Is It the Nicotine Itself That Constricts Blood Vessels?

Smokers are far more likely to experience complications following surgery than non-smokers for various reasons, including the presence of nicotine and carbon monoxide. This is why virtually all qualified plastic surgeons require patients to stop smoking at least 3 weeks prior to a procedure. If by "imitation cigarettes" you are referring to electronic cigarettes, most of those products still include some nicotine, which constricts blood vessels.  If you are committed to doing whatever is needed to get the best possible results of your cosmetic surgery, I recommend stopping all smoking and nicotine intake of any kind, including nicotine patches, before your surgery. I also include in this list all weight-loss pills (many contain ephedrine-type of substance or other vasoconstricting chemicals) and some medications treating ADHD for the same reasons. Good luck to you!

 

Nicotine is the bane of facelifts, and any other surgery. The vasoconstriction is deadly to skin flaps, and increases the complication rate of any procedure.  In ANY form, smoke, vapor, patch, chew, even second hand. I routinely test ALL my patients for nicotine, If they are positive I won't operate on them. I see it as my responsibility not to operate on nicotine positive patients, and we are all happier for that testing.Best,Dr Results

Nicotine does decrease the blood supply to certain areas of the body. As far as whether or not the surgery can be performed on nicotine alone it depends on many things. #  1 the overall health of the patient# 2 how long they have been off cigarettes # 3 patient expectations about the decrease in results and increased healing time that will be requiredIt is about informed and detailed consent so that both the patient and the surgeon are on the same page. We all want the same goal of good results and happy patients. The best thing would be to stop nicotine all together. I do understand however that is not an easy thing to do!Hope this helps.Best of luck,DrC

Hello,

The answer is "YES"!
Nicotine is a vasoconstrictor, meaning it will narrow the arteries supplying oxygen to the tissues. This can lead to complications in wound healing especially in surgeries requiring elevation of flaps, such as facelifts, breast reductions and tummy tucks. It is crucial to stop using tobacco/nicotine products at least 3-4 weeks prior to surgery and for 4 weeks thereafter. Synthetic cigarettes including vape and e-cigarettes along with nicotine patches and gum are also harmful.
Oxygen delivery to tissues is critical to healing and anything that impairs this process will compromise healing. In addition to Nicotine, carbon monoxide is another such harmful substance in tobacco that
leads to vasoconstriction. Any surgeon who values patient safety and strives to minimize complications will always decline surgery for patients who have failed to cease tobacco/vape usage.

Warm regards,

Dr. Pedy Ganchi
Village Plastic Surgery

Smoking combines the effect of nicotine that constricts the blood vessels and the effect of carbon monoxide that reduces the ability of the blood to transport oxygen to the tissues. This way it creates a combined negative impact on the healing tissues in particular when tension is also involved which reduces the blood flow. For this reason, the  World Health Organisation has recently issued a statement indicating that their studies show a minimum of one month of stopping smoking before surgery is necessary to decrease its negative impact on healing.It becomes more difficult to know whether the same is applicable to nicotine in vaping, chewing gum or patches but it is fair to assume that at least part of the negatives of smoking would still be applicable still constriction of the blood vessels. The main issue here is related to the risk of creating irreversible damage in the  skin versus the desire to continue using nicotine around the time of surgery.  No surgeon wants to risk a poor result and in an elective intervention we try to minimise the risks not only related to  nicotine but a multitude of other factors. It would be in your interest to exert your willpower and stop the risk factors that you can  rather than   to continue  the inhalers and expect a lucky  outcome.

Nicotine does constrict blood vessels, and, therefore could decrease the blood supply to the skin creating issues with healing. This is true whether the nicotine is coming from cigarettes, e-cigs devices, gum, patch and so on. Not every smoker will have problems healing, but there is certainly an increase in risk. I recommend that patients stop using nicotine for 3-4 weeks prior to facelift and often plan for treatments with hyperbaric oxygen after surgery to improve healing (if needed). Given the fact that this is a completely elective procedure, I do not recommend surgery on active smokers/nicotine users. I don't believe the risk is worth it - it's better to plan and postpone the surgery until you're ready.

The answer is very simple. Yes, nicotine does constrict skin blood vessels and causes a much higher rate of complications for cosmetic surgery procedures. Narrowing of the blood vessels means less blood flow and then oxygen to the cells. This is needed to heal from surgery.  All surgeries are usually more likely to have complications in smokers especially lung complications but also depending on the type of surgery if tissue is rearranged, these flaps can also be at risk for dying or undergoing necrosis.  The risk is simply not worth it.  
Any vaping, gum, patches or imitation ecigarettes that contain nicotine can have the same effect even though they may not contain all of the other harmful chemicals.  While some people can use these products to wean off cigarettes, they are still things that you should stop before surgery to avoid complications.  I typically recommend my patients be off of all nicotine products for 3-4 weeks before  and at least 4-6 weeks after (but preferably for life) to allow optimal surgical healing.  
I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and go over your concerns with them.
I hope this helps answer your question.  If it does, please take a moment to up vote this answer on the “respond” button on the top right.  

Yes you are correct it is the actual nicotine itself that causes vasoconstriction which can lead to poor healing after any surgery, and in facelift can be disastrous as the think skin flaps are at risk of necrosis (dying from lack of blood flow).  The imitation or e cigarettes that contain nicotine may be useful tool for quitting smoking but are not a healthy alternative to smoking.  Nicotine without the smoke can still cause heart disease, vascular disease, and make you at higher risk for some cancers.  If I have a patient who is a smoker, I would recommend they quit smoking at least 2 weeks prior and stay away from any nicotine products for at least a month after surgery (but hopefully for the rest of their life as well).  You may find some surgeons that say performing a facelift in the deep plane may be less risky for smokers.  But if you are planning to invest in appearance by having a facelift, wouldn't you also consider investing in your health and longevity by quitting smoking and enjoying the results of your facelift for longer?

The nicotine in cigarettes and other tobacco products (patches, gums, e-cigarettes, chewing tobacco, etc) causes constriction of the blood vessels and increases the chances of complications after facelift procedures. This decrease in blood flow to the skin can compromise the blood flow of the facial skin flap and result in death of the skin (necrosis). Some surgeons will perform facelifts on tobacco users, but almost all surgeons will force patients to stop using nicotine products at least several weeks in advance and for several weeks after surgery. Some patients may lie about their smoking in the perioperative period, but this is a dangerous proposition as loss of the skin can be a devastating complication that results in significant scarring.
All the best,

Nicotine is a very strong vasoconstrictor, but it’s not the only vasoconstrictor that smoke has. Smoking is more dangerous than just having the Nicotine gum or other electrical devices like Vape. However, I would not perform a facelift with someone who still uses any of these methods that contain nicotine as it can lead to complications following surgery.

Thank you for your question!  Smoking cigarettes is especially bad prior to surgery for a number of reasons.  First of all, carbon monoxide causes the red blood cells to not release the much needed oxygen the tissues require for healing.  This can affect all post operative tissues from optimal healing, thus tissue necrosis (death) may result.  This can be seen especially with face-lifting, breast lifting, and abdominoplasties.  Skin loss may result and cause poor scar formation and prolonged wound care that can be embarrassing as a patient.  Secondly, vasoconstriction can affect the flow of blood to the treated tissue so that now, not only are the red blood cells holding onto oxygen, but the flow of blood for tissue perfusion is affected!  In addition, look at all the literature pointing to preventative causes of heart disease, cancer, etc related to smoking.  As for electronic cigarettes, correct me if I am wrong, but I think carbon monoxide is not the problem, but vasoconstriction is the issue.  So, weather you smoke cigarettes or electronic cigarettes, or use nicotine patches or chew nicotine gum, it all affects your wound healing and body in general.  When undergoing a surgical procedure, especially elective surgery, it is most important to optimize the body to enhance healing and recovery.  All forms of nicotine should be stopped weeks before surgery.  I hope this helps!!