Hi, Thank you for the question. A smoking history is also a known risk factor for increased complications with surgery, because nicotine and other toxins in tobacco products can cause damage and constriction of blood vessels. This can in turn decrease the blood supply to healing tissue and increase the risk of wound breakdown, skin loss, healing complications. Regarding elective surgery and smoking, a cessation period of at least four to six weeks before surgery and after surgery has been recommended. Some physicians will do a nicotine test prior to surgery to ensure that the patient has been compliant and it is safe to proceed with surgery. I suggest that you seek an in person consultation with a Board-Certified Plastic Surgeon specializing in Labiaplasty surgeries to further discuss your options, specific techniques, concerns and expectations. I hope this helps.Best regards, Dr. Karanetz Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon