Why Do I Need to Quit Smoking Before Plastic Surgery?

While smoking is a difficult habit that poses multiple medical threats to those who do it, there are special reasons for not only stopping smoking before plastic surgery operations, but abstaining from all forms of nicotine, including vaping, patches, and chewing tobacco as well. Smoking tobacco is addictive due to the presence of nicotine, which has the unfortunate effect of shrinking blood vessels and decreasing the blood flow to the entire body. Blood flow delivers oxygen and nutrients to tissues that are trying to heal and removes waste products.

When a person has an operation that involves moving tissue around—as in a facelift, breast lift, breast augmentation, breast reduction, or tummy tuck—the blood supply to the local structures is diminished, at least temporarily, as an effect of the operation. If one adds the effect of nicotine to that situation, it can mean that there is not enough blood flow to the tissue to allow healing. This can show up as loss of skin (slough), a wound that comes apart or will not heal, prolonged healing, and very significant increase in scarring.

Tissues regain more normal circulation with time, and will probably tolerate nicotine after adequate recovery has occurred, but there should be no hurry to get back to use. I would recommend allowing a bare minimum of 4 weeks after the operation, assuming that everything is already going very well, because a good result can become a bad result if nicotine use is restarted too early.

Other effects are a potential increase in the likelihood of infection (due to inadequate delivery of the cells and blood substances responsible for protecting us) and problems with anesthesia (due to increased irritability of the airway and slowed self-cleansing of the airways).

As physicians, plastic surgeons would love it if we could get everyone to completely stop nicotine use permanently, but at the very least, we need to require that patients stop for an appropriate time before and after certain operations, to minimize the risk of severe complications.

My own approach is that I would prefer not to have a patient at all, rather than have a patient with serious preventable complications because they would not follow the rules about nicotine. I do test smokers ahead of the operation to determine if they are still using nicotine. If the patient wishes to resume smoking later, that is their choice as an adult.

If you have questions about quitting smoking or would like to schedule a consultation with Dr. Copeland, please contact Copeland Cosmetic Surgery.