Plastic surgeons are doctors of medicine first before they specialize in surgery. As such, the care of the whole patient is always their concern so efforts are directed at guiding their patients toward healthy lifestyle choices such as cessation of smoking, proper diet, exercise, and weight management.
Specifically, with regard to smoking, it is critical that patients be off all nicotine products for a month before and a month after certain kinds of surgeries. These are surgeries that require extensive undermining of the skin to achieve their results. The most common of these are facelifts, breast lifts and reductions, and tummy tucks. By undermining the skin to lift it, the blood supply to the skin is partially compromised but not to the point where it will die. In the smoker, however, the nicotine constricts the blood vessels and can tip the fine balance of blood flow in these procedures toward the point where the skin may die and result in terrible scars and an extremely poor result. It is the nicotine that is the culprit here so gums and patches are just the same as actually smoking.
Also second-hand smoke has been shown to potentially cause the same healing problems so avoiding other smokers is also critical.
In procedures where the risk of skin death is minimal even in a smoker, such as eyelid lifts and breast augmentations, the safe conduct of anesthesia is vastly improved by not smoking. If a doctor has instructed a patient to not smoke, they must take this seriously!
