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Nicotine Increases Risks During Plastic Surgery

By: Dr. Christopher Khorsandi


If you are an active smoker, you will likely be asked to refrain from smoking for a period of time before and after plastic surgery. Your surgeon will discuss this with you during consultation and emphasize the importance of adhering to these guidelines. But it is a difficult task to quit smoking, even for a few weeks. You may be tempted to ignore the directions entirely, or you might turn to nicotine replacement therapy such as using a vaporizer or chewing tobacco, thinking this a safer option. What you may not realize, however, is that either of these choices can seriously affect the outcome of your surgery.

The Culprit: Nicotine

The presence of nicotine in the body significantly increases a number of risk factors for those who undergo surgery. It is important to note here that the danger lies not just in smoking, but in any form of exposure to nicotine. This includes vaping, patches, gum, and even second-hand smoke. When nicotine enters the body, it causes an increase in both heart rate and blood pressure. It makes your blood vessels constrict, or narrow. This impairs the ability of these blood vessels to deliver oxygen to the tissues. Oxygen is vital to the healing process. The lack of sufficient oxygen and other nutrients necessary for healing can cause tissue necrosis, or skin death, and lead to many other complications.

Associated Risks

The use of nicotine results in an increased overall risk of complications following surgery. This is true for any surgery, not just plastic surgery. Some researchers estimate that smokers are as much as 40% more likely to have a major complication within a month of surgery than non-smokers. There is also increased risk for serious medical events such as:

  • Pneumonia
  • Heart attack
  • Stroke
  • Infection
  • Incision Separation
  • Delayed Wound Healing

In addition, research suggests that smokers experience more post- surgical pain than non-smokers following outpatient surgery. Within the realm of plastic surgery, some specific risks associated with nicotine use include greater potential for tissue loss, wound healing issues, infection, and increased likelihood of reoperation. The patients most frequently affected are those who undergo any form of flap surgery, such as a breast lift, face lift, or tummy tuck.

How to Minimize Your Risk

The best option, of course, is to quit smoking entirely. Patients are encouraged to take this opportunity to eliminate smoking from their daily activities. But while this is the ideal, it is not absolutely necessary. In order to minimize your risk of post-operative complications, you will need to abstain from smoking, chewing, vaping, and any other exposure to nicotine for a total of four to six weeks. The exact recommendations will vary between surgeons, but plan to stay away from nicotine for at least two weeks before and after surgery.

* All information subject to change. Images may contain models. Individual results are not guaranteed and may vary.