SMAS Facelift Side Effect True for Smokers?

I keep reading that SMAS Facelift is bad for smokers--it has something to do about the skin dying. Is this true? Should I not have one, as I do smoke? Please advise.

Doctor Answers 26

The SMAS facelift is actually ideal for smokers

When you do a SMAS facelift, you are elevating the layers of the face in a deeper plane which allows you to preserve a thicker skin flap. The added vascularity that is associated with a thicker flap is actually safer for smokers. This approach is what I use for people with a significant history of smoking.

One thing that you should do is to go to someone with a lot of experience with performing facelifts. You also want someone that is going to take his time.

Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

SMAS facelift in Smokers

Smokers are at higher risk for a number of post-operative complications, ranging from skin slough of the facial skin, oxygenation issues before-during-and postoperatively, etc.

Nicotine, either in the form of primary or second hand smoke, nicotine patches or any form of nicotine delivery system, causes the small blood vessels in the skin to constrict and reduces blood flow to the flaps of skin elevated during the facelift surgery. The thinner the flaps, the higher the risk of compromise.

All patients in my office are advised to discontinue smoking or using nicotine delivery devices for a minimum of 4 weeks prior to and after surgery --especially facelift surgery.

If patients will not or can not stop smoking as advised, I will not perform the surgery.

David L. J. Wardle, MD
Ottawa Plastic Surgeon

Either way, you should not smoke 2 weeks before and after any facelift.

All smokers need to stop smoking before a facelift of any type. The more the skin is separated from its blood supply as in a full SMAS lift, the greater the risk of the skin dying. In 30 years of doing facelifts, I feel a more conservative lift is warranted in smokers. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Smokers and face lifts - a bad combination

Smoking interferes with blood flow, and active smokers are at much higher risk for complications (ie: wide scars, slow healing, and even skin death with significant scarring) with any surgery. Surgery that requires wide undermining of a skin flap (such as certain face lift techniques, tummy tucks, or large breast lifts) are high risk for patients who smoke. Most surgeons will require that smokers abstain for at least 3-4 weeks before and after the procedure (although this does not lower the risk to that of a non-smoker, it is a significant improvement.) Additionally, it is smart to pick modifications of the procedures that provide a more "robust" blood supply to the undermined flap - either by limiting the amount of undermining, or going deeper and incorporating more vascularized tissues. The typical SMAS face lift requires a widely undermined thin skin flap, followed by another thin vascularized flap (the SMAS layer). Although a more limited procedure may give less of a result, it maybe smart to compromise to reduce your risk. I would suggest you visit with a board certified plastic surgeon who specializes in face lifts, and frankly discuss you medical history, and listen to their advice regarding the safest way to achieve your goals.

Michael A. Bogdan, MD, FACS
Dallas Plastic Surgeon
4.9 out of 5 stars 67 reviews

The best thing to do if you are a smoker who wants a facelift is to quit smoking.

Any type of facelift surgery, not just SMAS facelift, will have a higher risk of complications when performed on a smoker. Smoking greatly increases the risk of vascular compromise during surgery, which can lead to necrosis (skin death). Smoking also interferes with the body’s healing ability. The best thing to do if you are a smoker who wants a facelift is to quit smoking. If this is impossible, there may be other options available such as a mini-lift instead of a full facelift. In any case, you should stop smoking for at least two weeks both before and after surgery, and you should take care to visit a board-certified facial plastic surgeon who has experience performing surgery on smokers. I hope this helps.

Jonathan Kulbersh, MD
Charlotte Facial Plastic Surgeon
5.0 out of 5 stars 66 reviews

Facelift and smoking

Yes, unfortunately, it is true.  The act of smoking is fine but the nicotine and carbon monoxide in cigarettes has a detrimental effect on healing of the skin.  Also, there's an increased risk of scarring, bruising, and infection with smoking.  

I recommend that my patients stop 2 weeks before and 2 weeks after the surgery.  Of course, if you can go that long, you might as well quit.  Most people can't go that long and I think recognizing this fact is important.  As a result, we discuss options such as e-cigarettes that can deliver lower doses of nicotine without the carbon monoxide.  I will say that this is also not ideal but if you really want a facelift, and are willing to understand and accept the risk, decreasing your risk by eliminating carbon monoxide during the healing period is a big first step.  The nicotine is still there so your risk of infection, scarring, skin death, and bruising are still there, but hopefully lower. 

Mike Majmundar, MD
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 49 reviews

Facelift for smokers

Smokers have additional challenges for a facelift or skin flap.  Speak to your surgeon about non surgical options as well, including the Ultherapy lift.


Dr. Karamanoukian

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

SMAS Facelift Side Effect True for Smokers

Smoking changes the blood flow to tissues. It can have long-lasting effects on the microcirculation. With any elective cosmetic procedure I recommend the patient's refrain from smoking for six weeks before and six weeks after surgery. 

Refraining from smoking does not completely reverse the changes caused by smoking, however it gives the patient the best chance to decrease the risk of postoperative complication. 

Austin Hayes, MD
Portland Plastic Surgeon
5.0 out of 5 stars 32 reviews

Smoking and surgery

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

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Facelift with smokers

I truly feel that stopping smoking 2 weeks before facelift is correct, but not that important. With smokers, the micro-circulation has changed, so a modified facelift needs to be performrmed so that the skin is not pulled as hard while the SMAS layer can be pulled harder and tighter.

David A. F. Ellis, MD
Toronto Facial Plastic Surgeon
3.5 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.