Light Smoker Quitting 3 Weeks Before Deep-plane Midface Lift?

Question

I am scheduled for a deep plane mid facelift and have been a light to moderate smoker for nearly a decade. I stopped smoking but it will be only 21 days of no smoking before my surgery (and I won't smoke at all after obviously!) I am 31 and in good health. Should I be worried?

Larry S. Nichter, MD, MS, FACS · Answer

My experience is that the less you smoke the better and the longer you have stopped prior to surgery the better. 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. Three weeks is better than two, but 2 months would even be better. Most experts unanimously agree that smoking increases the risk of most surgical complications significantly. Just about all plastic surgeons strongly recommend women  to stop smoking and all nicotine products well in advance of all plastic surgery and especially lift procedures..  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 constrict ( spasm or  tighten up). Over time, these constricted arteries and capillaries deliver less blood to the 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.

	As an aside most people are unaware that smoking greatly accelerates the age of your skin and will shorten the beneficial effects of your cosmetic lift procedure.

Kenneth D. Steinsapir, MD · Answer

Yes, medically discontinuing smoking is the most important thing you can do for your health. However, this should not be done immediately prior to surgery. The reason for this is that the lung cillia begin to awake up at about three weeks after discontinuing smoking. This means that you really being to bring up mucus from the lungs. This is not a good thing for a general anesthesia. It is actually safer for you to stop smoking 8 to 12 weeks prior to surgery to allow the lungs to quiet down.

Pablo Prichard, MD · Answer

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. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk.  Your skin and tissue can turn black and fall off if this happens. 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. Hookah also does not decrease nicotine.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

William Portuese, MD · Answer

Most people who are 31 years of age do not need a deep-plane facelift. If you decide to undergo a facelift at age 31, it is best to stop smoking for three weeks before surgery and at least two weeks after the surgery. The deep-plane midface lift will not address nasolabial folds. Flat, saggy cheeks are best treated with cheek implants and not a lift.

Darryl J. Blinski, MD · Answer

Light smoker quitting 3 weeks prior to mid face lift, I have 2 concerns. Are you truly a candidate? And you must be aware of the risks even though you "quit".

	From MIAMI DR. B

Edward J. Domanskis, MD (in memoriam) · Answer

I advise my patients to quit smoking at least for two weeks prior and two weeks after. Unfortunately, sometimes, they do not abide by this so I vary my cuts as well as how I do my facelift in order to try and avoid the potential problems of smoking. Watch my video.

R. Stephen Mulholland, MD (retired) · Answer

You are very right to be concerned as smoking with any type of facelift surgery increases the risk of delayed healing from compromised blood flow as a result of the some of the vasoconstrictive chemicals in the smoke (same with tummy tucks, arm and body lifts). A deep plane facelift and sub-periosteal mid-facelift will preserve a more robust blood supply over a skin lift technique, but the increased risk is still present. The question becomes, how long in advance is quitting smoking enough that the flap perfusion physiology is unaffected and your surgical risks then begin to approximate non-smokers.

	In the lab, there is basic flap perfusion research that indicates even 10 days may be enough to normalize muscle flap blood flow, but, in a "real life" facelift situation with other factors at play, most physicians will demand at least 3 weeks of complete smoking cessation. Please ensure you consult your facelift surgeon about their smoking before surgery policy and if in doubt, delay the surgery until you are comfortable.

Richard W. Fleming, MD (retired) · Answer

Healing may be delayed, but you should do fine if you truly stop smoking 3 weeks before surgery. Hopefully you will take advantage of this opportunity to quit forever.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	Typically smokers should stop 10 days prior and 10 days after a facelift procedure so you should be ok. At 31, sometimes a midface lift is appropriate but very rarely is a deep plane facelift. There is a difference between a midfacelift and a deep plane facelift.

	Best,

	Dr.S.

Arnold Zweig, MD (retired) · Answer

Congratulations on stopping smoking.  You are wise to have concerns on having surgery performed so soon after quitting. I prefer for my patients who are former smokers to have quit smoking for a minimum of 6 months (and preferably longer) prior to having any surgery and especially a face lift. 

	The blood supply needs to be adequate for healing after surgery and the nicotine from cigarettes or any other type of product that contains nicotine typically constricts the blood vessels which compromises the blood supply.  One of the risks you face with an inadequate blood supply is the skin or tissue dying and then you have the possibility of complications that an otherwise healthy, non-smoker would not have after the same type of surgery.

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