Nicotine and Plastic Surgery: What Patients Need to Know

If you’re considering plastic surgery, one of the most important — and often underestimated — risk factors is nicotine use. Whether it’s cigarettes, vaping, cigars, chewing tobacco, or even nicotine patches and gum, nicotine can significantly impact your surgical outcome. In addition to increasing your risks of surgical complications, you can also experience increased risk of respiratory and cardiac complications from anesthesia.

How Nicotine Affects Healing

Nicotine is a powerful vasoconstrictor, meaning it narrows blood vessels. That restriction reduces blood flow to tissues — and blood flow is essential for:

Plastic surgery procedures often involve delicate tissue handling and skin elevation. These tissues rely heavily on strong blood supply to survive and heal properly.When blood flow is compromised, complications increase.

Increased Risks After Plastic Surgery

Patients who use nicotine face significantly higher risks of:

In procedures like facelifts, tummy tucks, and breast lifts — where skin is elevated and repositioned — nicotine-related complications can be particularly severe.

Procedures Most Affected by Nicotine

Nicotine is especially dangerous for procedures involving large skin flaps or compromised blood supply, such as:

How Long Should You Stop Nicotine Before Surgery?

Most plastic surgeons require patients to stop all nicotine products at least 4–6 weeks before surgery and continue avoiding them for 4–6 weeks after surgery.

Important:
Switching from cigarettes to vaping does not reduce surgical risk if nicotine is still present. Some practices perform nicotine testing before surgery to ensure patient safety.

“But I Only Vape” — Does It Still Matter?

Yes.Even nicotine patches and gum can negatively affect surgical healing because the issue is the nicotine itself — not just smoke.While vaping eliminates some toxins found in cigarette smoke, it does not eliminate the vasoconstrictive effects of nicotine.

What About Marijuana?

Smoking marijuana also affects wound healing due to smoke-related vascular changes and carbon monoxide exposure. If inhaled, it may pose similar surgical risks. This is something patients should discuss openly with their surgeon.

Why Surgeons Are Strict About This Standard

Plastic surgery is often elective. That means your surgeon’s priority is minimizing avoidable risks. Nicotine-related complications can lead to:

From a surgeon’s perspective, operating on an active nicotine user significantly increases risk — and many surgeons will postpone surgery until patients are nicotine-free.

The Bottom Line

If you’re investing in plastic surgery, give your body the best possible chance to heal. Quitting nicotine — even temporarily — can dramatically reduce complication rates and improve your aesthetic results.If you’re considering surgery, have an honest conversation with your surgeon about nicotine use. Your safety and outcome depend on it.

Why Submuscular Breast Implants Are Often Better Than Over-the-Muscle Placement

When considering breast augmentation, one of the most important decisions you’ll make with your surgeon is implant placement. Implants can be positioned either over the chest muscle (subglandular),  under the chest muscle (submuscular).While both techniques have their place, submuscular placement is often considered the superior option for many patients due to improved aesthetics, safety, and long-term outcomes.

What Is Submuscular Breast Implant Placement?

In submuscular placement, the implant is positioned partially or fully beneath the pectoralis major muscle. This technique provides additional soft tissue coverage over the implant.In contrast, over-the-muscle placement positions the implant directly behind the breast tissue but above the muscle.

1. More Natural-Looking Results

One of the primary advantages of submuscular implants is a more natural contour — especially in patients with thinner breast tissue.Because the muscle provides additional coverage:

For patients with low body fat or minimal existing breast tissue, this added coverage makes a significant difference in achieving a natural aesthetic.

2. Lower Risk of Capsular Contracture

Capsular contracture — a condition where scar tissue tightens around the implant — is one of the most common complications after breast augmentation.

Studies have consistently shown that submuscular placement is associated with a lower rate of capsular contracture compared to over-the-muscle placement. This has been the standard of care for over 50 years. While the exact mechanism isn’t fully understood, improved implant coverage and reduced bacterial contamination risk may play a role.

3. Better Mammogram Visualization

For patients concerned about breast cancer screening, submuscular placement offers an advantage.

Because the implant sits beneath the muscle, there is typically less interference with mammogram imaging. This can improve visualization of breast tissue and may make screening easier for radiologists.

4. Reduced Implant Visibility and Palpability

Submuscular placement reduces:

This is especially important for athletic or thin patients who want discreet, natural-looking enhancement.

5. Improved Long-Term Support

The pectoral muscle provides additional structural support for the implant. Over time, this can help reduce:

While implants are not lifetime devices, submuscular placement often contributes to longer-lasting aesthetic results.

The Bottom Line

For many patients, submuscular breast implant placement provides:

That said, breast augmentation is not one-size-fits-all. The best results come from individualized planning, surgical expertise, and clear communication about your aesthetic goals.

Dr. Graham is an expert in Breast Surgery in Rochester, NY. If you’re considering breast augmentation, schedule a consultation to discuss which implant placement is right for you — and how we can create results that look beautifully natural and uniquely yours.

Ozempic Body: Understanding the Physical Changes That Can Follow Weight Loss Medications

GLP-1 medications like Ozempic®, Wegovy®, and Mounjaro® have transformed the weight-loss conversation. While many patients celebrate meaningful and life-changing weight reduction, a new term has entered popular culture: “Ozempic Body.”This phrase refers to the physical changes some individuals notice after rapid or significant weight loss—particularly changes in skin tone, volume, and body contours.Understanding what “Ozempic Body” means, why it happens, and what options exist can help patients feel informed and empowered as they navigate their aesthetic goals.

What Is “Ozempic Body”?

“Ozempic Body” is not a medical diagnosis. It’s a colloquial term used to describe body contour changes that can occur after substantial weight loss, especially when weight is lost quickly.Common concerns associated with Ozempic Body include:

These changes are not unique to Ozempic—they can happen with any significant weight loss, whether achieved through medication, bariatric surgery, or lifestyle changes.

Why Does Ozempic Body Happen?

1. Rapid Weight Loss
When weight is lost quickly, the skin may not have enough time to retract and tighten, especially in areas that have been stretched for years.

2. Loss of Fat Volume
Fat provides structure and fullness. When fat volume decreases, it can reveal lax skin or lead to contour irregularities.

3. Age and Skin Elasticity
As we age, collagen and elastin levels decline, making it harder for skin to bounce back after weight loss.

4. Genetics
Some people are genetically predisposed to better skin retraction than others.

Is Ozempic Body Preventable?

Not entirely—but certain factors may help minimize its appearance:

Even with these measures, some degree of skin laxity or volume loss is normal after significant weight reduction.

Aesthetic Options for Addressing Ozempic Body

For patients who are happy with their weight loss but unhappy with body contours, aesthetic medicine and plastic surgery can offer solutions tailored to individual needs.

Non-Surgical Options May Include:

Surgical Options May Include:

A consultation with a board-certified plastic surgeon is the best way to determine which options are appropriate.

Weight Loss Is a Success—Refinement Is a Personal Choice

It’s important to emphasize that Ozempic Body does not mean weight loss failed. On the contrary, it often reflects a major health achievement. Weight loss is associated with innumerable health benefits including improving cardiovascular, musculoskeletal, and even mentall health. Furthermore, it decreases cancer risk and overall body inflammation. Choosing to address body contour concerns afterward is not about vanity—it’s about optimizing health while aligning the outside with how patients feel on the inside.

Final Thoughts

GLP-1 medications have opened new doors for weight management, but they can also introduce unexpected aesthetic changes. Understanding Ozempic Body helps normalize the conversation and reminds patients that options exist. In addition, the bariatric surgery literature shows that patients who undergo cosmetic skin removal after weight loss are much less likely to undergo weight regain, a common problem with GLP-1 medications after their cessation.

If you’ve experienced physical changes after weight loss and want to explore ways to restore balance, confidence, and contour, a personalized consultation can help map out the next steps. Dr. Graham is an expert in breast and body surgery, learning his craft at a major bariatric center in Ohio. He has over 20 years of experience and innate artistic ability.

Ozempic Breasts: What It Is, Why It Happens, and What You Can Do

As medications like Ozempic® (semaglutide) continue to grow in popularity for weight loss and diabetes management, new terms are emerging online—one of the most talked about being “Ozempic breasts.”

If you’ve noticed changes in breast size, shape, or firmness while losing weight on Ozempic, you’re not alone. The good news? These changes are common, expected, and manageable.

Let’s break down what “Ozempic breasts” really means, why it happens, and what options exist to address it.

What Are “Ozempic Breasts”?

“Ozempic breasts” is a non-medical term used to describe changes in breast appearance after significant weight losswhile taking GLP-1 medications like Ozempic.

Common changes include:

Importantly, Ozempic itself does not directly affect breast tissue. These changes are the result of fat loss, not the medication targeting the breasts.

Why Does Ozempic Cause Breast Changes?

  1. Breasts Are Largely Made of Fat

Breasts are composed of:

When weight loss occurs—especially rapid or significant weight loss—the fat volume in the breasts often decreases.

  1. Rapid Weight Loss Affects Skin Elasticity

GLP-1 medications can lead to faster weight loss than traditional methods. When this happens:

Age, genetics, and prior pregnancies can increase this effect.

  1. Hormonal Changes and Aging Play a Role

As we age, natural decreases in estrogen reduce skin elasticity and collagen production, making breast changes more noticeable during weight loss.

Is This Unique to Ozempic?

No. Similar changes have been observed with:

“Ozempic breasts” is simply a modern label for a long-recognized consequence of weight loss.

Can You Prevent Ozempic Breasts?

While you can’t completely prevent breast changes during weight loss, you can minimize their severity:

✔ Gradual Weight Loss (When Possible)

Slower weight loss allows skin more time to adapt.

✔ Proper Nutrition

Adequate protein supports skin integrity and collagen production.

✔ Supportive Bras

Well-fitted bras reduce strain on breast skin during weight changes.

Surgical Options After Weight Loss

🔹 Breast Augmentation

Restores lost volume using implants. The only way to get perkiness is with a breast implant.

🔹 Breast Lift (Mastopexy)

Addresses sagging and repositions the nipple.

🔹 Augmentation + Lift

Combines volume restoration with reshaping for comprehensive results. This can be done as a single or two stage operation depending on your anatomy and surgeon’s experience.

Many surgeons recommend waiting until weight stabilizes before considering surgery. A stable weight for at least 3-6 months is recommended. Reaching you ideal weight is essential for long lasting results.

When Should You See a Specialist?

Consider consulting a board-certified plastic surgeon if:

A personalized consultation can determine the best approach for your goals. Dr. Graham is an expert in cosmetic breast surgery, having over 20 years of experience.

Can You Use an HSA for Plastic Surgery Procedures?

 Patients often ask whether Health Savings Accounts (HSAs) can be used to pay for plastic surgery. The answer depends on one key factor: medical necessity. While most cosmetic procedures are not HSA-eligible, certain plastic and reconstructive surgeries may qualify when they are performed to treat a medical condition—not just to improve appearance. Below, we explain what patients should know before using HSA funds.

Understanding the IRS Rules

The IRS allows HSA funds to be used for medical care that is intended to:

Procedures performed solely for cosmetic reasons are generally not eligible for HSA reimbursement.

Procedures That Are Not HSA-Eligible

Purely elective cosmetic procedures typically do not qualify, including:

These treatments are considered appearance-enhancing rather than medically necessary.

When Plastic Surgery May Be HSA-Eligible

Certain plastic surgery procedures may qualify for HSA use when they address a documented medical concern.

Examples include:

In these cases, the goal of surgery is health improvement—not cosmetic enhancement.

The Importance of Medical Documentation

For HSA eligibility, patients typically need a Letter of Medical Necessity (LMN) from a qualified healthcare provider. This letter should explain:

Without proper documentation, HSA claims may be denied if audited.

Procedures with Both Medical and Cosmetic Components

Some surgeries include both functional and aesthetic elements. In these situations:

For example:

Itemized billing is essential in these cases.

Are Consultations Covered by an HSA?

Patients should confirm eligibility before using HSA funds.

What Happens If HSA Funds Are Used Incorrectly?

Using HSA money for non-eligible cosmetic procedures may result in:

This is why verification and documentation are so important.

Our Recommendation to Patients

Before planning to use HSA funds for any plastic surgery procedure, we recommend that patients:

  1. Discuss medical symptoms with their provider
  2. Obtain a Letter of Medical Necessity, if applicable

Final Thoughts

While most cosmetic procedures are not HSA-eligible, many reconstructive and medically necessary plastic surgery procedures may qualify. Discuss the possibility of using your HSA or FSA with your plastic surgeon. They may be willing to work with you for full or partial payment. Dr. Graham and his staff will do all they can to facilitate using HSA/FSA funds to help finance your surgery.

ENT vs. Plastic Surgeon for Cosmetic Rhinoplasty

Patients considering rhinoplasty often ask whether an ENT (ear, nose, and throat) surgeon or a plastic surgeon is the better choice for cosmetic nose surgery. The answer isn’t about which specialty is “better”—it’s about choosing a surgeon with the right training, experience, and focus on rhinoplasty.

Both ENT surgeons and plastic surgeons can achieve excellent cosmetic results when rhinoplasty is a core part of their practice.

Understanding the Difference in Training

ENT Surgeons

ENTs (otolaryngologists) are specialists in the anatomy and function of the nose and airway. Their training emphasizes:

Plastic Surgeons

Plastic surgeons are trained in aesthetic surgery of the nose, face and body, with emphasis on:

Plastic surgeons often bring a refined artistic perspective to cosmetic nasal reshaping.

Who Performs Better Cosmetic Rhinoplasty?

There is no single specialty that consistently produces better cosmetic rhinoplasty results. Outcomes depend on:

A surgeon who performs rhinoplasty frequently—rather than occasionally—will typically achieve more predictable, refined outcomes.

When an ENT May Be the Right Choice-Functional Issues

An ENT surgeon may be particularly well suited if your rhinoplasty involves both functional and cosmetic concerns, such as:

ENTs with advanced facial plastic training are uniquely equipped to preserve or improve breathing while reshaping the nose.

When a Plastic Surgeon May Be the Right Choice-Cosmetic Appearance

A plastic surgeon may be ideal if your goals are primarily cosmetic, including:

Plastic surgeons often excel in achieving subtle aesthetic refinements that complement the rest of the face.

What Matters Most When Choosing a Rhinoplasty Surgeon

Rather than focusing solely on a surgeon’s specialty, patients should consider:

Final Thoughts

Both ENT surgeons and plastic surgeons can perform exceptional cosmetic rhinoplasty. The most important factor is selecting a surgeon who specializes in rhinoplasty, understands nasal function, and consistently delivers results that align with your aesthetic goals.

Dr. Graham is an expert in both primary and revision rhinoplasty. He has trained with the masters from across the globe to perfect his craft. He offers the latest technology, including waterjet rhinoplasty.