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SMAS Facelift Side Effect True for Smokers?

I keep reading that SMAS Facelift is bad for smokers--it has something to do about the skin dying. Is this true? Should I not have one, as I do smoke? Please advise.

Doctor Answers 24

The SMAS facelift is actually ideal for smokers

When you do a SMAS facelift, you are elevating the layers of the face in a deeper plane which allows you to preserve a thicker skin flap. The added vascularity that is associated with a thicker flap is actually safer for smokers. This approach is what I use for people with a significant history of smoking.

One thing that you should do is to go to someone with a lot of experience with performing facelifts. You also want someone that is going to take his time.

Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 41 reviews

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SMAS facelift in Smokers

Smokers are at higher risk for a number of post-operative complications, ranging from skin slough of the facial skin, oxygenation issues before-during-and postoperatively, etc.

Nicotine, either in the form of primary or second hand smoke, nicotine patches or any form of nicotine delivery system, causes the small blood vessels in the skin to constrict and reduces blood flow to the flaps of skin elevated during the facelift surgery. The thinner the flaps, the higher the risk of compromise.

All patients in my office are advised to discontinue smoking or using nicotine delivery devices for a minimum of 4 weeks prior to and after surgery --especially facelift surgery.

If patients will not or can not stop smoking as advised, I will not perform the surgery.

David L. J. Wardle, MD
Orange County Plastic Surgeon

Either way, you should not smoke 2 weeks before and after any facelift.

All smokers need to stop smoking before a facelift of any type. The more the skin is separated from its blood supply as in a full SMAS lift, the greater the risk of the skin dying. In 30 years of doing facelifts, I feel a more conservative lift is warranted in smokers. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Smokers and face lifts - a bad combination

Smoking interferes with blood flow, and active smokers are at much higher risk for complications (ie: wide scars, slow healing, and even skin death with significant scarring) with any surgery. Surgery that requires wide undermining of a skin flap (such as certain face lift techniques, tummy tucks, or large breast lifts) are high risk for patients who smoke. Most surgeons will require that smokers abstain for at least 3-4 weeks before and after the procedure (although this does not lower the risk to that of a non-smoker, it is a significant improvement.) Additionally, it is smart to pick modifications of the procedures that provide a more "robust" blood supply to the undermined flap - either by limiting the amount of undermining, or going deeper and incorporating more vascularized tissues. The typical SMAS face lift requires a widely undermined thin skin flap, followed by another thin vascularized flap (the SMAS layer). Although a more limited procedure may give less of a result, it maybe smart to compromise to reduce your risk. I would suggest you visit with a board certified plastic surgeon who specializes in face lifts, and frankly discuss you medical history, and listen to their advice regarding the safest way to achieve your goals.

Facelift for smokers

Smokers have additional challenges for a facelift or skin flap.  Speak to your surgeon about non surgical options as well, including the Ultherapy lift.


Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 57 reviews

SMAS Facelift Side Effect True for Smokers

Smoking changes the blood flow to tissues. It can have long-lasting effects on the microcirculation. With any elective cosmetic procedure I recommend the patient's refrain from smoking for six weeks before and six weeks after surgery. 

Refraining from smoking does not completely reverse the changes caused by smoking, however it gives the patient the best chance to decrease the risk of postoperative complication. 

Austin Hayes, MD
Portland Plastic Surgeon
5.0 out of 5 stars 4 reviews

Smoking and surgery

Here are the major points of smoking Tobacco or Marijuana before or after surgery:
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke. Hookah also does not decrease nicotine.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Best wishes,
Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 29 reviews

Facelift with smokers

I truly feel that stopping smoking 2 weeks before facelift is correct, but not that important. With smokers, the micro-circulation has changed, so a modified facelift needs to be performrmed so that the skin is not pulled as hard while the SMAS layer can be pulled harder and tighter.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
4.5 out of 5 stars 2 reviews

Smoking and the SMAS face lift

 Smoking cigarettes can have a deleterious effect on the healing process which includes sloughing of tissues, and infection and poor overall healing. It is important to make sure you do not smoke and stay away from  second hand smoke.   For many examples, please see the link below to our SMAS face lift photo gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 60 reviews

Smoking and Facelifts is not an ideal combination

Smoking has several effects on healing after all types of surgery but it can be especially problematic in facelift surgery. This is because the nicotine in cigarettes causes blood vessels to shrink down and decreases the blood flow of oxygen and nutrients to the skin that needs to heal. If there is enough compromise from the smoking then the skin edges can die off - while this can be treated it is difficult to do so and may result in rather poor scarring.

Smoking needs to be stopped 2 - 4 weeks before surgery to help limit the impact it could have.

All the best,

Dr. J

Kamran Jafri, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 8 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.