Background Cigarette smoking is the leading cause of preventable death and a major public health concern. Numerous clinical and experimental studies have examined the effect of nicotine on wound healing and surgical procedures, but there are limited published reports in the dermatologic surgery literature. Objective This article seeks to develop evidence-based recommendations regarding the effect of tobacco use in patients undergoing dermatologic surgery procedures. Methods This article reviews the existing published English-language literature pertaining to the effects of tobacco on wound healing and surgical complications. Results Tobacco use is associated with a higher incidence of postoperative complications including wound dehiscence, flap or graft necrosis, prolonged healing time, and infections. Limitations This review article only summarizes past reports and studies. Conclusion Recommendations for smoking cessation before dermatologic surgery are provided based on the available data.