San Francisco Plastic Surgery & Laser Center | Usha Rajagopal, MD

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Why Smoking and Plastic Surgery Don’t Mix

If you’re a smoker, you’ve heard it a million times before: Smoking is bad for you. It’s a terrible habit. You should quit.

All of this is true, and in ideal world, everyone would stop smoking immediately. Realistically, though, this is not going to happen—and I’m not here to try to convince you to give up your own habit. Not forever, anyway. But if you’re planning to have surgery of any kind, including plastic surgery, then you will have to at least take a break—a long one—from smoking.

Here’s why: Nicotine (whether in cigarette or any other form) is a vasoconstrictor, which means that it causes your blood vessels to close up. When your blood vessels constrict like this, they can’t bring the oxygen that helps fight infection and keeps your tissues alive to the places that need it. The incisions made during surgery cut through some of those blood vessels, which means that even if you haven’t been smoking, your skin is receiving less oxygen than usual during recovery; if you have been smoking, the nicotine reduces the amount of oxygen even further, and that’s when complications arise.

There are always risks involved in surgery; smoking, however, brings those risks to an entirely new level. Having nicotine in your system during and after surgery increases your risk for developing severe infections or pneumonia, and makes tissue death more likely. A 2009 study also indicated that nicotine can cause complications while you’re under anesthesia during surgery.

Smoking can have devastating results for plastic surgeries including (but not limited to) face lifts, tummy tucks, breast lifts and augmentations, and arm lifts. It can cause infection and skin death, and in the case of breast augmentation, it increases the risk of capsular contracture.

I’m not telling you to quite forever. But if you’re going to have surgery, you shouldn’t use nicotine of any kind in the four weeks preceding surgery, or the four weeks following. If you can’t do that, then you shouldn’t have surgery at all.