Marketed as a kinder, gentler smoking alternative, vaping has steadily gained popularity in recent years — particularly among Gen Z. Though the rate of traditional cigarette smoking continues to decline, statistics show that the two habits go hand in hand. For young adults, vaping often leads to smoking, and about half of adult vapers also smoke.
The dire health consequences of smoking (think: heart disease, lung disease, lung cancer) are well documented. According to the Centers for Disease Control and Prevention (CDC), cigarette smoking leads to a 1,300 preventable deaths per day. Yes, you read that correctly. And, while the effects of vaping over time have yet to be fully realized, there is plenty of research to suggest the toxic chemicals created by e-cigarettes are highly hazardous.
So, if that’s what smoking and tobacco usage is doing to our bodies, what impact does it have on the skin? How much does smoking and vaping (even secondhand) affect our complexion, our capacity for healing, and our oral health? And can any of those changes be reversed? For answers, we turned to board certified dermatologists, plastic surgeons, and dentists.
Smoking vs. Vaping: What’s the Difference?
Traditional cigarettes contain ground tobacco leaves mixed with a nicotine extract, glue, sugars, ammonia (to increase the bioavailability of the nicotine), flavorings, and other chemicals — including some 600 additives that are approved by the U.S. Food and Drug Administration (FDA) for ingestion, but are hazardous when combusted and inhaled. When lit, cigarette smoke carries 7,000 different chemicals (including 70 known carcinogens) into the lungs.
E-cigarettes, on the other hand, deliver the chemical cocktail via aerosol rather than smoke. The term ‘vaping’ is actually a misnomer, as the liquid isn’t simply turned into a gas. Instead, it’s a mixture of the liquid solution and the metal particles from the heating coil. The liquid itself contains over 60 chemicals that multiply into volatile organic compounds, carcinogens, and heavy metals as the liquid becomes aerosolized.
One of the factors that makes e-cigarettes so popular amongst young adults is the flavor offerings, but research shows the additives in flavored vaping liquid are particularly toxic — especially in combination. While adults often turn to vaping as a ‘safer’ alternative to tobacco products, evidence indicates that the practice may just prolong their unhealthy habit and bring an increased risk of vaping-related disease.
Smoking and Vaping by the Numbers
The CDC reports that about 34 million Americans smoke cigarettes, and 16 million people are living with a smoking-related disease. More than 10 million U.S. adults use vaping products, and studies estimate that about half of those vapers are also smokers. A study published in JAMA Pediatrics by Truth Initiative, a non-profit organization aimed at curbing tobacco use, found the percentage of teens and young adults (ages 15 to 34) who have ever used JUUL (a type of e-cigarette) more than doubled between 2018 and 2019. Young people who vape are about four times more likely to become cigarette smokers.
Impact of Smoking and Vaping on the Body
The detrimental effects of smoking are commonly known, and preliminary research suggests that vaping — though perhaps not as deadly as cigarettes — carries its own set of health risks. Both smoking and vaping cause lung inflammation, which can lead to the telltale ‘smoker’s cough,’ as well as chronic conditions like bronchitis, asthma and emphysema. The CDC includes smoking among the risk factors that would make someone immunocompromised and at an increased risk of contracting COVID-19.
The inflammation decreases lung function — meaning every cell in the body is getting less oxygen as a result. Furthermore, nicotine constricts blood vessels, which leads to cells also receiving less blood. It goes without saying, but oxygen- and nutrient-deprived cells are inherently less healthy.
Ultimately, these internal deficiencies manifest externally on the skin, hair, and mouth.
How Smoking and Vaping Affect the Skin
Without proper blood circulation, your skin doesn’t receive the support necessary to stay lifted, firm, and radiant. Both combustible and electronic cigarettes expose your body to free radicals, while depleting levels of vitamins A and C — antioxidants that play important roles in collagen and elastin production.
The result of nutrient deprivation? Premature aging in the form of dryness, enlarged pores, sagging, wrinkling, hyperpigmentation, and uneven texture. And it doesn’t just impact the area around the mouth, where those mechanical ‘smoker’s lines’ appear. Studies of identical twins show that smoking contributes to crow's feet around the eyes and forehead wrinkles, too. It has also been identified as a cause of sagging skin on the breasts and arms.
Addressing these concerns requires a combination of techniques. “Lasers, microneedling, peels, and skincare can all be used to reverse and improve the effects of smoking,” says Jason Emer, MD, a West Hollywood-based board certified dermatologist. For deep smoker’s lines around the mouth, he recommends more aggressive treatments like dermal filler, deep chemical peels, and ablative CO2 laser skin resurfacing.
While current smokers and vapers may see some improvement from professional procedures, Dr. Emer says patients who quit have the best results. “We can never completely reverse all the signs of damage from smoking and inhaled toxins on the skin,” he explains. “But regular, ongoing anti-aging treatments that resurface, tighten, and stimulate collagen will help.” He recommends treatment every three to four months for patients seeking a significant improvement.
Beyond premature aging, smoking tobacco cigarettes has been implicated as a risk factor in chronic skin conditions like acne and psoriasis, as well as autoimmune disorders like lupus (which often affects skin) and acne inversa. Furthermore, smokers are twice as likely as nonsmokers to suffer from squamous cell carcinoma and are at an increased risk for melanoma — two common forms of skin cancer.
How Smoking and Vaping Compromise Wound Healing
While quitting can slow skin’s premature aging process, most smoking- and vaping-related wrinkles and sagging are best corrected with surgery. This brings up another important consideration: Many plastic surgeons count nicotine use as a significant risk factor, and may refuse to perform certain procedures on smokers/vapers.
Richard J. Brown, MD, an Arizona-based board certified plastic surgeon and author of the Real Beauty Bible, has a zero tolerance policy. “Patients sometimes ask me if they can just ‘sign something,’ so they can continue smoking through their surgery and recovery process,” he shares. “I tell them it’s just way too risky — for both of us.”
Because nicotine is a vasoconstrictor, any incisions made during surgery will receive less blood during the healing process. With fewer nutrients and immune cells reaching the wound, clotting problems, infection, and cellular death are more likely to occur. “Anybody who has nicotine in their system is running the risk of their skin and underlying tissue turning black and dying after surgery,” Dr. Brown warns.
How Smoking and Vaping Harm the Hair
Though the evidence isn’t conclusive, there is research that links smoking cigarettes to hair loss and graying. The theory is that the combination of blood vessel constriction, inflammation, toxicity, and hormone imbalance damages hair follicles. “There is not perfect evidence on the impact of smoking and hair loss,” says Benjamin Paul, MD, a facial plastic and reconstructive surgeon in New York City who specializes in hair restoration. “But we do know that nicotine constricts blood flow to the scalp, and that blood flow is critical for hair growth. It would then make sense that smoking would negatively impact hair growth.”
Non-surgical hair loss treatments include oral and topical supplements like finasteride and minoxidil, as well as treatments like platelet-rich plasma (PRP) injections. On the surgical end of the spectrum, hair transplants remain the gold standard, and Dr. Paul cautions against using any kind of nicotine product post-op. “Nicotine is especially dangerous in the recovery after hair transplant,” he explains. “Blood flow is critical to bring nutrients and oxygen to the recipient site.”
How Smoking and Vaping Damage Oral Health
For starters, let's clear something up: e-cigarettes are damaging to oral health, too. New York dentist Alina Lane, DDS, says she’s seen an increase in patients who vape because they think it’s less harmful than traditional cigarettes. “Many have taken up vaping nicotine, THC, or even CBD oil as a new hobby,” she reports. “Ultimately, I believe this will lead to an increase in oral diseases, which can be prevented by avoiding smoking.”
These diseases, Dr. Lane says, include oral cancer, gum recession, tooth decay, and gum disease. Because the body’s natural healing processes are suppressed, smokers and vapers will also experience increased failure of dental implants and poor healing after tooth extraction. Oh, and then there is the spike in fractured teeth due to an increase in grinding from the stimulant (i.e. nicotine).
Nicotine stains teeth yellow over time, which is often the first side effect that smokers and vapers recognize, according to Dr. Lane. In addition, vaping liquid does its own damage. “Vegetable glycerin and flavorings — which give the vapor it’s appealing smell/taste — are known to increase the adhesion of bacteria to the surface of teeth and reduce the hardness of enamel, resulting in more discoloration and tooth decay,” she says. Gum recession, meanwhile, can make teeth appear older and cause sensitivity.
Some of these conditions are treatable. Professional or at-home teeth whitening treatments can alleviate stains, while sensitivity-minded toothpastes can generally help with recession-related pain — though more invasive measures are usually required. “Gum recession is one condition that typically requires gum surgery and grafting to correct,” Dr. Lane explains. “With periodontitis and bone loss around teeth, it is possible to stop or slow the progression of disease, however, it is not possible to regain lost bone.”
The best way to prevent smoking and vaping related oral conditions? Shake the habit. Until then, Dr. Lane advises practicing proper hygiene and avoiding dietary sugar. “Thoroughly brushing twice a day for two minutes and flossing at least once daily will help to prevent or minimize gum inflammation and tooth decay,” she shares. “Visiting your dentist for regular check-ups will help catch and treat problems, such as tooth decay, early.”
Just in case you needed one more reason to not inhale, secondhand smoke and secondhand vaping aerosol are just as hazardous to the health of those around you. If you or a loved one is trying to quit, here are a few resources to help get you started: American Cancer Society Quit for Life, American Lung Association Lung Helpline and Tobacco Quitline, National Cancer Institute Smokefree, and National Cancer Institute Smokefree Teen.
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