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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 (21)

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
3.5 out of 5 stars 29 reviews

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 14 reviews

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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.

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 48 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 55 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

SMAS & Smoking


This is very true. If you are a heavy smoker, you should avoid surgery or laser resurfacing. Depending on what you are looking to have done, there are several non-invasive skin-tightening procedures that you may be a good candidate for.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 3 reviews

SMAS Facelift and Smoking


There is no question that smoking has deleterious effects on wound healing and facelift flaps.  The elements in cigarette smoke make it much more likely that the elevated skin may die.  It is still possible to perform a SMAS facelift on a smoker if careful attention is paid to elevating the flaps.  The best thing for you to do is stop smoking around the period where you are having the facelift performed.  

Michael Sundine, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 15 reviews

Smoking and a SMAS Facelift


When one smokes, or uses tobacco, there is vascular constriction.  Good wound healing is all about getting enough blood supply to the area.  In a facelift operation the thickness of the flaps are thin, making the bloodflow even more important.  The incision will also be put on some tension.  Tension is the enemy of good wound healing, and coupled with decreased blood flow in smokers, finds the patient at higher risk of wound problems.  The SMAS technique is excellent, but the surgeon has to work with the tissues given.  Our office does not do facelifts on smokers.  Some respected colleagues still may do them, but usually the extent of the dissection is less.  Please stop smoking, (for dozens of reasons).  If the prospect of a facelift is a motavation to quit, then so be it.

Jeffrey Roth, MD
Las Vegas Plastic Surgeon
4.5 out of 5 stars 7 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.