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".

Dear Babscali,

 

I think the best facelift for a smoker is NO facelift.  The risk of skin necrosis is too high.  If you keep searching, you will eventually find a surgeon willing to take your money and do the facelift, but I encourage not to do this.  See your family doctor and ask about medications to help with smoking cessation.  There are several medications that can really help kick the habit.  At the very least, you should be able to stop smoking for 4 weeks before and after a facelift.  

Good luck! I sincerely hope you don't get the facelift while still smoking.

Warmest Regards,

Asif Pirani, MD, FRCS(C)

I am sure that there will pretty much be almost an unanimous opinion here that there is no safe facelift procedure for a smoker. The more you smoke the more dangerous the procedure. In my practice we try to do everything we can to assist the patient to stop smoking 2 months or more prior to surgery, doing so decreases their risks of having a portion of their skin dying and infection. If patients cannot stop, or refuse to we either do not accept them as a patient or offer a minimally undermining procedure such as the MACS lift, but still inform them of their increase risk and often have them sign a form that they realize the jeopardy they are placing themselves under against medical advise and accept these risks.

The best thing for an active smoker who refuses to stop smoking is to avoid having a Facelift.  The results due to skin loss can be truly horrific and sometimes irreparable.  Although I have agreed to perform a Facelift in smokers, it is only in individuals who sign a consent that states they agree to stop smoking for 6 weeks before and 6 weeks after smoking with consent to perform nicotine testing.  If a scent of smoke is detected in the preoperative period, the case is canceled. I, like most reputable Surgeons, am not willing to sacrifice my reputation for one extra case.

There is no best procedure for a smoker. I do not personally operate on patients who smoke because their risk ratio is up to ten fold higher than a non-smoker. I’m not willing to compromise my aesthetic procedure or the aesthetic result in a patient that is not going to stop smoking for at least 6-8 weeks before an operative procedure. My best advice to you is to stop smoking or to not smoke for at least 6-8 weeks. Long term that will serve you well over a span of two years and will decrease your risk of cancer long term, (both lung and perioral cancer are directly related to smoking).

What face lift procedure is best for a smoker?  The answer is: no face lift.

I agree with previous posts in that there is NO safe face lift for a patient that smokes.  I, and most other plastic surgeons in Florida and the United States, would not perform any kind of face lift on a patient that smokes.

Patients that smoke are more prone to skin necrosis (i.e skin death), complicated/delayed wound healing, infection, and terrible scarring.  

I recommend that you stop smoking at least 8 weeks before and after undergoing a face lift.

Jaime Perez, M.D.

Face Lift Specialist in Tampa, Florida

Plastic Surgery Center of Tampa, Florida