Smokers and deep plane facelifts - what are the restrictions?

Complete nicotine cessation is a preoperative requirement of most surgeons before patients undergo a facelift, including deep plane facelifts. This is because nicotine, from any source, constricts blood flow to the skin, thereby increasing the rate of complications.

Hi Legalamb! That’s an excellent question.

The same smoking restrictions apply for any kind of facelift surgery, or any aesthetic surgery. Smoking and nicotine in any form — including cigarettes, vaping, patches, and gum — significantly reduce blood flow to the skin.

Because of this, we recommend stopping all nicotine use at least 4–6 weeks before surgery and continuing to avoid it for at least 4 weeks afterward. This allows blood vessels to recover and minimizes the risk of skin necrosis, delayed wound healing, and poor scarring.

Smoking causes blood vessel constriction in the short term and plaque buildup in the longterm, resulting in impaired oxygen delivery to your tissues. In this scenario, you may have poor wound healing or tissue necrosis (skin turns black and dies) after a facelift and are also at high risk for other complications such as a hematoma (blood pooling in the wound).

Typically we recommend that patients discontinue smoking at least 2 weeks before surgery but recommendations will vary by surgeon. Some research suggests that hyperbaric oxygen treatments after surgery may improve improve recovery after facelifts in patients with a history of smoking.

Good luck!

Not sure what you mean by "same" in terms of what else you are comparing it to, but especially for facelift surgeries, you want to avoid smoking to avoid causing ischemia/necrosis of the skin flap, which can cause really bad scarring.

Although a preservation deep plane facelift theoretically has less risk of necrosis with smoking (in the postop phase) than techniques that call for a greater amount of skin elevation, I still ask patients to discontinue all nicotine products for 6 weeks before/after surgery. This is especially true of smoking, which also complicates airway reactivity and lung compliance during sedation. Every organ system in the body functions better without smoking and many of my smoking patients have completely given up when they face this challenge