Cannabis and Wound Healing: A Narrative Review of Current Evidence and Applications to Facial Plastic Surgery.

Naimi B.; Hom D. · Journal of personalized medicine · 2026

**Background & Methods** This is a narrative review examining the relationship between cannabis use and wound healing with specific applications to facial plastic surgery. The authors synthesize current evidence on cannabinoid biology, surgical outcomes, and perioperative considerations for patients using cannabis products. **Key Findings** • Systemic cannabis use, particularly when inhaled or used heavily perioperatively, may be associated with increased surgical complications in selected populations, including infection, delayed healing, hematoma, nonunion, and reoperation; however, cannabis-only use was not associated with increased complications in mandibular fracture repair, whereas concurrent cannabis and tobacco use significantly increased rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. • Cannabinoids exert biologic effects through CB1 and CB2 receptors expressed in the central nervous system, immune cells, vasculature, and skin, influencing inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. • Preclinical and early dermatologic evidence suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair, though evidence specific to facial plastic surgery procedures (rhinoplasty, rhytidectomy, blepharoplasty, browlift, facial rejuvenation) remains absent. **Dosage & Administration** Not reported. The review notes that "cannabis use" encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, and topical CBD, without specified dosing parameters. **Safety & Adverse Effects** Associated complications include surgical site infection, delayed wound healing, hematoma formation, nonunion, abscess formation, and need for reoperation. Risk appears increased with systemic perioperative use and amplified when cannabis is used concurrently with tobacco or nicotine. **Evidence Quality** Evidence is limited by significant methodologic constraints: retrospective study designs, inconsistent exposure definitions, inadequate characterization of cannabinoid dose and route of administration, confounding by tobacco use and comorbidities, and small cohort sizes. No prospective studies or randomized controlled trials specific to facial plastic surgery were identified. The single most relevant facial surgery study evaluated only mandibular fracture repair. The authors note that the net effect of cannabinoid exposure on wound healing is likely context-dependent, varying by receptor expression, wound-healing phase, route, cannabinoid composition, local tissue environment, and patient-specific risk factors.

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