Where can I go to get proof it's smoking causing skin to die after facelifts?

I resist facelift operating on any smoker as the risks to facial flap survival are imo unnecessarily high. At the very least you should give up for 2 weeks prior to surgery. I would also ask you to sign a consent form specifically for smokers that confirms that you understand the risk of complication is significantly higher for those that smoke. Lastly I would only performed minimal undermining of the facial flap and apply nitroglycerin paste to it in the first 12 hours.

Kind regards

It's wonderful that you did not have any problems during your past procedures, but when surgeons advise patients not to smoke, it's for a very good reason.  The nicotine in cigarettes can cause your blood vessels to narrow, decreasing blood flow to the tissues.  I would never perform a standard facelift in a person who smokes.  The complication rate is just too high.  Eyelid surgery and breast augmentation utilize smaller incisions and do not create a flap of tissue which has to survive and heal.  We perform a deep plane facelift on people who smoke, and because the flap is thicker, the chance of complications is lower.  There is still a higher rate of complications, however, than in people who do not smoke.  It is best to stop smoking about 2 weeks before surgery, and 2 weeks after.  That is an adequate amount of time for your body to heal, before you begin to smoke again.

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. The older plastic surgeons in our community have books of photos with "scared straight" type disastrous outcomes, (referred to their practice for treatment) from when lot of people used to smoke, (think Mad Men).  Please stop smoking, (for dozens of reasons). If the prospect of a facelift is a motivation to quit, then so be it.

In addition to its adverse effects on general health, smoking tobacco increases the chance’s of a plastic surgery patient having complications and can negatively affect her results.                                                                                                                                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.

A long history of medical studies have shown revealed the risks patients take when they smoke. A 1984 study, which followed 1,100 face lift patients, “found that a smoker was 12.46 times more likely to suffer skin loss than a patient who did not smoke.”

A more recent study in 2003 reviewed 132 Abdominoplasty patients. The study “showed wound healing problems in 47.9% of smokers versus 14.8% of non-smokers.”

Whether a plastic surgery candidate smokes or not is a big factor in whether a surgeon will perform surgery on that person or not. At the Pacific Center for Plastic Surgery, patients will be asked about their smoking habits, if any, which will be factored into the doctor’s decisions in her/his case.

Source: Bulletin of the American College of Surgeons

Smoking will increase the risk for complications after any operation. All plastic surgeons would prefer the patient's not smoke per several weeks prior to elective operation. However, if the patient is willing to assume the risks of not smoking there is no contraindication to proceed with the operation.

In general, you will want to avoid smoking at least 6 weeks before and 6 weeks after surgery. Nicotine itself is a vasoconstrictor. When vasoconstriction takes place, surface area inside the blood vessels decreases. This results in poor blood flow and a rise in blood pressure. In effect, healing is greatly compromised. I would highly recommend refraining from smoking before and after surgery, as it can have a negative impact on your healing. I hope this helps, and best of luck!

The theme you are reading in all the posts is that smoking increases the chances of skin flap necrosis if you undergo a traditional facelift. All plastic surgeons do not want to have an angry patient who has 2 or 3 inches of dead skin after a face lift and looks 100% worse then what they did before surgery.  A modified facelift such as a deep plane facelift is a bit safer. The best would be to quit for 1 month before and after surgery if possible. I hope this helps. Good Luck!

Smoking combined with facelift surgery is a date with disaster.  Smoking decreases the circulation to the skin. The skin circulation has already been compromised by the nature of the surgery.  The two added together further decrease the circulation and lead to poor wound healing and/or skin loss.  I would direct you to the American Society of Plastic Surgery website for examples and data. 

Dr. ES

Patients that smoke cigarettes have a higher incidence of surgical complications, including wound healing and infection. In a facelift patient that smokes the worrisome complication is the “slough of the flap”, that’s when the skin edges become necrotic. This causes poor healing and unsightly scars. Some plastic surgeons refuse to perform facelifts on smokers. In my practice I routinely perform facelifts on some select patients that smoke. This is done after thorough consultation, rigorous pre-operative preparation, custom tailored surgical technique and very specific post-operative regimen.  Using this approach I have not had a significant skin slough in over 20 years of practice. 

There is definitely an increased risk of problems in a facelift if you are a smoker. No one will dispute that. What the odds are and how bad the problems can be varies considerably among patients. Most surgeons make recommendations based on their personal experience. Some will not do a facelift on any smoker under any circumstances. If you do have a facelift, however, aside from stopping smoking, do not use a nicotine patch or gum. The complications for those are even worse.