Are Electronic Cigarettes Better For Healing Since They Don't Contain Carbon Monoxide?

I'm trying to quit smoking to help myself heal. Does it do any good to just have 3 a day to wean myself off, or am I wasting my time. Since electronic cigarettes still have nicotine, are they better because they don't contain carbon monoxide?

Doctor Answers 8

Nicotine, e-cigarettes, and surgery

When one smokes, or uses tobacco in any form, there is vascular constriction. Nicotine is a major vasoconstrictor. Good wound healing is all about getting enough blood supply to the area. 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. Our office does not do facelifts on smokers. Breast reductions and tummy tucks are also on tension and the chance of them falling apart is many fold higher. Please stop using nicotine, (for dozens of reasons). 

Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

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. 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 47 reviews

Are electronic cigarettes better for healing since they don't containe carbon monoxide?

Hello! Thank you for your question! The issue with nicotine or inhalational agent is that it also acts as a vasoconstrictor, clamping down of blood vessels. Blood supply is always of great concern during any surgical procedure, but especially in surgical procedures where the viability of the skin/tissue is obviously important. Since the vascularity to the area is already tenuous since it will be raised by cutting around the area, maximizing blood flow to the tissue is critical.

Typically, we recommend at least 6 weeks of smoking cessation prior to and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, nipple necrosis, poor scarring, and wound complications, as well as other health consequences including blood clots. The anesthesia risk is greater with general anesthesia as well as pulmonary issues/lung infections postoperatively. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Nicotine is the problem

Most e-cigarettes contain nicotine, and that is the issue with would healing after any lift operation. There are some e-cigarettes without nicotine, but I am not sure they will help with the craving.

It only takes one episode of constriction of the small blood vessels after surgery to interfere with would healing or even cause tissue loss, so even 3 cigarettes a day is really risky. 

Thanks for the question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Nicotine is a bigger problem than carbon monoxide in cigarettes (but neither is good).

Nicotine is such a potent vasoconstrictor that it alone, in even minute quantities (such as second-hand smoke), is sufficient to cause dead skin in breast lift, facelift, tummy tuck, or other flap procedures where skin is cut, lifted, and pulled tighter.

You must stop ALL tobacco use, and any kind of nicotine patch, gum, spray, or e-cigarette containing nicotine. Of course, REAL cigarettes ALSO contain carbon monoxide and other noxious chemicals harmful to your body and healing, so perhaps if nicotine is not quite enough to kill off susceptible skin, then carbon monoxide is like shooting the dead horse "one more time, just to be sure!"

Seriously, you are spending lots of money for elective surgery and presumably want the best result with the lowest likelihood of complications, right? So, STOP smoking right now, including e-cigarettes, or don't waste your money or subject yourself to unnecessary risk. You really don't want dead skin in any area. Neither do we plastic surgeons! Best wishes and good luck with smoking cessation! BTW, Chantix and Zyban are OK during surgery. Ask your doctor for more information if you are serious about quitting. Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Nicotine increases the risk of complications

Thanks for this great question. One of my patients just asked me this today! I applaud your efforts to stop smoking. This can be very difficult and there are many "stop smoking" aids available. Unfortunately, just like cigarettes, many of them like eCigs, nicotine gum and patches, all have nicotine in them. Nicotine constricts your small blood vessels, the ones that are extremely important to your post-operative healing. I avoid operating on any patient who is actively smoking or actively using nicotine products. 

I encourage you to use this as an incentive to make the final step towards stopping smoking. It's not easy, but you and your body will be safer and healthier if you succeed.

Kara K. Criswell, MD, FACS
Charlotte Plastic Surgeon
4.8 out of 5 stars 72 reviews

Nicotine no good

If the electronic cigarette provides nicotine, then I would say you have to stop it as well. Nicotine is a vasoconstrictor and not good for healing.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Nicotine and healing do not mix

In order to give yourself the best chance for proper healing you should be nicotine free for 6 weeks prior to surgery as well as throughout the healing process.  Nicotine is the real culprit since it causes the blood supply to be altered, thus affecting the ability to heal properly.  Any type of nicotine should be avoided- including the patches and gums that aid in quitting smoking but still contain nicotine.  Good luck!

Mennen T. Gallas, MD
Katy Plastic Surgeon
5.0 out of 5 stars 19 reviews

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.