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with regards to smoking and the use of tobacco in surgery the position is pretty straightforward and itamp;#39;s fairly firm patients must not use nicotine or any types of smoking for three weeks before surgery and for three weeks after surgery that means not one puff on a single cigarette or one puff on weed whether itamp;#39;s tobacco or whether itamp;#39;s marijuana the reason for that is really twofold smoking has free radicals which can damage the small blood vessels that are partially responsible for wound healing and certainly nicotine causes a very strong contraction of those blood vessels and that can cause problems as well the sorts of problems that could be seen could be problems with the incisions healing but also certainly could be problems with things like skin graft take so the stakes being pretty high-end the double incision surgery it could mean the loss of a free graft which would be a very big deal so unfortunately my trans patients understand this theyam