Why do I need to stop smoking in order to have a facelift?

Smoking or the use of any nicotine releasing products, such as patches, vaporizers or gums, has been shown to increase the incidence of serious complications after facelift surgery.   For this reason, many plastic surgeons, myself included, refuse to perform facelifts on patients who are smokers or are using nicotine in any form.  The safety of our patients is always our primary concern.  Therefore at the very least, smoking or the use of any nicotine releasing products should be completely stopped at least several weeks before a facelift, and not restarted for a week or more after such an operation.   I strongly recommend that all smokers permanently quit as soon as possible, not just if they are considering plastic surgery, but purely for their own good health and those around them.

I would not recommend you have the procedure until you stop the smoking for a significant period of time. When performing a facelift the tissues are lifted off of the underlying tissues and therefore the blood supply is somewhat decreased. Smoking causes the blood vessels to tighten and cause further reduction in blood supply. That can lead to skin dying and poor scarring. There is a significant risk with the nicotine effect. I do not perform face lifts on people who smoke. 

It is extremely important that you stop smoking for at least two weeks before a facelift or any other surgical procedure. The substances in cigarette smoke cause the small vessels (capillaries) to constrict, which decreases blood flow to skin flaps and wounds to decrease. If this occurs you can encounter opening of the wounds, or worse, the skin can die.

Q: Why do I need to stop smoking in order to have a facelift?

A: Safety should always be the primary concern in any procedure. The goal of all plastic surgeons that perform facelifts is to improve the appearance with minimal side effects or problems. Exposure to smoke, either directly or indirectly, or the use of any nicotine releasing products, has been shown to increase the incidence of serious complications after facelift surgery and in most other cosmetic or reconstructive procedures. Most plastic surgeons, refuse to perform facelifts on patients who are active smokers or are using nicotine in any form.  It is generally recommended that all smoking or the use of any nicotine releasing products should be completely stopped at least 10- 14 days before a facelift, and for a minimum of 10-14 days after the surgical procedure. Ideally, one should stop permanently, not just because of its effect on aging, but from an overall health perspective.

All wound healing depends on blood supply. The blood flow to the skin and underlying tissue is diminished by smoking, which constricts the small blood vessels. Smokers have a significantly higher rate of delayed healing, infection, opening of the incisions, necrosis or loss of the facial skin that is elevated and the underlying tissue, poor scarring, and anesthesia problems.

Be honest with your plastic surgeon about your exposure to smoke and follow all instructions. Remember that you are a participant in your care.

Robert Singer, MD  FACS

La Jolla, California

Q: Why do I need to stop smoking in order to have a facelift?

A: Safety should always be the primary concern in any procedure. The goal of all plastic surgeons that perform facelifts is to improve the appearance with minimal side effects or problems. Exposure to smoke, either directly or indirectly, or the use of any nicotine releasing products, has been shown to increase the incidence of serious complications after facelift surgery and in most other cosmetic or reconstructive procedures. Most plastic surgeons, refuse to perform facelifts on patients who are active smokers or are using nicotine in any form.  It is generally recommended that all smoking or the use of any nicotine releasing products should be completely stopped at least 10- 14 days before a facelift, and for a minimum of 10-14 days after the surgical procedure. Ideally, one should stop permanently, not just because of its effect on aging, but from an overall health perspective.

All wound healing depends on blood supply. The blood flow to the skin and underlying tissue is diminished by smoking, which constricts the small blood vessels. Smokers have a significantly higher rate of delayed healing, infection, opening of the incisions, necrosis or loss of the facial skin that is elevated and the underlying tissue, poor scarring, and anesthesia problems.

Be honest with your plastic surgeon about your exposure to smoke and follow all instructions. Remember that you are a participant in your care.

Robert Singer, MD  FACS

La Jolla, California

Yes, you need to stop smoking before your facelift.  All surgeons wish the best for their patients and want to produce the best results possible.  Smoking, or the use of any nicotine product in any form can adversely affect the healing process of your facelift and result in skin loss, poor scars, increased risk of bleeding, etc.  Many plastic surgeons do not want  this additional risk and feel if the patient does not want to be an active participant in maximizing their results from their facelift surgery then it is best not to operate on them.  Quitting all nicotine products a minimum of 3 weeks prior to your facelift surgery and 3 weeks after your facelift is mandatory.  There are a number of cessation programs available which you could check out.  Complete smoking cessation would be fully in your benefit.

It is crucial that you stop smoking at least 5 date weeks prior to having facelift surgery.  Residual nicotine in your blood system can cause loss of blood supply to the face lifted skin and create very severe wound healing problems and scarring.

In my practice who request the patient's abstained from nicotine products entirely 45 date weeks before facelift and we performed blood test to check for residual nicotine in the blood before doing facelift surgery.

The answer is simple; you should stop smoking before facelift surgery.  The nicotine will cause decrease blood flow to the undermined skin and can cause skin death.  This is a basic principle in facelift surgery and a principle to practice.  However, in have a do perform facelifts on smokers who reduce their intake.  My protocol is to pre-treat with Oxygen treatment before and after surgery.  The surgery must be modified.  The skin is lifted with the SMAS attached which is the deep layer of tissue. This will maintain a ok blood supply.  The area behind the ear is the problem area and a short scar facelift is better.  This is a more aggressive approach to facelift surgery.  The patient needs to understand the risk.   This, however, is not the standard of most plastic surgery practices and is more risk to the patient.