Does nicotine increase the risk of reabsorption?

Question

I will be undergoing a nasal reconstruction which entails extensive grafting. Coastal cartilage for the top of the bony base, and ear and septal for the middle vault, and ear for the lower lateral crura. Does nicotine use increase the risk of reabsorption? I am in my early thirties and physically fit. I have only had one primary rhinoplasty. The vascularity of my nose is relatively good.

Stephen Prendiville, MD · Answer

After reviewing your history, I can see that you have had a failed primary Rhinoplasty.  Since it sounds as if your revision is already planned and will entail extensive cartilage grafting, it is in your best interest to do everything to maximize your recovery.  Since nicotine is a vasoconstrictor and impairs blood flow, it is to be avoided at all costs.  If you can't stop smoking or using nicotine products, you shouldn't have surgery.

Adam Bryce Weinfeld, MD · Answer

It is best to stop smoking (or any form of nicotine - including patches, nicotine gum, etc) prior to any surgery for optimal healing.  I usually recommend a minimum of 1 month before and 1 month after surgery, but longer is better.  You should discuss this with your surgeon as each surgeon may have different preferences.

Michael T. Somenek, MD · Answer

I think the best advice is to avoid nicotine throughout the healing process. Anytime that you introduce something that can potentially decrease vascularity, you need to know that this can affect your result. While there may not be an scientific evidence specifically focusing on the effects that nicotine has on cartilage grafts within the nose, I would avoid it.

Stacey Folk, MD · Answer

Nicotine will do you no favors when it comes to surgery. I encourage patients to stop 4-6 weeks before surgery and at least one month (or forever) after. Maybe now is as good a reason as ever to give it up.Best of luck,

Jarrod Little, MD · Answer

Revision rhinoplasty is one of the most difficult of all aesthetic procedures.  Proceeding with a revision surgery absolutely requires that all variables are accounted for.  There is credible evidence that nicotine (in any form) increases wound healing problems through multiple pathways.  Any of the pathways may influence the long-term survival of cartilage grafts and ultimate aesthetic result.  It is imperative that you do not proceed with any procedure until you have achieved sustained nicotine cessation.  It is always better for a patient to have no procedure at all, rather than a procedure performed before modifications of potential risk factors.  It is important that you personally consult with a board-certified Plastic Surgeon, who specializes in rhinoplasty

Michael M. Omidi, MD, FACS · Answer

Thank you for the question. It's strongly advised that you discontinue nicotine intake before rhinoplasty. Most plastic surgeons will advise you to stop smoking at one or two months prior to surgery because it takes some time for the nicotine to be excreted.  An in-person exam with a board-certified plastic surgeon would be the best way to assess your situation and guarantee an individualized medical advice. Best of luck!

Does nicotine increase the risk of reabsorption?

Answers (6)

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