Smokers must stop smoking before and after surgery, period. The risks of large patches of dead skin and permanent scarring are far too great in patients who are actively smoking. In this matter there is little debate. The question is how to deal with a smoker who has temporarily quit smoking for the requisite 4 weeks. I know studies debate this, but I believe there is a significantly higher risk of skin slough (dead skin) even with smokers who have ceased smoking.
Therefore in our practice, I caution smokers that they must be prepared to accept a more conservative result than nonsmokers. The degree of tightness and tissue movement inherently affects blood supply, the most vulnerable element in smokers' tissues. It is simply not in the best interest of any patient to incur great risk with surgery, especially if the problem is reversible or avoidable.
The main determinants of complications, in my opinion, are not only the technique, but the tightness on the tissues and the surgical technique. The deep plane technique does have some inherent advantages in that the central facial skin is not undermined, so blood vessels continue to come through the central facial SMAS to the skin. However if too much tension is put on the flaps, an almost inherent necessity in my opinion to achieve a satisfactory result with a deep plane procedure, this may actually predispose to complications the same way as undermining with a multivector facelift with greater tension.
With all facial plastic surgery issues, a great deal of experience and many thousands of cases are helpful in striking the right balance between an excellent result and acceptable management of risk when a patient has a potential risk factor such as smoking.