American Society of Plastic Surgeons
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9 months ago

Can any kind of facelift procedure be offered to a smoker?

Jonathan Zelken, MD Newport Beach, CA
9 months ago

Hi there, yes. However, many plastic surgeons mandate a urine cotinine screen that ensures that you've quit for 3 weeks prior to the operation. If you can't kick the habit, less invasive options like CO2 laser resurfacing and FaceTite radiofrequency tightening can be offered- albeit with a heightened complication profile. How much do you smoke? Would you consider cessation for 3 weeks prior and after surgery?


Dr Zelken

The simple answer is NO!! The risk of operating on a smoker for a true facelift is too high. The undermining of skin and the layers in a real Facelift precludes me from offering to any such patient unless they stop smoking successfully for at least 4-6 weeks preop and hopefully will not resume post op!!

The risks and complication rate in a smoker skyrocket especially in a facelift patient from skin loss to infections to pulmonary problems- Remember this is elective cosmetic surgery !!

Steven Wallach, MD New York, NY
9 months ago

Smoking impairs wound healing. Therefore, the majority of plastic surgeons will recommend that you stop smoking several weeks before surgery and also avoid cigarette smoking for several weeks after surgery during the initial healing process.

Donald Griffin, MD Nashville, TN
9 months ago

A typical facelift procedure requires skin undermining which diminishes the blood flow to the skin that is elevated. Nicotine products, whether cigarettes, chewing tobacco, or vapes constrict small blood vessels in the elevated skin further reducing blood flow to the point that some of the skin suffers irreversible lack of oxygen and blood supply and the skin dies or necroses. This risk is too high for most surgeons to knowingly take which is why they require patients to stop smoking before and after surgery. There are non-surgical alternatives, but they do not provide the same lifting effect as a surgical facelift.

Smoking increases the possibility for complications following facelift surgery. Many plastic surgeons will not operate on active smokers. I recommend that patients stop smoking 4-6 weeks before surgery and for 4 weeks after surgery. If they are unable to stop, the surgeon must be informed. I will operate on smokers; however, I alter the operation to reduce the complication rate by minimizing skin elevation. These operations achieve improvement; however, the changes will be less comprehensive. For patients that can stop smoking before the operation, healing complications are reduced; however, their risk is still greater that non-smokers.

Jon Ver Halen, MD Colleyville, TX
9 months ago

Hello and thank you for your excellent question. You need to be absolutely nicotine free for 3 weeks (at least) prior to surgery to be an appropriate candidate for a facelift. There are many ways to help you quit. I suggest you contact your plastic surgeon, or primary care doctor to help you with this. If you are able to comply with these recommendations, you will be setting yourself up to obtain the best results you can. Good luck!

Daniel Allan, MD Las Cruces, NM
9 months ago

I wouldn't do it. Any operation is to some extent a partnership between the patient and the surgeon. In fact, that is true for all health care. The patient has the responsibility to follow directions and to put him /herself in the best possible state for the procedure. We frequently have to operate on patients in a sub-optimal condition because their medical problem demands intervention, and doctor and patient "bite the bullet." If you are determined to have a face lift I am sure you will find someone to do it-venality is not unknown in this specialty. You may even do well, with an uncomplicated recovery, and wonder why the surgeons in this column were reluctant. In that event, you and the surgeon were lucky and got away with it. That is not a good basis on which to undertake a totally elective procedure.

John Lomax, MD , IL
9 months ago

It can be done. As my colleagues have stated it is a high risk operation but I disagree that it should be avoided in all cases. The procedure is more tedious and more precise so as to minimize injury to the flaps. The type of suture used and its placement will differ. We have done for 30 years with no difference in healing. The risks to smokers are documented very well but it can be done. It will all depend on the patient, how much they smoke, other underlying conditions, the quality of their skin, just to mention a few of the factors involved.

Ramasamy Lingappan, MD Madurai, TN - India
9 months ago

It is better if you quit smoking and then undergo facelift procedure. Smoking increases the risk of complications. if you are not able to quit please choose a non invasive options like Laser resurfacing of face or minimal invasive methods like thread lifts.

Rick Rosen, MD Norwalk, CT
9 months ago

I would strongly advise you not to have a facelift if you are a smoker and continuing to smoke. The risk of significant complications is much higher in a smoker. If you are not able to quit smoking, then doing fillers and/or botox may give you some rejuvenation of the face. I recommend at least 6 weeks or longer preferably if wanting to have a facelift. I also recommend no second hand smoke or patches as the nicotine effect will still affect the results.

Michael Cohen, MD Gig Harbor, WA
9 months ago

Because the surgery is elective, it should be done when all the conditions are optimal, so as to minimize the risks of complications as much as possible. Smoking is extremely detrimental to wound healing, especially after plastic surgery operations that tend to undermine much of the blood supply to the healing wound edges. A facelift procedure is an example of a procedure where tissues are undermined and blood supply is partially disrupted. Your risk of tissue necrosis will be higher if you smoke before of after your surgery. I usually recommend 6 weeks of not smoking before and 3 months after the surgery (hopefully that's enough time to quit smoking altogether). Best of luck.


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