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 37

Nicotine Is a Vasoconstrictor

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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 71 reviews

Does the nicotine produce vessel constriction?

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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

Nicotine is a vasoconstrictor

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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.

Nicotine and facelift surgery

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Yes nicotine, in whatever form, increases the risk of complications during facelift surgery.  I wouldn't recommend undergoing a facelift while on nicotine of any kind.  E-cigarettes help smokers avoid the other toxins in conventional cigarettes but still has nicotine unfortunately.  

Jeffrey Lee, MD
Quincy General Surgeon

Imitation cigarettes

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I think any good and responsible facelift surgeon would not feel anymore comfortable about imitation cigarettes than regular cigarettes. There is certainly less tar and other carcinogens but the nicotine and carbon dioxide concerns are still a factor. Other elements of concern with imitation cigarettes are yet to be evaluated. Do yourself a favor and quit altogether.....then after a few months consider your facelift.

Smoking and surgery

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It is nicotine that constricts vessels and slows healing among other things. Nicotine is found in the E-cigarettes now available. I have all surgical patients sign a smokers consent before surgery which expresses the importance of NOT smoking.

Gregory Roche, DO
Bloomfield Hills Facial Plastic Surgeon
4.1 out of 5 stars 23 reviews

How Nicotine Affects Surgical Results

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Nicotine is just one of the ways in which smoking cigarettes can harm your health, and you’re correct that e-cigarettes have become a popular tool in the “step-down” method for smoking cessation. They allow people to get the nicotine their bodies are physically addicted to, while cutting out some of the other problems cigarettes cause, and because e-cigarettes come in a variety of strengths, people can use them to gradually reduce their nicotine levels until they can quit entirely. And while this is certainly a step in the right direction, e-cigarettes are still problematic for your health because they still contain nicotine. Nicotine restricts your blood vessels, and in terms of surgery, this means that less blood (which your body needs in order to heal) reaches your skin and other tissue, and this can lead to very serious complications. I generally advise patients to stop smoking or using any form of nicotine at least six weeks before surgery, and to continue avoiding it for at least six weeks after surgery.

John L. LeRoy, MD, FACS
Atlanta Plastic Surgeon
5.0 out of 5 stars 1 review

Is It the Nicotine Itself That Constricts Blood Vessels?

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Yes, the nicotine in traditional cigarettes and e-cigs causes vasoconstricition or reduced blood flow to the tissues healing. If this is restricted too much, the tissue may not survive. Other harmful chemicals are inhaled with smoking and have negative effects on the body. 

It is best to stop smoking completely, but definitely before and after a surgical procedure. 

Brian J. Lee, MD
Fort Wayne Plastic Surgeon
5.0 out of 5 stars 13 reviews

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

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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!!

Patient by patient

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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 13 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.