Why Can't I Have Neck or Facelift as a Smoker?

I've had both upper and lower eye lid surgery, arm reduction and a tummy tuck. I am a smoker and am 51 years old. I've healed fine in all cases. Why can't I have a neck or facelift?

Doctor Answers 37

Smoking and facelift surgery.

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Most cautious plastic surgeons will not perform any cosmetic procedure that involves a lot of tissue undermining on a smoker.  These procedures include facelifts, neck lifts, breast lifts, tummy tucks, and breast reductions to name a few.  At my Austin, Texas plastic surgery practice I routinely make patients wait 4-6 week without smoking before having any of the above procedures.  The issue is nicotine which causes constriction of the smallest blood vessels which are needed to heal procedures that have a lot of undermining of tissues.  Failure to quit smoking can lead to devastating results such as open wounds and loss of entire parts of the cheeks or sections of breast/abdomen.  Chantix and smoking cessation programs can help.  Just because you got away with it once doesn’t mean you will be lucky again, so a prudent approach is to stop smoking for at least 4-6 weeks before and after a facelift. 

Best of luck,

Dr. Kerr.

Facelift for Smokers

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Whenever you undergo elective surgery, our goals are to ensure your safety and to have great results.  Smoking impairs the blood supply to the area of skin that has been dissected or lifted and can potentially compromise your results with skin sloughing or skin necrosis. 

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Smoking and surgery

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Nicotine decreases the oxygen to tissues by vasoconstriction and therefore increases the risks of surgery to the areas operated on. You were lucky with your prior surgeries without complication. I would not suggest taking the risk with the facelift.

Facelifting for Smoker?

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Nicotine is constrictor of blood vessels,  decreasing blood flow to tissues that need to flow to heal after surgery. When plastic surgeons do operations that involve longer incisions and/or tissue flaps,  the blood flow to these areas become critical. Without the blood flow ( or a decreased blood flow secondary to the effects of nicotine) healing can be compromised and/or tissue may not survive (tissue necrosis).

For this reason, most plastic surgeons will not operate on patients who smoke within a time period prior to surgery (for specific operations such as facelifting, breast lifting, tummy tuck surgery etc.).

I hope this helps.


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Having any surgery and continuing to smoke is a bad idea.  The healing process is compromised due to constricting the blood vessels and blood supply.  The healing time will be much longer.

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 18 reviews

Reason why combining Nicotine ( Smoking) and Facelift / Tummy Tucks is a Really Bad Idea

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Nicotine causes severe and prolonged narrowing of all blood vessels in the body (resulting in hypertension and a harder working hert). The effect is especially marked in the skin when the blood circulation drops significantly even after a single cigarette smoked or inhaled from a nearby smoker. 

In operations in which the skin is undermined and lifted widely from the underlying muscles ( Facelift , Tummy Tuck, Breast Lift etc) and then depends critically on a good circulation through the skin. In a smoker, this circulation is seriously compromised, leading to death of a large area of the skin with a very poor cosmetic result after a long recovery and potentially several operations. 

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

Facelifts and nicotine don't mix

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The nicotine in any form constricts the blood flow to the skin and when it is lifted to do a facelift a substantial amount could die and make horrible scar.  Don't try to do this!

Smoking and surgery

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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. 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
4.9 out of 5 stars 42 reviews

Smoking and facelift/necklifts

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When one smokes, or uses tobacco, there is vascular constriction. Nicotine is a major vasoconstrictor. There are others in tobacco as well. 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 facelift 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 motivation to quit, then so be it.

Jeffrey J. Roth, MD, FACS
Las Vegas Plastic Surgeon
4.6 out of 5 stars 17 reviews

Neck or Facelift in a Smoker

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   In a face and neck lift the amount of undermining with the impaired blood supply from the smoking puts the patient at risk for skin loss.  Kenneth Hughes, MD Los Angeles, CA

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.