Smoking Before Plastic Surgery?

I had a consultation today for a Breast Augmentation and a Tummy Tuck. The doctor said that I would need to stop smoking 6 weeks before surgery. Is that true? I've researched all over the Internet and people are saying 2, 3, maybe 4 weeks. I'm kind of confused and don't know what is right.

Doctor Answers 12

Absolutely the longer the better....

Hi there-

The critical thing for you to understand is that your surgeon recommended this time period to you not because he or she did not want to operate on you, but because they are concerned for your safety, and they want to maximize the probability that you will achieve the great outcome and smooth recovery you want.

The longer you go without nicotine, the better the chances will be that you will indeed get this desired smooth recovery free from complications and with a beautiful outcome at the end.

There is no question that cessation of smoking for a few weeks before surgery would lower your risks, but there should also be no question that if you were to abstain for a longer period the risk would be even lower.

Your surgeon was correct in his/her recommendation.

Listen to your surgeon

I would echo Dr. Rand's thoughts. There is no doubt that nicotine of any kind will inhibit your body's ability to heal, in particular a procedure such as a tummy tuck. You should take your doc's advice very seriously-- in may cases, once patients are forced to quit nicotine in order to have a procedure they really want, after the procedure they see no reason to restart the smoking. In other words, they use it as a powerful motivator to quit smoking for good, which does wonders for their health.

In summary: listen to your surgeon, don't use nicotine products of any kind, and use this as a chance to get off of the nicotine forever!

Good luck,

Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 124 reviews

The longer the better...

Make a commitment to yourself to have the best possible outcome possible and don't skimp. These surgeries are a big financial and emotional investment. If you can't stop smoking, don't have surgery. If you try and cheat, please don't blame your surgeon for any complications because he/she is trying to protect you. We all take problems after surgery very personally and don't want anything bad to happen to anyone! I say 4 weeks minimum for a tummy tuck and if I find that they are cheating - I cancel surgery. It's THAT IMPORTANT!

Robert S. Houser, DO
Columbus Plastic Surgeon
5.0 out of 5 stars 8 reviews

At least 4 weeks before and 4 weeks after away from all nicotine

Your doctor is only trying to help you avoid a disastrous complication from your tummy tuck (not the augmentation). When you are exposed to nicotine in any form (cigarettes, gums, patches, second hand smoke) your skin circulation is compromised such that doing a tummy tuck, beast lift or facelift can result is serious complications.

I am not going to candy coat the problem here because I want you to clearly understand what can happen if you don't comply with this. The skin will die, turn black, slough off, smell horrible and potentially get infected. It will take many months to heal this open wound because the tummy tuck is closed under tension and the scar can never be revised and the result will look horrible.

So please respect your doctor's request - it is for your own good and do not short change it or cheat on it!

Smoking before surgery

2 weeks is probably enough time but most doctors allow a bit more time to allow the patient to commit to their non-smoking regimen.

The nicotine and toxins are out of the system fairly quickly, but the desire to have a cigarette may not be. Therefore a buffer zone is a good policy.

Although there are studies for and against this concept, I believe chronic smokers, even patients who have quit recently, still have an increased incidence of complications.

Smoking causes greatly increased complication rates, decreased ability to resist infections, greater incidence of anesthetic complications such as pneumonia because the cilia in the tracheobronchial tree are poisoned by cigarettes. Cigarettes have nicotine in them, a powerful vasoconstrictor. This causes shrinking of blood vessels, reduced blood supply, and reduced wound healing.

Patients who smoke shortly after facelift surgery or tummy tuck surgery can have disastrous results.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 119 reviews

Smoking and plastic surgery

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.

Smoking before plastic surgery

When one smokes, or uses tobacco, there is vascular constriction. Nicotine is a major vasoconstrictor. There are others in tobacco as well. Good wound healing is all about getting enough blood supply to the area. 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. Our office does not do facelifts on smokers. Breast reductions and tummy tucks are also on tension and the chance of them falling apart is many fold higher. Some respected colleagues still may do these, but usually the extent of the dissection is less. Please stop smoking, (for dozens of reasons). If the prospect of your procedure is a motivation to quit, then so be it. 

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.5 out of 5 stars 13 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. 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.
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 37 reviews

Smoking before plastic surgery?

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 14 reviews

2 Weeks Before, 2 Weeks After in my practice.

Thank you for your question! I get this quite a bit from smokers. Personally, I am "thrilled" about operations on patients who DO NOT SMOKE. The risks depend on other health and the specific procedure. In my practice I advise to not smoke two (2) weeks prior and two (2) weeks post-operation. I recommend quitting to all of my patients and provide assist with Chantix, etc. or refer to a professional who specializes in quitting smoking.

Frank L. Stile, MD
Las Vegas Plastic Surgeon
5.0 out of 5 stars 30 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.