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I Am Having a Temporal Facelift Along with Lower Eye Sag Removal. Is 3 Weeks Long Enough to Be Nicotine Free or Should I Cancel?

I Am Having a Temporal Facelift Along with Lower Eye Sag Removal. Is 3 Weeks Long Enough to Be Nicotine Free or Should I Cancel.

Doctor Answers (10)

Smoking and surgery

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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


Phoenix Plastic Surgeon
5.0 out of 5 stars 27 reviews

Temporal Facelift Along with Lower Eye Sag Removal.Is 3 Weeks Long Enough to Be Nicotine Free or Should I Cancel.

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Most surgeons think that 2-4 weeks off smoking before and after are important. You should consider rescheduling if this is not possible for you.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 37 reviews

Smoking and Temple or Facelift considerations

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Most experts unanimously agree that smoking increases the risk of most surgical complications significantly. This especially applies to lifting procedures such as the temple lift you are scheduled to have done. Just about all plastic surgeons strongly recommend  women  to stop smoking and all nicotine products well in advance of breast augmentation with breast implants.  Many plastic surgeons recommend stopping all tobacco products several months prior to surgery.
Here is the reason why: the nicotine in cigarettes and other tobacco products (including Nicorette gum, patches, etc) is a vasoconstrictor, meaning it makes the Smoking is a significant multiplier of many potential complications following surgery and breast augmentation with implants are no exception. Nicotine from smoking causes blood vessels to vasoconstrict ( tighten up). Over time, these constricted arteries and capillaries deliver less blood to the breast tissue which is needed for normal healing. Smokers therefore have an increased incidence of higher likelihood of complications such as tissue sloughing (death by necrosis) and  infection.  General complications of surgery such as blood clots, anesthetic problems such as pneumonia are also increased.
A recent scientific article in the Archives of Internal Medicine indicated that, among all forms of surgery, quitting smoking eight weeks prior was never associated with an increased risk of complications.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 45 reviews

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When to stop smoking

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Most experts would agree the wound healing problems from smoking are minimized after the second week of cessation. There are however some anaesthesia problems from the respiratory effects of smoking.

Richard Ellenbogen, MD
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Smoking and facelift surgery

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I'm really not sure what you mean by "temporal facelift". You need to ask your surgeon specifically about your smoking. I recommend being smoke free for three weeks both before and after surgery. 

Ronald Schuster, MD
Baltimore Plastic Surgeon
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Smoking risks with temporal facelift and lower eyelid surgery.

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Your surgeon deserves to have his or her advice followed on this question, as it is he or she that will be asked to deal with the problems that result should there be any difficulty related to surgery and smoking. That being said, let's answer based on the specifics you have provided.

Neither temporal facelift nor lower lid blepharoplasty (skin muscle flap technique) have as much skin ischemia risk as a full cheek-flap type facelift or skin-flap only blepharoplasty, which both may have higher risk for ischemic healing concerns in someone with nicotine exposure (and this includes second-hand smoke, gum, patch, spray, and nicotine inhalers or electronic nicotine cigarettes).

I agree with my colleagues. 2 weeks is the minimum I ask for, and 4 weeks is better, particularly as it gives your lungs time to clear the secretions that (re)start to move as lung cilia function returns after smoking cessation. Nicotine is an extremely potent vasoconstrictor, so the risk with nicotine is the potential compromise of circulation that could lead to dead skin. But smoking also paralyzes the cilia in the lungs that propel mucous and inhaled particulate foreign bodies from our microscopic airways. When you stop smoking, your cilia function gradually recovers, and you will start to again clear secretions that previously had been retained, causing coughing. This can peak 1-4 weeks after smoking cessation, so coughing after facial surgery could cause elevated blood pressure that could lead to bleeding, re-operation, or risk to your cosmetic result.

So, yes, this IS a big deal, and we're not just "piling-on" when we ask our patients who are smokers to stop and stay stopped. Remember, it's your face that could have the problem, and it's we plastic surgeons that are asked to "fix" the results of poor results or complications that are a result of patient non-compliance.

Please, stop smoking permanently, and ask your surgeon regarding timing of surgery. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
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This is a question that should only be answered by your actual surgeon.

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Smoking cessation is important and hopefully this will be the event that helps you quit smoking.

Only your surgeon can answer why he wants you to stop smoking with such a short time before surgery.

My immediate concern would be if your surgery is planned for general anesthesia.  Stopping smoking 3 weeks before surgery means that pulmonary secretions, which increase as the lungs begin to heal after smoking cessation, will be at their worst at this time.  This will make your general anesthesia more difficult.  For this reason, I prefer the smoke free interval before surgery to be 2 months rather than 3 weeks.

Temporal facelift can be performed as a thin flap or a thick flap.  Smoking damages the small blood vessel that support a thin flap.  However if your surgeon plans to work with a thick flap, smoking will have little bearing on this.  SInce only your surgeon will be responsible for your surgery, this is the person whose opinion matters here.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 16 reviews

Smoking cessation before surgery

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Most people advise 2 weeks, but the longer the better.  There was a recent study that showed stopping for even 5 days before surgery made a significant difference in healing. Good for you for stopping.  Smoking will only add age to your face where you are trying to reverse it with surgery.

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

Smoking and facelifts

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Most surgeons request 2 weeks and prefer 4 weeks.  You are somewhere in between.  I would ask you surgeon because different techniques are more risky in smokers.  It is my opinion that long time smokers have long time changes in their skin's blood supply.  Thus when i do a facelift on a smoker i use a different technique than I do on non smoker.  I still get great results but with the change their is an added margin of safety.

Adam Bryce Weinfeld, MD
Austin Plastic Surgeon
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Smoking and plastic surgery

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Minimum time recommended for smoking cessation before plastic surgery is usually 2 weeks before and 2 weeks after the procedure.  However, for procedures involving delicate flaps such as face lifts and eyelid lifts, 4 weeks before and after would be better advised.  Of course this depends on the extent of your smoking history.  Eyelids are delicate  and you don't want to suffer from wound healing complications in this area so I would be very conservative.  

John Michael Thomassen, MD
Fort Lauderdale 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.