Although tobacco smoking is known to result in coronary heart disease, chronic obstructive pulmonary disease, peripheral vascular disease, cerebrovascular disease, lung cancer, and other smoking cancers, many surgeons believe that smoking also results in impaired wound healing and poor surgical results. Large clinical experiences in several areas of plastic surgery reinforce this suspicion. Procedures that have been noted to be adversely affected by cigarette smoking include rhytidectomy, abdominoplasty, breast reconstruction, free-tissue transfer, and digital replantation. This article reviews the available data, introduces new clinical data, and hypothesizes about the ways in which some procedures are more affected than others.