Substances used for smoking hookah need not be completely dry. The most commonly used substance (known as tobamel or maassel) is a 1:2 mixture of tobacco with a sweet substance such as honey, molasses, or semi-dried fruit. Originally tobacco was mixed with one of these sweeteners to form jurak (e.g. Zhaghoul brand), a flavorless, moistened tobacco. Fruit-flavored shisha got its start in the late 1980s when Egyptian tobacco companies experimented with flavored tobacco as a way to transition people away from cigarette smoking. Today, shisha tobacco comes in many flavours, such as apple, strawberry, melon, cappuccino or mint, and is often mixed with dried fruit extracts.

In a hookah, tobamel (maassel) is not directly ignited but is heated to a high temperature using lit coals. These coals rest on a metal mesh or perforated aluminum foil which covers a clay or metal bowl containing the tobacco. When a user inhales through the hose, the coals heat the shisha, producing smoke. The smoke then enters the body of the hookah, passing through a glass receptacle containing water which filters and cools the smoke. The smoker inhales this smoke through a long hose with a mouth piece. This filtration is suggested to filter out, in part, tar and nicotine from the tobacco. However, most brands of shisha tobacco generally contain a mention saying "no tar" and very small amounts of nicotine (0.5%) to begin with.

Due to the mechanics of the hookah, multi-person hookahs exist, where multiple hoses lead to a single tobacco chamber. These are popular in the Western world where hookah smoking is a social phenomenon.