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?
Is It the Nicotine Itself That Constricts Blood Vessels?
Doctor Answers 24
Does the nicotine produce vessel constriction?
Nicotine and Surgery
Nicotine Is a Vasoconstrictor
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Does nicotine constrict blood vessels?
Smoking and facelifts
Smoking and 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. This is especially bad in breast reductions or face lifts. 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.
Pablo Prichard, MD
Use of Nicotine Increases Chance of Necrosis, Tissue Loss & Severe Scarring Following Facelift
Skin necrosis, tissue loss and severe scarring, following facelift surgery are devastating problems. The use of nicotine products has been shown to increase the incidence of this complication. For this reason, all types of nicotine should be avoided before and after facial rejuvenation surgery.
Nicotine causes vasoconstriction of blood vessels which results in decreased blood flow to the skin. This results in decreased oxygen delivery to the skin. Any procedure that requires the elevation of skin flaps can be adversely impacted by this phenomenon. For this reason we generally, recommend that patients not use nicotine products for 4 to 6 weeks prior to surgery. This includes cigarettes, Nicorette gum, patches and anything else that contains nicotine.
Nicotine and facelifts
Nicotine and Surgery?
Safety should always be the primary concern in any procedure. The goal of all plastic surgeons that perform facelifts is to improve the appearance with minimal side effects or problems. Exposure to smoke, either directly or indirectly, or the use of any nicotine releasing products, has been shown to increase the incidence of serious complications after facelift surgery and in most other cosmetic or reconstructive procedures. Most plastic surgeons refuse to perform facelifts on patients who are active smokers or are using nicotine in any form. It is generally recommended that all smoking or the use of any nicotine releasing products should be completely stopped at least 10- 14 days before a facelift, and for a minimum of 10-14 days after the surgical procedure. Ideally, one should stop permanently, not just because of its effect on aging, but from an overall health perspective.
All wound healing depends on blood supply. The blood flow to the skin and underlying tissue is diminished by smoking, which constricts the small blood vessels. Smokers have a significantly higher rate of delayed healing, infection, opening of the incisions, necrosis or loss of the facial skin that is elevated and the underlying tissue, poor scarring, and anesthesia problems.
Be honest with your plastic surgeon who should be certified by the American Board of American Plastic Surgery and ideally a member of The American Society for Aesthetic Plastic Surgery (ASAPS) about your exposure to smoke and follow all instructions. Remember that you are a participant in your care.
Robert Singer, MD FACS
La Jolla, California