Cigarettes, vapes and nicotine
why they are a risk for surgery

Why cigarettes, vapes and other nicotine products increase the risk of complications in plastic surgery, and how long before surgery they must be stopped.

“I smoke a little”, “only a vape” and “lighter cigarettes” are sentences often heard at a consultation. But for healing there is no safe amount. The problem is nicotine, and it is present in all forms.

What nicotine does

• It narrows the small blood vessels, so less blood and oxygen reach the skin and the wound.
• With tobacco smoke, carbon monoxide is added, which reduces the transport of oxygen.
• It slows healing, weakens the defence against infection and increases the risk of blood clots.

In operations where the skin is lifted and part of its blood supply is cut — such as a facelift, abdominoplasty, breast lift and breast reduction — the blood that remains is critical.

What complications are possible

• Loss (necrosis) of skin — along the edges of the incision, on the abdomen, on the face, on the nipple.
• Separation of the wound and delayed healing.
• Infections.
• Fat necrosis — firm lumps.
• A wider, more pronounced scar.
• Thrombosis and lung complications.
• A harder time waking up after anaesthesia — coughing and breathing difficulties.

Which products count

• cigarettes, cigars, pipes, hookah;
• vapes and e-cigarettes with nicotine;
• heated tobacco products;
• nicotine pouches and snus;
• nicotine gum, patches and sprays.

Patches and gum are not a safe alternative because of the nicotine. Vapes are often thought of as “lighter”, but the data so far, including from experimental studies and reported cases of skin necrosis after mastectomy, show similar effects on healing. The data in humans are limited, so a vape is treated like a cigarette.

How long before and after the operation

• At least 4 weeks before and 4 weeks after the operation — longer is better. Some surgeons also require 6 weeks.
• A small part of the damage to the vessels recovers over time, so the sooner you stop, the better.
• It applies to all forms and to “just one” cigarette — even that affects the vessels.

If you do not manage

Say so honestly. In these situations the operation may be postponed, and that is better than lost skin or an unsuccessful operation. A conversation with your GP about support and treatment of the dependence can help. Stopping cigarettes because of an operation is often a good reason to stop them for good.