Hi memstan,The term you are referring to is called skin necrosis. It will be easier to google this term than skin turning black after facelift. The better question how does smoking increase your chance of the skin turning black or "dying" (skin necrosis) after a facelift. Cigarettes have nicotine, as well as e-cigarettes and nicotine patches. Nicotine as a drug constricts blood vessels.When performing a facelift the thin skin is lifted off the fat. Normally the skin can be fed from the blood vessels from the fat layer, but in plastic surgery skin is often lifted off of the fat. This requires the blood flow to go along the skin blood vessels to feed this thin sheet of skin with oxygen and nutrients from the blood vessels.If the nicotine constricts the blood vessels in a chronic smoker, what might happen to the parts of the skin which is furthest from the blood supply. Typically the areas at risk are the furthest from the where the skin is still attached to the fat. Another problem area, is if too much skin is removed, and the skin is pulled together with too much tension. This tension stretches the skin and the skin stretching can further constrict the blood vessels in addition to the nicotine. In fact too much tension on a skin incision on a non-smoker is also a risk factor for skin necrosis. Diabetics are also at risk for skin necrosis. The high blood sugar in diabetics causes poor circulation which leads to necrosis of the toes and fingers and worse. The small blood vessels have such poor circulation that non-operated fingers and toes simple clot off and die. When an appendage dies (also necrosis) we will also call that gangrene, or dry gangrene.In order to offer a facelift/necklift to a smoker, it is best for the smoker to quit all nicotine products for 6 weeks before and after surgery for the best healing and reduction in the chance for skin necrosis. Although the skin necrosis risk does not go as low as non-smoker levels, it is much safer than an actively smoking patient.Additional modifications that a surgeon can do, is to perform a deep plane facelift to keep more fat/tissue connected to the skin and supply the skin with more blood flow. When trimming the excess skin, it would be safer to trim slightly less skin to make sure there is little to no tension on the skin which may cause physical blood vessel constriction. Elevating the skin off of the underlying fat shorter distances would also the distance the blood vessels need to carry the oxygen and nutrient shorter and reduce some risk.Good question. Hopefully your question will help many other nicotine users who are considering a facelift.Best,Dr. Yang
