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 31

Nicotine Is a Vasoconstrictor

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!  

Toronto Plastic Surgeon
4.8 out of 5 stars 62 reviews

Does the nicotine produce vessel constriction?

Yes, the nicotine does constrict the vessels.  By doing so, less blood gets to the tissues, raising the risks of skin necrosis.  And this is not only by smoking.  If you live or are around people that are smoking, you will become a passive smoker, meaning that you will also suffer the effects of nicotine.  The nicotine gum also produces similar results.  So prior to a facelift, please stop ALL contact with nicotine, in order to prevent unwanted results.

Alberto Arguello, MD
Costa Rica Plastic Surgeon
4.8 out of 5 stars 27 reviews

Stopping any form of Nicotine is important pre-operatively. #smoking cessation

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!!

Joel B. Beck, MD, FACS
Bay Area Plastic Surgeon
4.9 out of 5 stars 112 reviews

Patient by patient

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 required

It 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,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Smoking and Facial Surgery

The best candidates for Lite Lift™ and other facelift surgery have a face and neck line beginning to sag, but whose skin has elasticity and whose bone structure is well defined and do not smoke Additionally, smoking may increase a chance of surgical complications and affect your #healing and the end result of your surgery. It's best to call your plastic #surgeon to better clarify. It's important to implement healthy lifestyle choices to not only prolong your surgical results, but most importantly, to reduce your risk of illness and disease which will impact your health. If you find it difficult to quit #smoking, speak to your physician who can provide information and programs that are properly designed to help you quit.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 110 reviews

Why should I stop smoking before a facelift?

Many thanks for posting your question.

The key factor in cigarettes is the nicotine - this is a powerful drug that closes down the blood vessels that your facelift requires for good wound healing. Therefore smokers have a much higher incidence of complications after facelift surgery, including wound infections and problems healing.

In addition, smokers coughing after surgery can result in bleeding starting which may cause a haematoma (collection of blood) which will require further surgery to drain it.

Personally I do not perform facelift surgery on people who continue to smoke, as it is not worth the risk

Marc Pacifico, MD, FRCS(Plast)
London Plastic Surgeon
5.0 out of 5 stars 49 reviews

Smoking and Facelift

Smoking will slow and complicate healing. In addition to nicotine, other factors such as carbon monoxide are harmful to the healing process. 

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 45 reviews

Nicotine does cause blood vessel constricion

While cutting out all the bad chemicals in cigarettes is certainly more health beneficial than smoking cigarettes, nicotine (whether inhaled or taken as a patch, a pill, or gum) does cause blood vessel constriction, which can effect your results. For cosmetic procedures, most all plastic surgeons will require that you stop smoking at least 3 weeks before and 4 weeks after your procedure. This is because it isn't worth the risk that you will have some wound healing problems. Nicotine causes constriction to tiny blood vessels. Because these are the vessels that we depend on after surgery to get blood supply to your incisions to heal them, they are the most important (more important than the larger vessels in your body that are minimally effected by nicotine). For those smaller blood vessels, the slightest constriction (like that caused by nicotine) can have a huge effect. It's just not worth it. Make sure you've broken away from the nicotine before going under the cosmetic knife.

Ross Blagg, MD
Austin Physician
5.0 out of 5 stars 18 reviews

Nicotine and Surgery

Yes, Nicotine will cause constriction in blood vessels but it is not the only problem with smoking cigarettes. Smoking also involves the inhalation of carbon monoxide which interfere with the blood cells ability to carry oxygen to the tissue. Most surgeons want patients to stop smoking before surgery since this reduces the risk of reduced circulation, wound healing problems and in some cases, skin loss due to poor circulation and low oxygen delivery. I think that patients who are having difficulty breaking the cigarette habit before surgery are still better off with a nicotine patch or gum then they are with other substitutes. The smoke inhalation has been shown to be the most harmful factor of cigarettes when it comes to facial plastic surgery.

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
4.9 out of 5 stars 70 reviews


Yes, the main culprit in smoking is the nicotine.  It takes several weeks for nicotine to wash out of your system and your microvascular circulation to return to normal.  This has big implications for wound healing in certain plastic surgery procedures.  I require all of my cosmetic surgery patients that are having large skin flaps raised to completely stop all forms of nicotine for 6 weeks.  These procedures include facelifts, abdominoplasty, anchor mastopexies, and breast reductions, among others.  Smoking/nicotine can cause major tissue loss in these procedures to the extent that I may not be able to fix them.  

Jeffrey D. Wagner, MD
Indianapolis Plastic Surgeon
4.9 out of 5 stars 26 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.