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

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.

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.

   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

It is absolutely imperative to stop smoking as it causes a much higher risk of complications including skin loss and other wound healing problems. Therefore, I do not operate on patients who smoke unless they have stopped for at least 4 weeks pre-operatively.

As long as you are willing to quite for a few weeks before and after surgery your surgical risks should be acceptable - especially if you have had a good outcome before

A good plastic surgery result relies on good blood flow. The nicotine, carbon monoxide, and hydrogen cyanide in the blood of smokers inhibits their blood's ability to deliver sufficient oxygen to their healing tissues. Thus, patients who smoke are at greater risk of complications and poor wound healing. This is why doctors are hesitant or even unwilling to perform surgery on patients who smoke. Although you are at increased risk for a full face lift, a modified or mini-facelift such as the Lite Lift™ can be performed with less risk than more extensive procedures.

most plastic surgeons dread performing a facelift in a smoker. The nicotine acts as a vasoconstrictor and may cause impaired blood supply to the skin flap. This can result in loss of skin, delayed healing and terrible scars as a result.  Each different surgeon has their own criteria for performing a facelift on a smoker.  Many require no smoking for at least two weeks pre op, some won't operate on smokers at all. The worst problem i have had in a smoker was a patient who stopped smoking but used a nicotine patch unbeknownst to me.  So if you are a smoker and are going to have a facelift, it is important that you not only cease smoking but also avoid a nicotine patch or gum.

Several surgeons have given very good explanations why facelifts in smokers are riskier. That is not to say you cannot undergo a facelift. You need to compromise on the expected outcome by reducing the incisions to avoid skin flap healing complications. Additionally, anticipate longer healing times and expect your surgeon to have you stop smoking for a short time before and after surgery. I have done facelifts in carefully selected and motivated smokers for many years. You will probably have good luck finding a surgeon willing to work with you.

Smoking can increase inflammation and cause skin healing issues such as skin loss and necrosis (premature death of cells in living tissue). Nicotine can increase the risk of blood clots and it restricts blood vessels that brings oxygenated blood to the tissues. Oxygen helps fight infections and helps keep tissues alive.

As all the other posts have noted, nicotine and other chemicals in the smoke constrict the blood vessels in your skin.  This reduction in skin blood flow can lead to poor healing, poor scarring and possible tissue death.  You were lucky to not have problems after your prior surgeries, but these surgeries are different than a facelift, in that some don't have much undermining of the skin , or the flap which is undermined is much thicker than a facelift flap.   Safety first, so avoid the high risk of problems with the skin of your face and either stop smoking for many weeks prior to and after surgery or re think having the surgery.