Plastic surgery is not for everyone – to be eligible to undergo the surgical procedure, you need to be a suitable candidate. Whenever a patient consults the surgeon regarding cosmetic surgery, one of the very first questions asked by the surgeon is whether the patient smokes or not. If you are a heavy smoker, there is a good chance that your plastic surgeon will advise you to quit smoking well before surgery.
Plastic surgery is a surgical specialty that involves the restoration, reconstruction, or alteration of the human body. It is divided into two main categories: reconstructive surgery and cosmetic surgery. While Reconstructive surgery is related to craniofacial surgery, hand surgery, and microsurgery, Cosmetic surgery, also known as aesthetic surgery, is performed to alter the aspect of certain features of the body and/or face or the body as a whole.
Plastic surgery procedures are elective – this means that they are performed to alter your appearance and the patient chooses to undergo the procedure. On the other hand, we have emergency and general surgery procedures– procedures that are performed to improve your health condition, to correct concerns that can come up after trauma, disease and so on.
Due to this difference between Plastic surgery and emergency general surgery, the surgeons, as well as the patients, have higher expectations but a very low tolerance for any complication after a cosmetic procedure. So if you are a smoker and are considering undergoing any plastic surgery procedure, it is best to quit smoking to help reduce the risk of any possible complications. If you can’t quit then you’ll have to give up for many weeks before and after surgery.
Why quit smoking before plastic surgery?
When plastic surgery is performed, the skin, fat and other superficial tissues can be pulled, stretched and skin can also be excised – for example when post weight loss procedures are performed. Skin and superficial tissues will survive only if blood vessels and the blood supply to these structures is intact. Oxygen supplied by the vessels after the surgery is vital for the survival of the tissues. While performing plastic surgery for a facelift (rhytidectomy), breast lift mastopexy, breast reduction mammaplasty, tummy tuck/abdominoplasty, and various other plastic surgical procedures, certain vessels are cut while some are left intact. These intact vessels are responsible for supplying oxygen to the tissues that have been worked on during a facelift (rhytidectomy) or a tummy tuck/abdominoplasty.
Cigarette smoke contains an active ingredient called Nicotine which is a potent vasoconstrictor. If you are a smoker the blood vessels go into a state of vasoconstriction. This leads to decreased oxygen delivery to the operated site and could lead to the death of the tissues, also known as tissue necrosis.
If you don’t quit smoking and have breast surgery like a breast augmentation mammoplasty or breast reduction mammaplasty procedure, you are at a very high risk of experiencing tissue death which can ultimately lead even to the loss of nipple – if you had a periareolar incision. Smoking before and after a face surgery puts you at risk of wound breakdown, getting unsatisfactory results and visible scarring.
Smoking causes damage to the regenerative capacity of cells and interferes at different steps of surgical wound repair. By interfering with the wound healing process, smoking contributes to low-quality scarring post-operatively.
The oxygen-carrying capacity of haemoglobin in blood is also reduced by the carbon monoxide present in smoke. Cosmetic procedures such as interventions at the level of the face and breast surgeries are very much reliant on proper blood supply for good results and a fast recovery period.
Changes brought about in the lungs and the respiratory tract by cigarette smoke also predisposes you to increased episodes of post-operative chest infections and persistent cough. Also, an increased frequency of coughing episodes can cause bleeding deep into the tissues of the freshly operated site resulting in hematoma formation, delayed wound healing causing discomfort, and affecting the quality of the scars.
Smoking can lead to tissue necrosis or death of your skin & tissues
A good supply of blood to the area affected by surgery is crucial during the recovery phase. Nicotine carbon monoxide present in smoke can significantly affect the blood supply and oxygenation of the tissues and this could lead to skin or fat tissue necrosis, as well as the opening of surgical incisions and even infections.
Effects of smoking on plastic surgery
- Wound healing is delayed – the lack of proper oxygenation of the tissues could lead to delayed wound healing
- Increased risks of Infection- due to the slower rate of wound healing, the chances of wound infection increases
- Increased risks of blood clots and Deep vein Thrombosis in smokers
- Increased risk of nipple necrosis when breast procedures are performed
- The higher cost of plastic surgery – scar formation is affected by smoking and this could lead to the need of additional scar treatment and even revision surgery after plastic surgery
- Decreased Immune System – smoking can increase susceptibility to infections by inhibiting our immune system, which can ultimately lead to serious systemic infections and/or life-threatening septic conditions
- Lowers chances of survival of fat transferred to the breast- this leads to unsatisfactory results which ultimately could lead to more operations and hence an increased cost
Scientific data about how smoking affects the results of plastic surgery
According to various literature, smokers are at a higher risk of developing complications after Plastic surgery compared to Non-smokers. Statistical data obtained from various researches have shown that skin necrosis following a facelift is 12.5 times more common in smokers; similarly, the incidence of necrosis following abdominal flap surgery is close to 28%. Those having breast reconstruction with implant were found to have a 33% incidence of implant loss. Even when autologous tissue like TRAM flap or DIEP flap was used in reconstruction, smokers still were found to be at a higher risk of tissue necrosis.
Research conducted in 2013 at John Hopkins followed 415 plastic surgery patients for three months post-operatively. Among them, 54 patients were active smokers and it was found that they have higher rates of tissue death as compared to other patients who were non-smokers.
Please QUIT smoking as soon as possible
There is only one option if you are planning on getting plastic surgery done, just give up smoking. This includes intake of Nicotine in any form. Most plastic surgeons will not operate on you until you quit smoking, vaping and taking recreational drugs. Dr Hunt or Dr Maryam will advise you to quit smoking at least three to six weeks before the surgery is scheduled, and that you do not smoke or consume any form of nicotine for at least three to six weeks after the procedure, preferably longer.
Giving up smoking at any time before surgery has significant benefits. Giving up smoking for about six weeks before the surgery can greatly reduce breathing problems that can occur while you are under general anaesthesia.
In some cases, the surgeon will need to confirm that you are a non-smoker before the surgery and you’ll be tested. If detected, your surgery may be postponed or even cancelled.
Be honest with your Plastic surgeon – Tell them about your habit
If you are having difficulty quitting smoking, then it is important to be completely honest with your plastic surgeon. Your health and well-being are of utmost importance and so delaying the procedure for a few weeks is not a big deal if there is a high risk of complications. Thus, to get a better result and reduce chances of complications, it is important that you honestly communicate with your surgeon the difficulties that you are facing quitting smoking. Failure to do so can put you at risk of various complications.
There are always risks associated with the surgery and the surgeon will aim to reduce these risks and get a better outcome out of it. Your surgeon will try his/ her best, and you can help them out by quitting smoking. While it may be very difficult for you to stop smoking, it’s important to think about your health in the long-term.
FAQs about Smoking and Plastic Surgery
Can e-vaping be used as an alternative to a smoking cigarette before the surgery?
- E-vaping is NOT a replacement for cigarette smoking before the surgery. It has a higher concentration of nicotine than a cigarette. Nicotine is the particle responsible for most of the complications of smoking. So you should avoid all forms of smoking before surgical procedures including e-vaping and patches.
Why should I stop smoking before having plastic surgery done?
- If you are planning to undergo a plastic surgery procedure, your plastic surgeon will advise you to stop smoking before and after the procedure due to various complications associated with it. Your surgeon may also refuse to undertake the surgery if you are unwilling to quit smoking. Tissue death can lead to skin and fat tissue necrosis, permanent loss of nipple when breast procedures are performed, delayed wound healing and infection, not to mention bad scarring.
How does nicotine cause tissue necrosis?
- Nicotine is a potent vasoconstrictor that reduces blood supply to the operated site causing tissue necrosis. This will lead to a delayed recovery period and can affect the results of the surgery. The wound may not heal properly internally and externally.
Why should I quit smoking as soon as possible?
- Smoking can lead to increased tissue death, delayed recovery, and poor surgical outcomes following a plastic surgical procedure. The earlier you quit smoking before surgery, the more the effects of cigarettes are washed out from your system. So it is important that you quit smoking as soon as possible. If you haven’t quit already, the best time to quit is now.
How can the surgeon know if I have quit smoking or not?
- The plastic surgeon might request a test to see if you are a non-smoker and thus eligible for surgery or not.
What to do if I have difficulty quitting smoking?
- In case you are having difficulty quitting smoking, you should delay the surgery and go forward with it only after you have quit smoking. This is because it reduces the possibility of complications that might have been avoided if you were not smoking. Your plastic surgeon’s priority is your safety above anything else. Avoiding complications is crucial for the success of your intervention. If you are unable to quit smoking or are not willing to do so, then undergoing plastic surgery might not be for you.
About Dr Jeremy Hunt – Specialist Plastic Surgeon
Dr Jeremy Hunt is a specialist plastic surgeon performing breast, body, face and nose surgery in Australia. He is a member of FRACS & ASPS and has over 20 years of experience providing plastic surgery in Sydney.
Dr Hunt provides personal, one-on-one service and attention to detail for his patients from the Sydney & Wollongong NSW area and across Australia.
Dr Hunt’s qualifications and education
Dr Jeremy A. Hunt MBBS FRACS graduated with a Bachelor of Medicine degree from Sydney University in 1990 and is a Fellow of the Royal Australasian College of Surgeons and member of ASPS – the Australian Society of Plastic Surgeons. He completed a Fellowship at the University of Texas in the United States, where he learnt from well-established and experienced plastic surgeons.
Next Step – Make an Enquiry or Request a consultation with Dr Hunt
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Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health professional.