When to Stop Smoking Before a Facelift

by Surgical Times
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Your surgeon’s recommendations to stop smoking for plastic surgery will typically range from between 2-4 weeks before surgery and from 4-8 weeks after surgery.

Suggested timeframes vary, but smoking cessation is a must for plastic surgery patients.

Active Smokers Not Candidates for Plastic Surgery

According to the latest professional publications, active smokers aren’t appropriate candidates for elective cosmetic surgery and the debate over whether to operate on them at all for certain plastic surgery procedures is ongoing.

Smokers are at the top of the list of medical criteria that deem patients as poor candidates and at risk for complications.

“To be considered a candidate for elective plastic surgery, patients must stop smoking at least 4 weeks preoperatively.”

Drs. Rod J. Rohrich, Abigail M. Rodriguez, and Ira L. Savetsky: “The Consult: What to Know, What to Do, and When to Say ‘No’”

No Smoking 4 Weeks Before Surgery

“To be considered a candidate for elective plastic surgery, patients must stop smoking at least 4 weeks preoperatively,” says the latest professional literature by leading plastic surgeons.

Facelifts Last 2X Longer for Nonsmokers

Celebrity facial plastic surgeon Dr. Andrew Jacono says that smoking cuts the lifespan of your facelift results in half.

He suggests patients permanently quit smoking but says that for those interested in only a brief hiatus, there is “light at the end of the tunnel,” and they can return to the destructive habit later if they choose.

“…The results of the surgical procedure will last about twice as long in a nonsmoker.”

Dr. Andrew Jacono, The Face of the Future, “Preparing for Surgery and Enhancing Healing”

“The results of the surgical procedure will last about twice as long in a nonsmoker,” he writes.

Deep Plane Facelift: No Smoking 3 Weeks Before Surgery

Dr. Jacono says that “deep plane facelifts are the only facelift type that can be performed safely on smokers.”

Because the skin and muscle aren’t separated in a deep plane facelift—as they are in a SMAS or mini-lift—the blood supply is better and skin necrosis is less like, he says.

In their 2021 chapter on the Deep Place Facelift, Drs. Thomas A. Mustoe and co-authors say, “Smoking must be stopped at least 3 weeks prior to surgery.”

A Sampling of Surgeon’s Orders

  • Dr. Daniel E. Rousso: 2 Weeks Before, 4 Weeks After
    In “The Male Facelift,” published in the August 2020 Journal of Facial Plastic Surgery, triple board-certified facial plastic surgeon Dr. Daniel E. Rousso and co-authors say plastic surgery patients should stop smoking “at least 2 weeks prior to surgery and for 4 weeks following surgery.”
  • Dr. Matthew Schulman: 4 Weeks Before, 8 Weeks After
    Board-certified plastic surgeon Matthew Schulman says, “I’m going to tell you you can’t smoke for four weeks before surgery and eight weeks after surgery. That’s the minimum. Obviously, the longer you go without smoking, the better your body’s going to heal,” he says in a March 2019 video.

In every case, your own surgeon’s advice will supersede this information and other general information provided elsewhere.

“That means no nicotine…including no nicotine gums to curb cravings because nicotine negatively affects healing.”

Dr. Andrew Jacono, The Face of the Future, “Preparing for Surgery and Enhancing Healing”

What Smoking Does

Despite the slightly varying recommended durations of abstaining from smoking, all plastic surgeons agree that the longer patients stop smoking the better.

Smoking before plastic surgery:

  • Worsens scarring.
  • Increases swelling.
  • Prolongs recovery time.
  • Reduces blood supply to the skin, depriving it of nourishment.
  • Increases the likeliness of surgical complications, including death.
  • Causes the skin’s blood vessels to constrict, thanks to the nicotine in cigarettes.
  • Causes some of the cosmetic concerns you’re likely trying to solve with a facelift.
  • Increases the risk of skin flap necrosis (death due to disease, injury, or blood supply failure).

Smoking, “Causes all layers of the skin to thin and lose elasticity; as a result, collagen and elastin are lost and wrinkles form,” writes Dr. Jacono.

Quitting the Day Before Surgery: “I smoked before my facelift.”

If your surgeon failed to clearly let you know to quit smoking well in advance of your surgery, that is a red flag not worth glossing over.

You may be about to have surgery by someone with little actual training in plastic surgery—as even pediatricians can legally do cosmetic surgery.

Omitting to inform patients about the importance of smoking cessation is unthinkable, unprofessional, and outright dangerous.

If your plastic surgeon did inform you to stop but you’ve slipped up or kept smoking, it’s best to stop now and call your surgeon’s patient coordinator and simply let them know what occurred and how frequently.

“Quitting smoking even the day before your surgery can lower your risk of complications.”

American Society of Anesthesiologists

It’s unlikely that you will have to reschedule your surgery, but it is imperative that you let your surgeon know so that they can make that call.

“Quitting smoking even the day before your surgery can lower your risk of complications,” the American Society of Anesthesiologists says, but your surgeon should always be informed of what happened.

If Quitting is Too Hard

If despite your best efforts you still cannot stop smoking, your surgeon may be able to prescribe a medication to help you quit short-term.

If refraining from smoking, tobacco, and nicotine for 1½ – 3 months is too difficult to follow through with, you may want to reconsider how well a facelift fits in with your lifestyle.

When You Can Start Smoking Again After Surgery

“[I]t is highly recommended that patients abstain from tobacco use at least 2 weeks prior to surgery and for 4 weeks following surgery to improve healing,” Dr. Rousso and co-authors say.

In all cases, patients should check with their surgeon.

“Tobacco or nicotine use should be stopped 2 weeks prior to surgery and for 4 weeks postoperatively,” says Rousso et al.

“The senior surgeon prefers that the patient should stop the use of tobacco products 2 weeks prior to the date of surgery. Some surgeons recommend 3 to 6 months of tobacco cessation prior to surgery. Even with adequate tobacco cessation, the risk of skin flap necrosis remains higher in the smoking patient than the nonsmoking patient.”

History

Smoking before and after surgery hasn’t always been so taboo.

Even four years after the first Surgeon General’s report, in at least one professional text alcohol avoidance made the list of preoperative care guidelines but smoking cessation goes unmentioned:

“Avoidance of alcoholic drinks for a period of 5-7 days before surgery will often forestall postoperative delirium tremens,” say Drs. Robert A. Wise and Harvey W. Baker, in their 1968 “Handbook of Operative Surgery; Surgery of the Head and Neck.”

References:

  1. Masters of Cosmetic Surgery—The Video Atlas, The Dallas Cosmetic Model [2021, Thieme]
    • Chapter 1, “The Consult: What to Know, What to Do, and When to Say ‘No’”
    • Chapter 2, “How to Optimize Results and Minimize Complications in Cosmetic Surgery”
    • Chapter 10, “Deep Plane Facelift”
  2. The Face of the Future by Dr. Andrew Jacono [2012, Addicus Books]
    • Chapter 10, “Preparing for Surgery and Enhancing Healing”
    • Chapter 12, “Facial Rejuvenation: Lifting the Face and Neck”
  3. Matthew Schulman M.D., “Stop Smoking Cigarettes Before Surgery,” 11 March 2019
  4. Original Article: “The Male Facelift,” by Paul P. Daraei MD, Ryan V. Marshall, MD, Austin S. Adams MD, and Daniel E. Rousso MD, August 2020
  5. “Handbook of Operative Surgery; Surgery of the Head and Neck,” Drs. Robert A. Wise and Harvey W. Baker [1968]
  6. “Is It Dangerous to Quit Smoking Shortly before Surgery?,” David O. Warner MD, and Yu Shi, MD, Anesthesiology, November 2011

Surgical Times provides objective public interest reporting on the practice of plastic surgery and is not affiliated with or funded by any surgeon or practice.

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