Best Facelift Procedure for a Smoker?

In deep and composite facelifts, the flap is undermined as a single unit -including skin, SMAS and malar fat- which provides excellent blood supply to the overlying skin. So, deep and composite facelifts carry much less risk of skin necrosis especially for smokers compared to all other facelift techniques having long skin flap dissection.

I would not advise having any type of full
facelift procedure done if you are a smoker. The risk of skin necrosis and
scarring is much higher, and recovery will take much longer as well. If you are
able to quit smoking for a few weeks before and after surgery, you may be a
candidate for a less invasive procedure such as a mini-lift, and there are a
variety of non-surgical skin rejuvenating options that could be considered as
well. If you are dead set on a surgical procedure, make sure that you only visit
a highly experienced, skilled, board-certified facial plastic surgeon who has
performed successful facelifts on smokers before and can give you an honest
evaluation and opinion.

The main culprit in smoking is the nicotine. It takes several weeks for nicotine to wash out of your system and your microvascular circulation to return to normal. This has big implications for wound healing in certain plastic surgery procedures. I require all of my cosmetic surgery patients that are having large skin flaps raised to completely stop all forms of nicotine for 6 weeks. These procedures include facelifts, abdominoplasty, anchor mastopexies, and breast reductions, among others. Smoking/nicotine can cause major tissue loss in these procedures.  In my practice and most other plastic surgeons I know, you must stop smoking if you want a facelift.  I am sure you care about how you will look afterwards and will be unaccepting of major complications such as skin slough. You may be able to find a surgeon who will proceed while you are still smoking, but personally, I'd look for someone else...

Cigarette smoking is associated with significant
complications in patients undergoing facelift surgery. Smoking causes constriction of small blood
vessels in skin flaps that are routinely raised during facelift
procedures. This can lead to skin
necrosis and skin loss. For
this reason most plastic surgeons recommend that patients stop smoking 4 to 6
weeks prior to facial rejuvenation procedures. Even when patients have stopped smoking ahead of time, there’s probably
still an increased risk of complications.It’s important to emphasize that
safety should be everyone’s first priority. For this reason, most plastic surgeons utilize more conservative
facelift techniques when performing facial rejuvenation procedures on patients
with a history of smoking. It’s
important that patients thoroughly discuss their history of cigarette smoking
with their plastic surgeon prior to surgery. This information is essential for the plastic surgeon to develop a safe
treatment plan for facial rejuvenation.

Any facelift procedure is unsuitable for a smoker. If you continue to smoke, there is no facelift method that can be recommended as "safer".