How Will Smoking Affect Fat Transfer Results?

Question

I am getting Fat transferred to my face around my mouth/cheek areas because I have a hollow look and lots of creases.I quit smoking 1 week ago (smoked 4 to 5-or less/day) surgery tomorrow but broke down and had 1/2 cig. Am I in trouble?

Trevor M. Born, MD · Answer

Dear Nutsforlooks
Smoking delays the healing in all surgeries.  The changes in the tissues/vessels is long lasting.  Congratulations on stopping smoking- almost- and certainly this will help you with the healing process.  The Facial tissue has a good supply of blood and it is unlikely that 1/2 a cigarette will make the survival of the fat transfer worse.
With Warm Regards,
Trevor M Born MD

Young R. Cho, MD, PhD · Answer

Thank you for your question. Smoking before or after your surgery can increase your risk of developing complications including infection and wound healing problems.  I tell my patients that it is ideal to stop a couple months ahead of surgery and then for a couple months after surgery. Please discuss with your surgeon what their guidelines are for your particular surgery.

Ricardo L. Rodriguez, MD · Answer

Ultimately, the "take" of any graft, be it a skin graft or fat graft ,depends on the delivery of oxygen to the tissues.
Acutely, smoking prevents oxygen delivery by shrinking the small blood vessels that deliver blood flow to the tissues while the patient is smoking. The effect of smoked nicotine is much more marked than, say, chew tobacco, because the dose of nicotine delivered is much higher as it is directly delivered from the lungs to the blood stream.
Chronically, smoking damages the blood vessels by hardening the vessels and shrinking them permanently. There is decreased blood flow to the tissues and that is why patients who chronically smoke have paler grayish skin.
Because of the stem cells that are present in fat grafts, new blood vessels can be created that actually make the skin younger. If you would like to read more about this, read the link below.

Otto Joseph Placik, MD · Answer

Smoking, yes any smoking, in the 4 weeks prior to surgery increases the risk of failure of graft take (survival). You must be willing to accept the risk. Put a percentage on this is impossible.

Darrick E. Antell, MD, FACS · Answer

Smoking shrinks the capillaries, or end blood vessels which feed the skin and other organs.  Even one cigarette will have this effect and theoretically you might have slightly less of the fat transfer survive, but it would be difficult to measure.
"It is what it is and for the particular operation you are about to undergo, my guess is that the affect of the smoking would be minimal.
Good luck.

Michael A. Persky, MD · Answer

Hi Nuts,
The success of your fat transfer procedure depends upon the "take" of the grafted fat which is dependent upon the establishment of blood supply to the newly placed fat.
Smoking, among other things, effects the oxygenation of the blood, and adversely affects the percentage of fat that "takes".  You want to maximize the chances for your fat grafts to live.  Therefore it is in your own best interest not to smoke anymore while the fat is establishing new blood supply.
The 1/2 cigarette that you had probably won't make a difference, but don't smoke anymore to avoid "trouble".
It would be an ideal time for you to consider giving up smoking for good.
Good luck and be well.
Dr. P

Pablo Prichard, MD · Answer

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. In fat transfer, the constricted blood flow can cause the fat to not get a blood supply and die.  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

Marc Schneider, MD · Answer

The technique is a wonderful way to rejuvenate the face. Though I am not aware of any specific medical studies that have evaluated fat grafting success and smoking, we do know smoking does impair circulation and circulation is the key to fat grafts surviving after they have been transplanted.

How Will Smoking Affect Fat Transfer Results?

Answers (8)

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