I'm schedule for Rhinoplasty & Fat Injections under my eyes in 10 days. What are the risks of smoking before surgery?

I'm scheduled for a corrective and cosmetic open rhinoplasty, as well as fat injections for under eye hollows in 10 days. I haven't quit smoking yet. I smoke less than a pack a day. I've had surgery 3 times before as a smoker and have healed very well. But have never been under general anesthesia. I'm concerned. What if I can't quit today? People who smoke go under anesthesia all the time. For course, it's preferred that I quit, but what if I can't? Truly, what risks am I up against?

Doctor Answers 11

Smoking and surgery

Smoking decreases bloodflow to the area that's needed for healing after surgery. Additionally smoking could cause issues regarding anesthesia and breathing.  You may have coughing after surgery which can increase swelling and possibly bleeding. It's never too late to stop smoking. Especially in your case if in open rhinoplasty's being performed this may compromise the skin flaps. Additionally the amount of graft take of your fat injection would be adversely affected by smoking.

New York Plastic Surgeon
4.8 out of 5 stars 95 reviews

Smoking and surgery and anesthesia are a bad mix

Smokers have more coughing and bronchitis type of problems after a general anesthetic. Smokers also have a higher carbon monoxide component in their bloodstream and nicotine which contributes to starving the tissues of oxygen required for excellent healing. With open rhinoplasty and smoking,  there is a chance of necrosis of the nasal tip. It might be a good idea to consider closed rhinoplasty techniques if you're continuing to smoke cigarettes.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Smoking and surgery

Smoking (nicotine) reduces the blood supply in the skin and impairs the process of healing. I have seen patient hold on to swelling for a longer period of time and had one incision open slightly after a simple routine procedure. Additionally the airways (lungs) can be more reactive from an anesthesia standpoint. It is best to quit prior to surgery to afford yourself the best outcome. 

Jennifer Parker Porter, MD, FACS
Bethesda Facial Plastic Surgeon
5.0 out of 5 stars 21 reviews

Smoking and plastic surgery

Thank you for asking. Nicotine in any form (cigarettes, electronic vapor, cigars, gum, chew, patches) will reduce blood flow to any healing sensitive areas. Patients may experience wounds, scars, infections and results that are sub-optimal. Please discuss with your surgeon. Quitting before a procedure and during the healing phase will be helpful. Good luck

David C. Yao, MD, FACS
Phoenix Plastic Surgeon
4.8 out of 5 stars 7 reviews

I'm schedule for Rhinoplasty & Fat Injections under my eyes in 10 days. What are the risks of smoking before surgery?

You are misunderstanding the problem. It's not the anesthesia. The risk is in skin necrosis (death)in the nasal tip where it is very thin and the circulation is more tenuous after the open technique. Cigarette smoke drastically dininishes the blood flow in the area and the effects of one cigarette last 8-12 hours so smoking less isn't any help. You need to have zero cigarettes for 10-14 days at a minimum before the surgery if you do not want to face that risk.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Smoking and rhinoplasty

First off, I can tell you that the smoking has contributed to the need for fat injections or some filler in the lower eyelids.  You can't expose yourself to the fumes and chemicals on a daily basis without suffering some premature aging in the face.  In terms of the rhinoplasty, it can contribute to skin necrosis and delayed healing as well as increasing surgical complications.  I would also distinguish between facial, elective surgery and other procedures you may have undergone in the past.  You should be honest with yourself and your plastic surgeon.  Ideally, you would have tried to quit using the patches or other methods far in advance of this operation.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Smoking and rhinoplasty

The risk of smoking is greater towards skin healing and not as much towards anesthesia. The main anesthesia related complication is penumonia afterwards if you are a smoker. With rhinoplasty you can have decreased blood supply to the nasal skin and develop nasal skin necrosis where the skin literally dies off in certain areas. It is less likely in primary (first time) rhinoplasty and in closed approach. You should also start taking 2grams of vitamin C every day to counter some of the negative effects of smoking. You must quite to minimize the risks.
Dr. J

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 107 reviews

Smoking and healing

Smoking is a "no, no" when it comes to surgery. Some reports suggest that it increases the complication rates by more than 50%.  With fat injection, you want the tissue to pick up a good blood supply. It needs oxygen not carbon monoxide from cigarettes to survive.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Smoking and surgery

Smoking does delay healing especially for any incision on the skin and make it redder, more bumpy and scar more. During the general anaesthetic your oxygen intake and carbon monoxide outflow is monitored along with other vital measurements such as pulse rate, blood pressure and heart cardiogram. You must tell the anaesthetist that you smoke and he will take that into account.. If they have told you to stop smoking then you really should do so. The general anaesthesia won't affect the healing, but your lungs need the best conditions possible. I encourage you to stop smoking beforehand if you can.

Jane Olver, MBBS, FRCS
London Oculoplastic Surgeon
4.3 out of 5 stars 6 reviews

Rhinoplasty, smoking, nicotine use

Hello and thanks for your question. In general it is not a good idea to have any nicotine in any form prior to surgery. This included nicotine in the form of cigarettes, electronic vapor, cigars, gum, chew, patches. They all can cause healing of the tissues and can put you under undo risks. Please discuss this with your plastic surgeon.  
Best wishes,
Dr Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 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.