When can I smoke and drink after rhinoplasty?

Question

Hi, I'm having a closed rhinoplasty next Thursday. I gave up smoking this week as recommended by my surgeon. However, as a 18 year old male I like my social life and as its currently the holidays I would like to know when it is possible to smoke/drink after surgery. I've heard many differing responses on this. Please can I have your opinions. Also, is it safe to smoke nicotine and tobacco free cigarettes before/after surgery? Finally, when is it safe to have sex after rhinoplasty? Thanks.

Deepak Raj Dugar, MD · Answer

Hello,Thank you for your question. I advice patients absolutely no smoking or alcohol four weeks prior and post surgery. Smoking and alcohol both delay and interfere with the healing process. It is not safe to smoke nicotine and tobacco free cigarettes before and after surgery. I advice patients to wait to engage in intercourse 4-6 weeks post rhinoplasty. All the best, Deepak Dugar, MDScarless Rhinoplasty ExpertBeverly Hills, CA 90210

Ozge Ergun, MD · Answer

Thanks for the question. You should wait 2-3 weeks because your operation area trying to get healed. Then after yes you can do smoke and drink. I wish you all the best.

Jerome Edelstein, MD · Answer

It's extremely important that patients avoid the use of both tobacco and alcohol before and after surgery since these substances inhibit the recovery process. You should not smoke or drink in the three weeks leading up to the nose job operation and for another three weeks afterward. However, you should ask your surgeon for their advice as they may have different guidelines.

Sam Naficy, MD, FACS · Answer

Although smoking, drinking, and sex may go together well, they don't go well with surgery.  Check with your surgeon about his/her specific recommendations

Ross A. Clevens, MD, FACS · Answer

Your results will be directly related to how you care for yourself before and after your surgery. I suggest that my patients stop smoking at least 4 weeks prior to surgery and continue to abstain for at least another 4 weeks after. As for alcohol, I suggest that patients limit consumption up to a week prior to surgery with no alcohol 24 hours prior to your procedure. It is also recommended that you not consume any alcohol while taking your medication post operatively as well. Finally, to limit your post operative swelling, it is suggested that you minimize any activity that raises your heart rate for at least two weeks. Best of Luck! Dr. Clevens

Richard H. Tholen, MD, FACS · Answer

Come on, you know the answer to this--your doctor has already told you that these things are not recommended for a specific time before AND after surgery. I recently re-operated on a breast lift plus implants patient who was healing beautifully until her 18th day post-op when she went clubbing, was over-served, slipped and fell in the parking lot, and "popped open" several inches of her incision. Blood all over, and of course her friends called 911, after which my patient was transported to the nearest emergency room (add up the ambulance, ER, and ER physician charges thus far) where I was called at 3AM.

	Of course, she was too inebriated for safe anesthesia, so she went home, and we re-operated the next morning. Fortunately, her implant was not exposed or I would have had to remove it, heal her breast, and then replace her implant in a third operation. And even with things working out OK and a salvaged great result, she spent about double for her breasts as a result of her little "night on the town."

	No smoking for two weeks before and after surgery is a MINIMUM; alcohol, as my example shows, may be "OK" a few days after surgery, but overindulging as a result of bad judgement can be a problem even 2 1/2 weeks post-op!

	No exercising is recommended for 3-4 weeks, so sexual activity should be considered in light of how vigorous your intimate activities are. Ask your surgeon, and follow his or her advice, as it is he/she you will have to go to if you misbehave and have a problem to "fix." How would you feel if your surgeon asked if it was OK with you if he or she could arrive for surgery tired, hung-over, or impaired (what, surgeons aren't allowed to "like their social life?")? What would you think? Your surgeon has every right to feel the same way when patients ask such questions. Surgery is a lifelong investment--do it right and don't compromise. You certainly don't want your surgeon to do so! Good luck!

Michael A. Persky, MD · Answer

Hi,

	Certainly alcohol and smoking tobacco and or marijuana before and after rhinoplasty surgery is not helpful in the healing process.  You should be motivated to get the best possible result from your rhinoplasty surgery.  Giving up drinking alcohol, smoking, and a little hoochie-kootchie for a few weeks should not be that difficult to maximize rhinoplasty results for the rest of your life.  You will have plenty of opportunities to smoke, drink, have unlimited sex, etc. in the future.  If you cannot give them up during your surgery period, then perhaps postpone surgery until you gain a bit more maturity.  Certainly listen to your rhinoplasty surgeon's advice.  As far as sexual activity goes, we tell our patients to limit physical activity, sports, and other activities where they may get hit in the nose with balls for the first 3 to 4 weeks after rhinoplasty.  Good luck and be well.

	Dr. P

Michael M. Omidi, MD, FACS · Answer

Thank you for the question. You should absolutely consult with your physician about your smoking habits in order to obtain the most reliable and individualized medical advice. Most specialists recommend abstaining from smoking for 2-3 weeks before a rhinoplasty, while others may insist on a full month or two. Smoking will cause irritation and restrict the blood flow to your healing areas, possibly causing complications during the recovery period.  Regarding sex after rhinoplasty, I would advise you to wait about 3 weeks before engaging in strenuous physical activities after rhinoplasty. Even if sexual activity poses no risk of nasal trauma, it might elevate your blood pressure and increase your heartbeat. This might exacerbate your swelling and even increase a chance of bleeding. 
 An in-person exam with a board-certified plastic surgeon would be the best way to assess your needs and obtain expert medical advice. Best of luck!

Pablo Prichard, MD · Answer

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. 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.Best wishes,Pablo Prichard, MD

Steven Wallach, MD · Answer

I recommend to my patients to not smoke for 4 weeks prior to surgery and to remain abstinent for 4 weeks after surgery. Even still the complication rate is still higher than a non-smoker.

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