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Smoking/drinking Rhinoplasty?

Hi, I'm having a closed rhinoplasty next Thursday. I gave up smoking this week as recommended by my surgeon. However, as a 18 year old male I like my social life and as its currently the holidays I would like to know when it is possible to smoke/drink after surgery. I've heard many differing responses on this. Please can I have your opinions. Also, is it safe to smoke nicotine and tobacco free cigarettes before/after surgery? Finally, when is it safe to have sex after rhinoplasty? Thanks.

Doctor Answers (11)

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

Phoenix Plastic Surgeon
5.0 out of 5 stars 27 reviews

Smoking, Drinking, Sex, and Rhinoplasty


I instruct my patients to stop smoking 2 weeks before and after rhinoplasty. I suggest they avoid strenuous activity for 2 weeks after surgery, so you draw your own conclusions about sex. Remember, you're spending a lot of time and money for a surgical result that will last the rest of your life. Having said all that, follow the instructions of your surgeon.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

Smoking and surgery


I recommend to my patients to not smoke for 4 weeks prior to surgery and to remain abstinent for 4 weeks after surgery. Even still the complication rate is still higher than a non-smoker.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

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Smoking, drinking, sex, and surgery


Although smoking, drinking, and sex may go together well, they don't go well with surgery.  Check with your surgeon about his/her specific recommendations

Sam Naficy, MD
Seattle Facial Plastic Surgeon
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Physical Activities After Rhinoplasty


While there is no exact scientific answer to your activity questions, it is an issue of protecting your investment. What would be the smart thing to do given your investment of time, money and physical recovery? I would think a patient would want to do everything humanly possible to get the best result and prevent complications from occurring. This would suggest to refrain from those activites that put you at risk for poor healing and injury. Thus smoking and alcohol (people do get drunk and fall down or get punched...usually right in the nose) would be best delayed until four to six weeks after surgery. As for sex, this is an issue of nose safety which you can figure out on your own. 

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
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Listen to your Surgeon's direction for best Rhioplasty results



Your results will be directly related to how you care for yourself before and after your surgery.  I suggest that my patients stop smoking at least 4 weeks prior to surgery and continue to abstain for at least another 4 weeks after. As for alcohol, I suggest that patients limit consumption up to a week prior to surgery with no alcohol 24 hours prior to your procedure.  It is also recommended that you not consume any alcohol while taking your medication post operatively as well. Finally, to limit your post operative swelling, it is suggested that you minimize any activity that raises your heart rate for at least two weeks.  Best of Luck!  Dr. Clevens



Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
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How long should one abstain from smoking, alcohol and exercise after rhinoplasty?


How long should one abstain from smoking, alcohol and exercise after rhinoplasty? You should avoid smoking for AT LEAST two weeks before and after a rhinoplasty. In someone such as yourself with what sounds like a very active social life I would recommend abstaining from alcohol for the same period of time. With regard to sexual activity, as you inquired, or exercise in general, I recommend minimizing activity that will raise your heart rate or blood pressure for at least two weeks. Low impact activity is perfectly acceptable soon after surgery but higher level activity can raise your risk of bleeding with the first 7-10 days after surgery.

These recommendations are very important. As Dr. Tholen's experience points on, nobody wants to have a patient's recovery go completely awry for a totally preventable reason. That causes ALOT of undue stress for both the patient and surgeon.

Please follow your surgeon's advice or reschedule for a time period when you'll be able to follow their recommendations to the letter.

Thank you for your question.

Stephen Weber MD, FACS

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

Perhaps your surgeon also likes his/her social life--how about arriving for surgery a bit tipsy?


Come on, you know the answer to this--your doctor has already told you that these things are not recommended for a specific time before AND after surgery. I recently re-operated on a breast lift plus implants patient who was healing beautifully until her 18th day post-op when she went clubbing, was over-served, slipped and fell in the parking lot, and "popped open" several inches of her incision. Blood all over, and of course her friends called 911, after which my patient was transported to the nearest emergency room (add up the ambulance, ER, and ER physician charges thus far) where I was called at 3AM.

Of course, she was too inebriated for safe anesthesia, so she went home, and we re-operated the next morning. Fortunately, her implant was not exposed or I would have had to remove it, heal her breast, and then replace her implant in a third operation. And even with things working out OK and a salvaged great result, she spent about double for her breasts as a result of her little "night on the town."

No smoking for two weeks before and after surgery is a MINIMUM; alcohol, as my example shows, may be "OK" a few days after surgery, but overindulging as a result of bad judgement can be a problem even 2 1/2 weeks post-op!

No exercising is recommended for 3-4 weeks, so sexual activity should be considered in light of how vigorous your intimate activities are. Ask your surgeon, and follow his or her advice, as it is he/she you will have to go to if you misbehave and have a problem to "fix." How would you feel if your surgeon asked if it was OK with you if he or she could arrive for surgery tired, hung-over, or impaired (what, surgeons aren't allowed to "like their social life?")? What would you think? Your surgeon has every right to feel the same way when patients ask such questions. Surgery is a lifelong investment--do it right and don't compromise. You certainly don't want your surgeon to do so! Good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Smoking and Drinking with Rhinoplasty



Certainly alcohol and smoking tobacco and or marijuana before and after rhinoplasty surgery is not helpful in the healing process.  You should be motivated to get the best possible result from your rhinoplasty surgery.  Giving up drinking alcohol, smoking, and a little hoochie-kootchie for a few weeks should not be that difficult to maximize rhinoplasty results for the rest of your life.  You will have plenty of opportunities to smoke, drink, have unlimited sex, etc. in the future.  If you cannot give them up during your surgery period, then perhaps postpone surgery until you gain a bit more maturity.  Certainly listen to your rhinoplasty surgeon's advice.  As far as sexual activity goes, we tell our patients to limit physical activity, sports, and other activities where they may get hit in the nose with balls for the first 3 to 4 weeks after rhinoplasty.  Good luck and be well.

Dr. P

Michael A. Persky, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Smoking, Drinking, and Sex: Impact on Rhinoplasty


Smoking (or other tobacco/nicotine products) is certainly to be avoided starting well before surgery (at least a month) and continuing for at least a month after surgery.  The nicotine and other chemicals in cigarette smoke reduce circulation to the tissues and cause other affects that reduce your immune system and healing abilities.  Plus it is just bad for all of your tissues and results in pre-mature aging and death.  I do not know what to say about a tobacco free smoking product as there are no standards here.

Drinking alcohol should not be a concern provided it is done in moderation.  No more than 2 or 3 drinks per 24 hour period where a drink is 12oz of beer, 4oz of wine, or 1oz of distilled spirits.  Certainly you should not drink at all in the 24 hours before surgery and the 24 hours after surgery.  You should also not drink if you are taking any medications that are not compatible with alcohol.

Sex prior to surgery is not an issue.  Following surgery you should allow adequate time for healing before resuming strenuous physical activity or activities that may physically impact your nose.  You and your physician will need to decide what that means to your sex life.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
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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.