Hi. Very good question. Rhinoplasty is a Plastic Surgery and all plastic surgeries The blood supply is one of the most demanding factor. Although the Nicotine might not have cause direct complications in the nasal surgery , we get many patients with Burger s disease where we have to cut-off that is amputate the toes or even legs. This disease is caused only due to nicotine. IF the patient does not stop using nicotine in any form he needs further amputations. The same principals are applied in your case as nicotine causes the very small arteries to get blocked on permanent basis. Secondly these arteries are blocked by spasm the moment one smokes or takes nicotine in any form. So this is very true what your Surgeon said- blood vessels may block or die and the tip of the nose. It is possible that your Surgeon has had such experiences , otherwise you tell us the reason why should he refuse you. and is it not that he is helping by giving you the best chance.