When was the last time you had a cigarette? Two days ago. I am very strict about not smoking before surgery. The nicotine in cigarettes causes small blood vessels to close down. And the problem with this is that this can cause either necrosis of the skin, which is what you’re seeing here, which is where the skin actually dies, or you can have wound dehiscence. In order for an incision to heal, you need both oxygen and you need a crossover of those blood vessels to heal over that incision. When those small blood vessels close, you’re not getting enough oxygen to the tissue, and you’re not getting enough tissue repair. Therefore, it’s really important to stop smoking at least six weeks before surgery, and that includes not using nicotine gum or nicotine patches.