Smokers must stop smoking before and after surgery, period. The risks of large patches of dead skin and permanent scarring are far too great in patients who are actively smoking. In this matter there is little debate. The question is how to deal with a smoker who has temporarily quit smoking for the requisite 4 weeks. I know studies debate this, but I believe there is a significantly higher risk of skin slough (dead skin) even with smokers who have ceased smoking.
Therefore in our practice, I caution smokers that they must be prepared to accept a more conservative result than nonsmokers. The degree of tightness and tissue movement inherently affects blood supply, the most vulnerable element in smokers' tissues. It is simply not in the best interest of any patient to incur great risk with surgery, especially if the problem is reversible or avoidable.
The main determinants of complications, in my opinion, are not only the technique, but the tightness on the tissues and the surgical technique. The deep plane technique does have some inherent advantages in that the central facial skin is not undermined, so blood vessels continue to come through the central facial SMAS to the skin. However if too much tension is put on the flaps, an almost inherent necessity in my opinion to achieve a satisfactory result with a deep plane procedure, this may actually predispose to complications the same way as undermining with a multivector facelift with greater tension.
With all facial plastic surgery issues, a great deal of experience and many thousands of cases are helpful in striking the right balance between an excellent result and acceptable management of risk when a patient has a potential risk factor such as smoking.
Best facelift for a smoker is no facelift at all
Since you already know that most plastic surgeons won't do a facelift on a smoker, why do you want to get around that advice and put yourself in harms way? The risk is skin death - the skin turns black and dies and creates unfixable scars. Sorry about being graphic but it sounds like you need to hear the reality behind the advice.
In order to reduce your risk but not eliminate it, you need to be away from all nicotine products for at least one month beofore and after surgery, including avoiding second hand smoke. You should commit to this if you want the surgery badly enough.
Best Facelift Procedure for Smoker
The best procedure for a smoker is to quit smoking. We recommend quitting for four weeks before and after surgery. The primary risk is skin loss secondary to compromised circulation. Depending on the patient's age and smoking history, I will do a conservative facelift. These means limited surgery (as a minilift), and therefore limited improvement.
Undermining the skin + smoking = skin loss
Plastic surgeons get nervous performing operations on smokers which involve undermining a lot of skin because cigarette smoking decreases the ability of the body to heal and the blood supply to the skin in numerous ways. That said, we perform operations every day on smokers if the procedure does not involve a great deal of undermining. I do always inform patients, however, that smokers absolutely do not heal as well as non-smokers. There are numerous things you can do to improve your appearance relatively safely if you cannot stop smoking. You simply must seek out a surgeon who will spend the time with you to determine the right operation for you. In over three hundred minji-facelift operations, I have not seen a single incidence of skin necrosis, and some of these were done on smokers. The more limited dissection involved wiith this procedure does not interfere with the blood supply to the skin nearly as much as a "full facelift".
I like the mini face lift with minimal flaps for someone whom smokes. There are some doctors whom will operate on smokers and some that will not. I think it is always safest to assume that someone whom smokes will probably continue smoking after surgery and plan the surgery accordingly and do a lesser procedure with thicker flaps and less dissection. I would also think of adding some laser resurfacing secondarily and fillers to enhance the result.
Hi, frankly I would strongly advise against any type of facelift if you smoke. The risks of skin necrosis (the skin turns black and sloughs off) and subsequent scarring are very real. If you are planning to spend the time and money for a facelift, it's in your best interest to be smoke-free. I certainly understand that it's difficult to quit smoking, but this will be the best option for you in the long run both for your health and your surgical results. Good luck, /nsn.
the safer of the 2 techniques is a deep plane facelift because less skin elevation is required to lift the face. But ideally being smoke free is the best case scenario.
Have you sought professional help to stop smoking?
My patients have had success with Welbutrin and there are newer drugs with good short term success rates available. You will need to be smoke free for at least 2 weeks before and 2 weeks after surgery.
Although you might do well regardless, it makes sense to control as many known risk factors before elective cosmetic surgery as possible.
Facelift and smoking do not mix
Smoking is the single most detrimental thing you can do to you face and skin, second only to severe sun exposure or photo aging. Twin studies or comparisons have been done to evaluate the aging effect on the skin between a smoking and a non smoking twin and the aging process can be accelerated over 10 years compared to the non smoking twin.
Smoking constricts the fine blood vessels in the skin dramatically increasing the risk of poor healing or skin loss after facelift. The best facelift in an individual who smokes is none at all. A short scar, or limited facelift, is conceivably 'safer' though you would do yourself and your surgeon a hugh favor by enrolling in a smoking cessation program, and celebrating with a facelift after you have quit.
Best of luck,
Peter E Johnson MD
It is not advisable to undergo any kind of facelift.
You have a lot of other options available to improve your looks. Botox and filler injections can make a big difference. Especially fillers can be used for doing a 'liquid facelift'
My favorite filler for that is Sculptra. In fact I have had patients who were too scared to get a facelift and ended up getting Sculptra and are very happy with the results.
If despite all this you end up going forward with smoking, please start Vitamin C 4grams a day, start regular exercise, healthy eating habits etc. That will help you increase the blood circulation and hopefully minimize the risk of necrosis of skin. If you still end up getting early signs of necrosis, consider immediate Hyperbaric Oxygen therapy to revert the necrosis along with stopping smoking.
I would not do either operation on you if you continue to smoke, because both the MACS and the deep plane facelift involve raising skin flaps which can have a poor blood supply.
Only the subperiosteal midface lift done through the mouth raises no flaps.