How Long Should You Quit Smoking Before Plastic Surgery?

I went to see my fifth plastic surgeon last week. She told me that I only needed one week without smoking a cigarette for her to operate on me. I found this odd because it seems like that wouldn't be enough time for the nicotine to be out of my system and my lungs cleared. Is that true?

Doctor Answers (7)

Quitting smoking before plastic surgery

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The thing you need to understand is that the nicotine constricts the blood flow in the tissues and can cause the tissue to turn black and die and result in very prolonged healing, possible further surgeries and bad scars. This is especially true in cases where the skin is widely undermined such as in a facelift, breast lift, breast reduction or tummy tuck.

You should stop for a full month before and another month after surgery if you are having one of these risky operations. Breast augmentation and eyelid surgeries carry much less risk for example.

I personally have a patient on my surgery schedule for a breast lift and she only stopped smoking 3 days ago, just 2 weeks before surgery despite my warnings. I have cancelled her surgery date and moved it to 2 weeks later so she will be off nicotine (second hand smoke is just as bad too) for a full 4 weeks!

Quitting smoking - depends on cosmetic surgery procedure

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It really depends on what you are having done. You don't really have to quit smoking at all but would be increasing risks for wound healing and possibly pulmonary and cardiac difficulties. Quitting smoking can actually be stressful in the short term.

Of course, it would be best if you never smoked at all. If you smoke a couple of cigarettes on Friday after work, that's really no problem. If you have smoked 2 packs a day for 20 years, most studies suggest that 8 weeks off the cancer sticks will substantially reduce risks (pulmonary and wound). It would not reverse any coronary disease but the blood would be better oxygenated during the operation. This recommendation is for substantial operations.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 11 reviews

How long should you quit smoking before plastic surgery?

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Hello! Thank you for your question! The issue with nicotine is that it also acts as a vasoconstrictor, clamping down of blood vessels. Blood supply is always of great concern during any surgical procedure, but especially in such procedures as breast procedures and a tummy tuck where the viability of the nipple, belly button, and skin flaps are obviously important. Since the vascularity to the area is already tenuous with the dissection of the abdominal tissue as well as cutting around the areas, maximizing blood flow to the tissue is critical.

Typically, we recommend at least 6 weeks of smoking cessation prior to and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, skin flap necrosis, and wound complications, as well as other health consequences. There is an increase pulmonary risk with the anesthesia and postop lung infections. The most devastating consequence of infection, especially since the tissue is tightened, is increased. This along with wound healing and scarring. Some surgeons will refuse to operate on smokers and often check urine or blood levels prior. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 13 reviews

How Smoking Retards Healing

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Smoking has a deleterious effect on cutaneous blood vessels. The nicotine found in cigarettes increases the level of a pituitary hormone called vasopressin ( ADH or anti-diuretic hormone). Vasopressin in turn leads to peripheral vasoconstriction (tightened blood vessels) and probably localized dermal ischemia ( decreased blood flow into an area). This results in poorer and more prolonged healing.

Nicotine has a short half-life, of about two hours. As a rule of thumb if you multiply the half-life by five, nicotine should be out of your system in ten hours. Therefore I would say that the last plastic surgeon was correct in telling you that you should quit a week before the surgery.

It goes without saying that you should not smoke in the weeks after surgery for better healing.

Also, if you are having the procedure to look younger, smoking is especially foolhardy. It is pretty well established that smoking causes wrinkles. I would refer you to the December 2007 issue of the Archives of Dermatology. The lead story compared identical twins, and showed the prominent wrinkling in the smoking twin compared to her copy. Rather than delve into this again, access my earlier post on the subject on RealSelf.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.5 out of 5 stars 10 reviews

How long should you stop smoking before surgery

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Thanks for your question -

As you've read from the other surgeons, smoking is a serious risks for complications. In addition to wound healing problems and possible tissue necrosis, you also risk anesthesia complications.

Usually a month is enough time to begin to minimize your risk. Remember, this doesn't only mean stopping smoking but avoiding nicotine gum, the patch or other sources of nicotine which can contribute to problems.

Also, be sure to have a plan for avoiding smoking during your recovery period. Many times patients can be at greater risk for relapse because you have increased downtime while your recovering and boredom or anxiety can contribute to the desire to smoke.

I hope this helps!

We generally advise to stop smoking 4 weeks before surgery.

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It really depends on the type of surgery you are having performed and the extent of tissue undermining. Removing a small facial mole is very different from a body lift surgery.

That having been said, most studies have shown that there is significant benefits to stopping smoking 4 weeks or more before surgery.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 51 reviews

Smoking not recommended before and after Surgery

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Smoking and alcohol usage before and after surgery is not recommended due to an increased risk of complications such as bleeding, scarring, wound healing problems or poor cosmetic outcome. I ask my patients to refrain from smoking four weeks before and four weeks after surgery. Good Luck with your surgery!

Paul L. Leong, MD, FACS
Pittsburgh Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.