In the process of performing a tummy tuck, the skin and fat on the stomach is elevated off of the underlying abdominal muscles. During this portion of the surgery, arteries and veins which pass from the muscles to the skin are removed, which reduces the blood supply to the abdominal skin significantly. Enough blood is able to get to this skin to keep it alive through small blood vessels, which travel from the back and sides as long as these vessels have not been damaged during previous surgeries.

For some unknown reason, our blood vessels have a natural receptor for the nicotine molecule. When nicotine is inhaled, ingested or absorbed through the skin, the nicotine molecule attaches to the blood vessels which stimulates them to constrict or narrow in size. This results in less blood traveling to their intended area such as the abdominal skin.

Under normal circumstances, this reduction in blood supply goes unnoticed because there is adequate blood traveling from multiple sources to the skin so that some decrease in perfusion does not threaten the viability of the skin. During a tummy tuck, however, the combination of reduced blood supply from surgery and nicotine blood vessel constriction often is too severe to keep the skin alive. Large areas of skin will often die requiring subsequent surgeries to remove the dead skin and replace it with skin grafts resulting in severe scarring and deformity.

All forms of nicotine including cigarette smoke, nicotine gum, nicotine patches and secondary smoke must be strictly avoided for at least three to four weeks before a tummy tuck and for one month after surgery. This is also true for other cosmetic surgeries where skin has been undermined and pulled tight such as facelifts, breast reductions, breast lifts, arm lifts and thigh lifts.

Even inhaling secondary smoke will cause a high enough concentration of nicotine in the bloodstream to cause blood vessel constriction and loss of skin. So, in addition to avoiding the use of tobacco in any form, you can’t be around anyone else who is smoking for at least three to four weeks before and after a tummy tuck.

Although no forms of nicotine to help you reduce or quit smoking is allowed at or around the time of surgery, there are other prescription medications that help patients quit smoking that do not contain any nicotine and can be used at the time of the procedure. It is not clear how these medications work to reduce the urge to smoke and there are potential side effects of any drug. Some of our patients who have successfully used Chantix to quit say that it made cigarettes taste bad so that their desire to smoke was dramatically reduced making it much easier to not smoke.

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