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Is It the Nicotine Itself That Constricts Blood Vessels?

2 surgeons referred to nicotine in restricting blood vessels. This confused me, as the popularity for imitation cigarettes is becoming more popular in helping smokers to stop inhaling all the other more dangerous chemicals. Would a surgeon still refuse to perform a facelift on a woman who uses these inhalers but has stopped smoking cigarettes?

Doctor Answers 19

Smoking and facelifts

 The use of nicotine, whether by conventional cigarettes or electronic, severely compromises bloodflow to the skin which can lead to devastating complications following facelift. Tobacco itself also contains several other toxic substances which damage the small vessels within tissue. This should mean that electric cigarettes are mildly less dangerous than conventional, though there is, as yet, and absence of any real data to support this. If you are considering facelift surgery, you should refrain from using all nicotine based products for at least eight weeks preoperatively and post-operatively. 

Smoking and surgery

Here are the major points of smoking Tobacco or Marijuana before or after surgery:
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 37 reviews

Use of Nicotine Increases Chance of Necrosis, Tissue Loss & Severe Scarring Following Facelift

Skin necrosis, tissue loss and severe scarring, following facelift surgery are devastating problems.  The use of nicotine products has been shown to increase the incidence of this complication.  For this reason, all types of nicotine should be avoided before and after facial rejuvenation surgery.

Nicotine causes vasoconstriction of blood vessels which results in decreased blood flow to the skin.  This results in decreased oxygen delivery to the skin.  Any procedure that requires the elevation of skin flaps can be adversely impacted by this phenomenon.  For this reason we generally, recommend that patients not use nicotine products for 4 to 6 weeks prior to surgery.  This includes cigarettes, Nicorette gum, patches and anything else that contains nicotine.

Nicotine and facelifts

When one smokes, or uses tobacco, there is vascular constriction. Nicotine is a major vasoconstrictor.  There are others in tobacco as well.  Good wound healing is all about getting enough blood supply to the area. In a facelift operation the thickness of the flaps are thin, making the bloodflow even more important. The incision will also be put on some tension. Tension is the enemy of good wound healing, and coupled with decreased blood flow in smokers, finds the patient at higher risk of wound problems. The SMAS facelift  technique is excellent, but the surgeon has to work with the tissues given. Our office does not do facelifts on smokers. Some respected colleagues still may do them, but usually the extent of the dissection is less. Please stop smoking, (for dozens of reasons). If the prospect of a facelift is a motivation to quit, then so be it.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.5 out of 5 stars 13 reviews

Nicotine and Surgery?

Safety should always be the primary concern in any procedure. The goal of all plastic surgeons that perform facelifts is to improve the appearance with minimal side effects or problems. Exposure to smoke, either directly or indirectly, or the use of any nicotine releasing products, has been shown to increase the incidence of serious complications after facelift surgery and in most other cosmetic or reconstructive procedures. Most plastic surgeons refuse to perform facelifts on patients who are active smokers or are using nicotine in any form. It is generally recommended that all smoking or the use of any nicotine releasing products should be completely stopped at least 10- 14 days before a facelift, and for a minimum of 10-14 days after the surgical procedure. Ideally, one should stop permanently, not just because of its effect on aging, but from an overall health perspective.

All wound healing depends on blood supply. The blood flow to the skin and underlying tissue is diminished by smoking, which constricts the small blood vessels. Smokers have a significantly higher rate of delayed healing, infection, opening of the incisions, necrosis or loss of the facial skin that is elevated and the underlying tissue, poor scarring, and anesthesia problems.

Be honest with your plastic surgeon who should be certified by the American Board of American Plastic Surgery and ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) about your exposure to smoke and follow all instructions. Remember that you are a participant in your care.

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.5 out of 5 stars 16 reviews

Nicotine Products and Facelift

   Any products that contain nicotine should not be used within a week before a facelift and for at least 6 weeks after facelift.  Find the plastic surgeon with ELITE credentials who performs hundreds of facelifts each year.  Kenneth Hughes, MD Los Angeles, CA

Nicotine can constrict your blood vessels

And the result could be that you could lose some of your skin and lead to more scarring. You should stay away from nicotine and especially smoking 2-4 weeks before and after your procedure.

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 43 reviews

Nicotine and surgery

Nicotine in all its forms retards healing after surgery. The vasoconstriction of the blood vessels is only one of the deleterious effects .It also retards the production of fibroblasts the healing cells themselves.. Why smoke. Isn't there enough evidence it harms you..duh

Richard Ellenbogen, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 19 reviews

All Nicotine Products are Dangerous prior to surgery

Great Question to ask - The Answer is it is the Nicotine that causes the harm by constricting blood vessels... Many patients think it is the act of smoking rather than the nicotine that causes the problems.My experience is that the less nicotine the better and the longer you have stopped prior to surgery the better. A recent scientific article in the Archives of Internal Medicine indicated that, among all forms of surgery, quitting smoking/nicotine eight weeks prior was never associated with an increased risk of complications. Three weeks is better than two, but 2 months would even be better. Most experts unanimously agree that nicotine in any form increases the risk of most surgical complications significantly. Just about all plastic surgeons strongly recommend women  to stop smoking and all nicotine products well in advance of all plastic surgery and especially lift procedures..  Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.
Here is the reason why: the nicotine in cigarettes and other tobacco products (including Nicorette gum, patches, etc) is a vasoconstrictor, meaning it makes the Smoking is a significant multiplier of many potential complications following surgery and breast augmentation with implants are no exception. Nicotine from smoking causes blood vessels to constrict ( spasm or  tighten up). Over time, these constricted arteries and capillaries deliver less blood to the tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as tissue sloughing (death by necrosis) and infection.  General complications of surgery such as blood clots, anesthetic problems such as pneumonia are also increased.

As an aside most people are unaware that smoking greatly accelerates the age of your skin and will shorten the beneficial effects of your cosmetic lift procedure

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 76 reviews

Does nicotine itself constrict blood vessels?

Nicotine itself is a vasoconstrictor. When vasoconstriction takes place, the following things will happen:

1) Surface area inside the blood vessels decreases
2) Less blood will be able to flow to a given area. 
3) Blood pressure will increase
4) Deprivation of valuable nutrients will take place due to the lack of blood flow

Blood has vital nutrients that are important to promote the healing process, and if not enough blood is flowing to a specific area, healing is compromised. 
Some imitation cigarettes contain nicotine, and will slow the bloodflow.  I am cautious, and have my patients stop smoking 3 months before a facelift.  Others may only make a patient stop for 3 weeks. Thanks and I hope this helps!

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.