SMAS Facelift Side Effect True for Smokers?

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.

Smoking (or any nicotine product eg patches) doubles your chance of wound healing problems and significantly increases the time of healing if these complications occur, even with deeper plane or SMAS facelifts. You should stop smoking ideally for 6 weeks before surgery to avoid increase complications (minimum 2 weeks).

Hi there, 
If you have already had your facelift procedure and are healing well per your Surgeon's assessment, you need not worry. However, nicotine presence in the body causes vasoconstriction (squeezing tight) of the blood vessels.  When blood isn't flowing abundantly, skin has an incredibly high chance of not healing in the post operative period and in cases involving 'skin flaps' (such as facelift), there is a potential for skin death. Current reccomendation is stoping all nicotine products 4 weeks before and after surgery with no second hand exposure. 

Facelifts in smokers are inherently more risky, regardless of the technique (SMAS, bi-planar, deep plane, etc) that the surgeon uses. There is simply a higher risk of skin loss due to decreased blood flow to the skin. Patients that smoke should quit for at least two weeks before and after surgery in order to improve the chances of skin survival. Additionally, many surgeons (myself included) modify the surgical technique slightly in patients who are smokers. This slightly less aggressive approach is designed to decrease the risk of skin necrosis.
All the best,

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. 

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

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. 

This is very true. If you are a heavy smoker, you should avoid surgery or laser resurfacing. Depending on what you are looking to have done, there are several non-invasive skin-tightening procedures that you may be a good candidate for.

When one smokes, or uses tobacco, there is vascular constriction.  Good wound healing is all about getting enough blood supply to the area.  In a facelift operation the thickness of the flaps are thin, making the bloodflow even more important.  The incision will also be put on some tension.  Tension is the enemy of good wound healing, and coupled with decreased blood flow in smokers, finds the patient at higher risk of wound problems.  The SMAS technique is excellent, but the surgeon has to work with the tissues given.  Our office does not do facelifts on smokers.  Some respected colleagues still may do them, but usually the extent of the dissection is less.  Please stop smoking, (for dozens of reasons).  If the prospect of a facelift is a motavation to quit, then so be it.

You are right to be worried if you are a smoker because of increase risk of complications including having some skin that may not survive. Most important is that the surgeon should have experience operating on surgeons and use a technique that has minimal undermining of the skin flaps whether or not a SMAS technique is utilized.

The good news is that it is possible to have a successful result by a face lift procedure if you are a smoker. The bad news is that your risk of a problem is greatly accelerated. If you are truly unable to stop smoking and all nicotine products then to minimize your risk of a problem, choose the procedure that is the least invasive (i.e. less undermining). I have perfomed several successful procedures using a mini-facelift approach that focuses on rejeuvenating the deeper tissues (SMAS) with minimal undermining, abbreviated incisions and minimal tension on the skin