With all the smoking cessation tools available to those trying to quit, an unexpected motivator is coming from the increasingly popular world of cosmetic surgery. Several patients are successfully quitting after being told by their surgeons that their smoking will impede proper healing of their skin after the surgery, the New York Times reported Aug. 14.

"Nicotine causes the tiny blood vessels in the skin to clamp down or constrict, which reduces blood supply to the skin," said Darshan Shah, M.D., a Bakersfield, Calif., plastic surgeon. That could mean poor wound healing and longer-lasting bruises from a face lift, tummy tuck or breast augmentation surgery.

Some surgeons, concerned about the quality of the very noticeable results of their procedures, refuse to operate on smokers unless they agree to quit several weeks before and after a procedure. Some are referring their prospective patients to smoking cessation counseling or familiarizing them with medications such as Wellbutrin or Chantix.

Others have taken more stringent measures before they will agree to operate. Samir Pancholi, M.D., of Las Vegas asks patients to submit to a urine test for the presence of nicotine. And there is a growing amount of evidence that for many smokers who have not been compelled to quit by general health considerations, the potential outcome of an elective surgery may serve as a potent motivator.

"They're putting image before health," said Nancy Irwin, a therapist in Los Angeles who reports receiving about 5 to 10 percent of her clients from cosmetic surgeons' referrals.