Procedures Resource Center Plastic Surgeon Info Contact Us Forum Blog Videos Home

Smoking and Cosmetic Surgery


Tobacco smoke contains more than 3,800 identified substances in which both nicotine and carbon monoxide are the two biggest that are most detrimental to wound healing  and of course has the potential of causing pulmonary complications.  Bottom line.......impaired wound healing can decrease the final cosmetic outcome of a procedure.


Tobacco use increases chronic health risks associated with smoking, and does have a direct correlation with nicotine causing blood vessels to constrict which result in less blood and oxygen going to the surgical site to help healing.  







Nicotine closed the blood vessels by constriction.  These blood vessels are responsible for bringing oxygenated blood to the tissues.  Blood cells that are oxygenated help to keep tissue alive as well as being instrumental in delivering important medications such as antibiotics.  Smoking clogs the lungs in which increases the risk of pulmonary infection such as pneumonia.

For some procedures, smoking has even more risks associated with it and these include breast reduction, tummy tuck, and facelift. These procedures have complex and extensive wounds that the body needs to heal and impairing this healing ability can cause real problems. Compared with nonsmokers, smokers have a higher incidence of insufficient healing after face-lift surgery, as well as a greater degree of complications following breast surgery.


Smoking can also prematurely age a person's face by:

  • Constriction of blood flow increases the free radicals

  • Decreases the skin's elasticity (leading to earlier sagging and wrinkling of the skin)

  • Repeated "puckering" action involved with having a cigarette in the mouth - in which causes lines and wrinkles




Because of the risk of complications with smoking, some plastic surgeons will require their patients to quit smoking prior to surgery.  Most will ask to have the patient quit for a period of two weeks before the procedure and also for a period of two weeks after the surgery.  Some plastic surgeons will help their patients with smoking cessation medication or will advise the patient to seek help from their internist on smoking before surgery.

Surgeons or physicians check the patient's background health completely before committing to perform the surgery.  Patients who are suffering from health problems like hypertension, diabetes or kidney problems are considered high risk.  And of course smokers are also considered a health risk as well. 

There are studies that show that plastic surgery patients who smoke are 12 times more likely to develop healing complications than non-smokers. 

The following complications occur with patients who smoke:

Any surgical procedure that create skin "flaps" such as breast reduction or abdominoplasty - are naturally more prone to healing complications.




Cigarette smoke contains these Toxic Chemicals

  • Nicotine: 

Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin, resulting in tissue ischemia and impaired healing of injured tissue. Nicotine can also contribute to blood cell platelet gumminess, raising the risk of thrombotic micro-vascular obstruction and tissue ischemia (an inadequate supply of blood to a part of the body, caused by partial or total blockage of an artery). In addition, production of red blood cells, fibroblasts, and macrophages are all reduced by nicotine.

Nicotine has also been implicated as a negative factor in pain management - as it has the tendency to distort one's perception and control of pain.


  • Carbon Monoxide: 

Carbon Monoxide binds to the hemoglobin in red blood cells and prevents it from carrying oxygen. This causes less blood to be delivered to the metabolically demanding healing tissue and once the smaller amount of blood arrives, it has greatly decreased oxygen which is needed to help the healing process progress.  Carbon monoxide is referred to as a potent cellular killer.


  • Hydrogen Cyanide:

Hydrogen Cyanide inhibits the enzyme systems necessary for oxidative metabolism and oxygen transport at the cellular level.  It is these enzyme systems that are important for the metabolism of oxygen at the level of the tissue where there is a need for this oxygen.  This is critical for proper tissue repair and wound healing.




Anesthesia can be hard on the human body.  It is even harder on patients who smoke.  Because of the fact that smokers have a tendency to develop coughs and an elevated heart rate, makes the odds higher for problems with anesthesia.  

Smoking causes the following symptoms:

  • Decreases lung capacity

  • Lowers the body immune system with trying to fight off an infection

  • Higher incidence of blood clots

  • Reduces oxygenation in the red blood cells

  • Constricts the blood vessels

  • Delayed wound healing

  • Elevate heart rate

  • Elevate blood pressure


Some plastic surgeons have various opinions about the issue of smoking and having cosmetic surgery, but most will agree that the patient should stop smoking for a period of time before the surgery and up to three to four weeks after the procedure.




Quitting Smokes Helps Post Surgery Recovery

Excerpts from: Lightening Up the Smokes Eases OR Recovery

By Adam Marcus

Bone-joint patients heal faster by cutting tobacco intake ahead of operation

Smokers facing elective surgery on bone joints heal better and recover faster if they quit or cut down their tobacco intake several weeks before the operation, a new study says.

Researchers in Denmark, who studied smokers undergoing hip and knee replacements, found that those who tried to quit six to eight weeks before surgery had fewer wound complications and a lower risk of cardiovascular trouble after the procedures. They also spent fewer days in the hospital recovering than did full-bore smokers, according to the study, which appears this week in the journal The Lancet.

"How short-term smoking cessation influences wound healing has not been shown clinically, but experimental data suggest that even a few days [off tobacco] could improve tissue blood flow and oxygenation, so it might very well have a positive effect on wound healing," Dr. Ann Møller, lead author of the study, said in an e-mail interview.

While other researchers have found that smoking impedes wound healing, the latest work is the first randomized trial to look at the impact of smoking cessation programs on post-operative outcomes, Møller said.

Møller, an anesthesiologist at Bispebjerg University Hospital in Copenhagen, and her colleagues followed 120 smokers scheduled for hip and knee replacement surgery.

Half of the smokers were told to stop, or to cut their cigarette intake by at least 50 percent, starting six to eight weeks before the operation. They were encouraged to do so with counseling and nicotine replacement, such as the patch. The rest of the smokers were allowed to continue smoking. All the smokers, who were typically in their mid-60s, reported puffing an average of 15 cigarettes a day before entering the study.

Of the men and women in the smoking cessation group, 36 managed to quit smoking, 14 cut their tobacco intake and six continued smoking. Only four of the people in the second group quit smoking before surgery, while the rest did not alter their tobacco intake significantly. Eight patients whose operations were delayed or canceled were dropped from the study.

Ten patients in the smoking cessation group, or 18 percent, suffered complications after surgery, compared with 52 percent of those in the second group, the researchers say. These complications included infections and bruising at the surgical site, urinary tract infections and gastric bleeding.

The difference was particularly marked for wound-related trouble, which occurred in only 5 percent of the stopped smokers, compared to 31 percent of those who did not stop.

None of the patients in the no-smoking group suffered a cardiovascular setback, while 5 people, or 10 percent, in the other group did.

"This doesn't mean that quitters cannot have complications, but that it will happen less often," Møller said.

Patients who received smoking-cessation therapy were also about 75 percent less likely to require additional surgery to correct problems with the initial procedure. And they spent less recuperation time in the hospital -- 11 days vs. 13 days.

Møller said the study shows that the effects of smoking on recovery are reversible, and that smoking-cessation therapy prior to surgery is "an intervention that gives us a major reduction in postoperative complications, patient suffering and, presumably, in health care costs."

Orthopedic surgeons say long lead times for elective procedures like joint operations offer a good opportunity for doctors to encourage their patients to quit smoking.

"Even [quitting] for a few weeks, you will see positive effects, but the longer the better," said Dr. Stuart Hirsch, chairman of the department of orthopedics at Somerset Medical Center in Somerville, N.J., and a member of the board of directors of the American Academy of Orthopaedic Surgeons.

Not only does smoking undermine tissue and vessel health, it weakens the bone mineral that keeps the skeleton strong, Hirsch said.

"It is a worthwhile effort to say to your patient, 'Stop smoking,'  Hirsch said. "What you want to do is partner with your patients for the very best result. If the patient doesn't do everything that he or she should do to get the very best result, they're going to be disappointed."