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.
SMAS Facelift Side Effect True for Smokers?
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.
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.
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.
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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.
The best thing to do if you are a smoker who wants a facelift is to quit smoking.
Facelift and 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.
Facelift for smokers
SMAS Facelift Side Effect True for Smokers
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.
Smoking and 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.
Pablo Prichard, MD