The E Cigarette and #Plasticsurgery

The idea of an electronic cigarette (or “e-cigarette” or “e-cig”) is traced to 1963, when Herbert Gilbert filed a patent for this type of product. 

The e-cigarette delivers vaporized nicotine to the inhaler by the use of a battery-powered device. The common components of all e-cigarette devices include a power source, a heating element (atomizer), and a liquid container. The atomizer vaporizes a liquid combination of nicotine, which may contain additional flavorings. 

From a health perspective, evidence suggests that e-cigarettes are safer than traditional cigarettes because the tar is removed, and maybe as safe as other nicotine replacement products, such as gum or patches. The long-term effects of inhaling nicotine vapor are unclear, but there is no evidence to date that it causes cancer or heart disease as cigarette smoking does. Indeed, many researchers agree that e-cigarettes will turn out to be much safer than conventional cigarettes. 

However there have been reports of adverse events involving e-cigarettes including hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems. 

The degree of health concerns e-cigarettes cause, for plastic surgery procedures, is debatable. In these procedures, nicotine-induced vasoconstriction in the periphery may lead to a higher incidence of partial or complete skin ischemia and wound complications. Procedures involving the raising of the skin to create a flap of tissue may be those procedures most likely to be affected.  This has been proven in an animal experimental model where an experimental group of rats were subjected to subcutaneous nicotine injection followed by transverse rectus abdominis musculocutaneous flap elevation and shown to have a significantly greater area of necrosis compared with a control group.  

In terms of cessation periods a study of 102 patients undergoing general surgical procedures showed that cessation of smoking for 3 to 4 weeks’ duration before surgery reduced the incidence of postoperative complications from 41 percent to 21 percent. There is additional level 1 evidence to suggest that the optimal duration of preoperative cessation is a minimum of 4 weeks.

The recently published review article from New York from which the information above has been derived is a valuable source of information. Mr Ross agrees with the findings of this review that patients should refrain from smoking (include e-cigarettes) for a minimum of 4 weeks  prior to any plastic surgery procedure. 


Taub, Peter J.; Matarasso, Alan E-Cigarettes and Potential Implications for Plastic Surgery. Plastic & Reconstructive Surgery. 138(6):1059e-1066e, December 2016.


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