is known to cause tiredness, diarrhea, and weight gain. Since your body will already be working overtime after your surgery, these symptoms will only place more strain on your body, potentially affecting your recovery and results.
• CBD can have a mild blood-thinning effect that could potentially inhibit blood clotting during and after surgery, resulting in unwanted bleeding.
• It is very difficult to verify the potency of CBD products. In a 2017 Dutch study, 18 out of the 46 CBD products sampled contained less than 0.1% CBD. Additionally, 26 out of the 46 samples had THC levels greater than 1%, with one sample containing as much as 57.5%.

I advise my patients not to use CBD products in any manner before or after undergoing plastic surgery.

3. How long before my plastic surgery should I quit using CBD? When can I resume using it?

CBD has a half-life of 1-2 days, meaning it takes about 2-4 days for the drug to fully leave the body. Airing on the side of caution, I suggest patients cease taking any CBD products at least 2 weeks before undergoing plastic surgery, along with any vitamins, supplements, nicotine, and blood-thinning medications. If you are concerned about withdrawal symptoms from stopping CBD, you should consult your primary doctor prior to doing so; he or she may help you taper off it or recommend additional support.

You should cease taking all CBD products at least 2 weeks prior to surgery, and wait to resume them until you are off all prescription medications.

If you choose to continue using CBD after your surgery, I encourage you to wait until you are finished taking all prescription painkillers and antibiotics, as CBD can interact with these medications (more about this below).

4. Is marijuana safe to use before & after plastic surgery?

Many people incorrectly assume that marijuana is safe to use before and after plastic surgery because it is legally used medicinally and even recreationally in some states. The truth is, marijuana can have a variety of undesirable effects on the body, which can affect your surgery and recovery. Here are a few:

• Marijuana affects the central nervous system, therefore regular marijuana users may need larger amounts of anesthesia (up to 3 times as much). Larger amounts of anesthesia can lead to issues like low blood pressure and delayed awakening from anesthesia.
• Marijuana is a vasodilator, meaning it has a dilating, or widening, effect on blood vessels, raising your resting heart rate and making the heart pump harder. In fact, research suggests the risk of heart attack is several times higher in the hour after smoking marijuana. Some sources claim that CBD may have similar effects on the cardiovascular system.
• Marijuana may increase pain. Although marijuana has been shown to reduce chronic pain in some patients, a recent study presented at the American Society of Anesthesiologists found that patients undergoing surgery who regularly used marijuana reported greater levels of pain and needed 58% more opioids per day than patients who did not regularly use marijuana.

For the above reasons, it is critical that you stop using marijuana in all forms at least 2 weeks before surgery and inform your plastic surgeon about your use. Similar to CBD usage, I recommend you do not resume using marijuana until you are off all prescription medications and antibiotics.

What about delta-8 and other THC-like products?

Delta-8 THC is another cannabinoid found in the cannabis plant that is legally available in certain states. Unlike CBD, delta-8 has psychoactive and intoxicating effects similar to THC.

Delta-8 is also not approved or regulated by the FDA. It has been known to cause adverse reactions like vomiting and hallucinations, and often contains added chemicals needed to convert other cannabinoids into delta-8 THC. We recommend patients treat delta-8 THC and other THC-like products similar to marijuana and follow the above recommendations for ceasing and resuming their usage.

5. Can CBD interact with any other medications?

Yes. According to the FDA, taking CBD with other medications may increase or decrease their efficacy due to CBD’s effects on liver enzymes. This may include herbal supplements, OTC drugs like ibuprofen and acetaminophen, anesthesia, psychiatric drugs, painkillers, antibiotics, and all other prescription drugs.

Discuss your CBD use with your plastic surgeon during your personal consultation

Before undergoing any plastic surgery procedure, it is important that you discuss any substances and medications you are using or have recently used with your plastic surgeon. This is not to shame you or make you feel uncomfortable, but rather to ensure your surgeon and anesthesiologist have the information they need to maintain your safety and comfort during your procedure. Schedule a judgment-free consultation with Fairfax plastic surgeon Dr. Christopher L. Hess to begin your journey towards a smooth plastic surgery and recovery.