Every patient who books surgery at Southwest Plastic Surgery hears the same instruction on their pre-op call: no nicotine for two weeks before and two weeks after. Most patients hear “no smoking.” That is not what it says.
Dr. Frank Agullo, who founded the practice, put it this way when we asked him to walk through the rule.
What is your rule on nicotine before and after surgery?
Dr. Agullo: “We want patients off of nicotine at least two weeks before and two weeks after, preferably two weeks or longer before and none after. I also encourage them to quit smoking for their overall general health.”
Why Nicotine, Not Just Smoking
Does the form of nicotine matter, smoking versus vaping, pouches, patches or gum?
Dr. Agullo: “Any type of nicotine is the same, and this is something patients don’t realize. They think that because we say smoking, we just want them to stop smoking. But any other form, like Zyn or dip or vaping, the patches and the gum, they all have nicotine. They have the same effect, which is they constrict the small capillaries that carry the nutrients and the growth factors and cells to the scar area to repair and heal. When these vessels clamp down, the flow of blood to these areas is decreased to the extent that we may have wound openings or even skin death.”
Our pre-op nurse gives patients the short version on every call: “Nicotine closes our blood vessels. If your blood vessels are blocked, you will not have enough oxygenation to the scars and we can create a problem called necrotic tissue, which means that the skin will die.”
| Form | Contains nicotine | Allowed in the two-week window |
|---|---|---|
| Cigarettes | Yes | No |
| Vape or e-cigarette | Yes | No |
| Nicotine pouches (Zyn and similar) | Yes | No |
| Dip, chew, snus | Yes | No |
| Nicotine patch, gum or lozenge | Yes | No |
| Cannabis (smoked or vaped) | Usually no | No, for an anesthesia reason |
What Goes Wrong
Have you seen what happens when a patient doesn’t quit?
Dr. Agullo: “Yes. This has occurred in patients who continue to smoke through the recovery period. We see the complications most often in tummy tucks, where there can be loss of skin in the inferior portion, in breast surgeries, where there can be loss of the nipple and areolar complex or breast skin, and in facelifts, where there can be necrosis of the skin flaps that we elevate. These all end up with bad scarring.”
The Procedures Dr. Agullo Will Not Do for a Smoker
Are there procedures you flat-out refuse to do on a nicotine user versus ones where you will proceed with a warning?
Dr. Agullo: “If I know a patient is smoking, I will refuse to do most procedures, but especially any facelift or neck lift, any breast lift or breast reduction, and tummy tucks. All these procedures rely on flaps and capillary blood flow.”
A tummy tuck, a breast lift and a facelift all involve lifting skin and moving it. That lifted skin lives on a thin blood supply until it heals back down, and nicotine is the thing most likely to cut that supply off.
Testing, and Help With Quitting
Do you test patients for nicotine?
Dr. Agullo: “I don’t nicotine test patients routinely, unless there is a question or a doubt. I do communicate very strongly with patients about what the consequences can be, and I trust that my patients are responsible adults who will comply, because they don’t want to have complications.”
The practice would rather help than police. As our pre-op nurse tells patients: “If you need help, you can just let us know so we can send you some Chantix as medication to help you stop smoking.”
Cannabis: Same Window, Different Reason
Marijuana and cannabis vapes, since patients ask in the same breath. Same rule or different?
Dr. Agullo: “Marijuana and cannabis vapes are a little bit different. They don’t usually have nicotine, but the smoke itself does cause airway reactivity and can interfere with general anesthesia. So I also recommend at least two weeks before and two weeks after to stay away from it.”
Secondhand Smoke and Nicotine Replacement
Secondhand exposure and nicotine replacement during recovery. What do you tell a patient whose partner smokes?
Dr. Agullo: “Secondhand smoking is just as bad as firsthand smoking, as the nicotine effect will clamp down the capillaries. So patients should stay away from partners that smoke. We don’t want to do a nicotine replacement during recovery because the nicotine will have the same effect in a gum or a patch as if the patient was smoking. It would clamp down capillaries and slow blood flow to the areas we need for healing.”
Patches and gum are good tools for quitting cigarettes in ordinary life. In the surgical window they deliver the same nicotine to the same capillaries, so they are held too.
What This Means for Your Surgery Date
If you use nicotine in any form, tell us at the consultation rather than the pre-op call. It does not change whether you can have surgery. It changes when, and the practice can help with the quitting part.
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center.
Schedule a Consultation
To plan surgery at Southwest Plastic Surgery, or to ask about help quitting nicotine before your date, call (915) 590-7900 or text 1-866-814-0038. #StayBeautiful
