Every rule on this site has flexibility somewhere except this one. The physiology explains why.
Nicotine constricts the small vessels that feed healing tissue; carbon monoxide displaces the oxygen those tissues need. Every incision, every raised flap of skin, every fat graft survives on exactly that microcirculation. One cigarette measurably narrows it for hours — and vaping, patches and gum deliver the same nicotine to the same vessels.
A single procedure gives nicotine one target. A combination hands it several at once: a tummy-tuck flap, arm incisions, grafted fat — all competing for compromised circulation simultaneously. Wound-healing complications, skin loss at incision edges and graft failure all run several-fold higher in smokers, and combined surgery concentrates that risk into one event.
Combined surgery asks your circulation to heal several zones at once; nicotine is the one variable that sabotages all of them together. Four weeks either side isn't a preference — it's part of the operation.
