Face Lift

Smoking and Facial Plastic Surgery -
A Risky Combo

Reviewed by Neil Schachter, MD

The harmful effects of smoking are well-documented. Smoking causes cancer of the lungs, mouth, throat, esophagus and stomach and raises your risk of bronchitis, emphysema, heart disease and stroke. One in every five deaths in the United States is attributed directly to smoking, according to the Centers for Disease Control and Prevention.

These are all great reasons to stop smoking, but there are more: smoking increases the risks of, and impedes recovery from, your facial plastic surgery procedure.

Why Smoking and Surgery Don't Mix

Smoking reduces the delivery of oxygen to tissues because it constricts blood vessels. If your cells are deprived of oxygen, you won't heal as well as you should. Wound separation, skin death and raised red scars may occur as a result.

Smokers who undergo surgery face a greater risk of anesthesia complications, infection, pneumonia, heart attack, stroke and death than nonsmokers who undergo surgery. They are also more likely to experience longer hospital stays or end up in the intensive care unit. For all of these reasons, many surgeons will not perform elective surgical procedures on smokers.

Smoking causes premature aging, so by continuing to smoke, you undo the anti-aging benefits of any facial plastic surgery procedure. It is counterproductive to smoke and take pains to look younger.

When and How to Quit

The best advice is to quit smoking immediately — for good. However, even quitting for a few weeks before and after surgery can reduce your risks and help ensure a smooth recovery from your facelift, brow lift, eyelid lift or other facial plastic surgery procedure. Your surgeon can provide you with more specific guidance regarding the timing of your smoking cessation.

Many people are able to quit cold turkey, but others benefit from various aids that are available. If you need help, ask your doctor for advice on which method is best for you.

Nicotine Replacement Therapy

One popular technique for quitting smoking is nicotine replacement therapy. Nicotine replacement products provide you with a low dose of nicotine without the harmful toxins found in smoke. The idea is that you'll have a better chance of success if you're eased off the nicotine gradually.

Nicotine replacement supplements come in various forms, including gum, inhalers, lozenges, nasal sprays and patches. Your doctor can help you decide which method is best for you. Nicotine replacement systems can't be used immediately before or during your surgery because they have some of the same detrimental effects as smoking cigarettes. Make sure your surgeon knows if you currently use any nicotine replacement products.

Smoking Cessation Medications

Several prescription medications are available to help you quit smoking. Bupropion (which is sold under the brand names Zyban and Wellbutrin) is an antidepressant drug that is thought to reduce the craving for nicotine.

Varenicline (brand name Chantix) also reduces cravings and other withdrawal symptoms. In addition, it helps diminish the pleasure a smoker gets from cigarettes.

Besides nicotine replacement and medications, other smoking cessation techniques include hypnotherapy, acupuncture, counseling and local or online support groups.

If you smoke, make sure you tell your surgeon during your initial consultation and keep him or her apprised of your smoking cessation progress as your surgery date approaches. Start your search for a surgeon now.

About the Reviewer of this Article

Neil Schachter, MD, is the Maurice Hexter Professor of Pulmonary, Pediatric and Community Medicine and the Medical Director of Respiratory Care at Mount Sinai Medical Center in New York City. He is past president of the American Lung Association (ALA) of the City of New York, the Connecticut Thoracic Society and the National Association of Medical Directors of Respiratory Care. Dr. Schachter currently serves on the Board of Directors of the ALA of New York and the ALA's National Board, where he is the chairman of the Scientific Advisory Committee. Dr. Schachter is the author of several books, including The Good Doctor's Guide to Colds and Flu.

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    Yael Halaas, MD, FACS

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