The Effects of Smoking on Plastic Surgery

Mon 19th May 2025

While we all know that smoking is bad for our health, you may not realise the highly detrimental effects that smoking has on surgery—and particularly plastic surgery. If you’re considering any cosmetic or plastic surgery procedure, you should be a non-smoker (and non-nicotine consumer). Or, you should have quit for ideally a good six weeks before your procedure.

Plastic surgery involves the reconstruction, restoration or alteration of the human body.

While smoking or taking nicotine-based products is bad for all types of surgery, it’s particularly detrimental to plastic surgery procedures.

During plastic surgery, some blood vessels are cut, while others are left intact. Blood vessels deliver oxygen to the tissues to keep them alive and to allow healthy wound healing. If the remaining blood vessels are compromised, oxygen supply to the tissues diminishes or stops, damaging or destroying the tissue and preventing wounds from healing

When you smoke or vape, your body ingests nicotine—a potent vasoconstrictor. Vasoconstriction decreases oxygen levels to the operated site and can cause tissue necrosis (tissue death). This is true for all other nicotine-containing products such as nicotine patches, snuff, chewing tobacco, e-cigarettes, pipes and cigars, so these products must be avoided.

The effects of nicotine on cosmetic surgery cannot be underestimated. For example, if a smoker were to have a Breast Lift, they risk tissue necrosis, which can even lead to losing a nipple. Any cosmetic surgery procedure can be affected by tissue damage, resulting in delayed healing, infection, wound breakdown, and excessive scarring.

Effects Of Smoking And Nicotine-based Products On Cosmetic Surgery

• Delayed healing – As nicotine constricts the blood vessels, essential oxygen cannot reach the tissues in adequate amounts, slowing the healing. This means that wounds won’t close quickly, and it will take longer to see the results.
• Tissue necrosis – As the tissues become starved of oxygen, the skin cannot adequately function and can die without much-needed oxygen.
• All patients consuming nicotine are at risk of their wounds breaking down and tissue necrosis. The greatest concerns are:
  • Breast reduction and breast lift patients – complete loss of the nipple-areolar
  • Abdominoplasty – loss of the abdominal wall skin
  • Facelift – loss of facial skin
  • Rhinoplasty (nose job) – nasal tip skin can die off

An area of skin (or nipple-areolar) that has undergone necrosis will take many weeks and months to heal, often requiring reconstructive surgery and resulting in a large scar.

• Risk of infection – By delaying healing, your body is more vulnerable to developing wounds. Bacteria can contaminate the area, leading to troublesome infections. Further, smoking weakens your immune system, impairing your respiratory system, which then decreases oxygen levels in the blood.
• Increased inflammation and pain – With less blood supply, the body cannot clear the inflammation in the surgical site, increasing inflammation and pain levels.
• Increased chances of blood clots and DVT – Smokers have a higher risk of developing blood clots and DVT’s after surgery.
• Compromised immune system – Smoking or taking nicotine-based substances inhibits our immune system. This leads to an increased susceptibility to infections and can lead to serious systemic infections or even life-threatening septic conditions.

• Surgical failure – If your surgery involved a fat transfer, then it is highly likely that none, or very little, of the fat will survive as your body would not be able to develop a microvascular blood supply and oxygenation of the fatty tissue.
• Higher chance of further expense – With problems such as delayed healing, infection, excessive scarring and tissue death, further surgery—and further expense—may be necessary.
• Anaesthetic Complications – Smoking obvioulsy has many negative affects on your cardiorespiratory system, and this can result in significant life threatening anaesthetic complications.

How Long Should You Stop Smoking Before Surgery?

Many plastic surgeons refuse to operate on a smoker or those taking any nicotine products. Ideally, you should quit smoking completely before considering a plastic surgery procedure. If you can’t quit, you should stop smoking for ideally six weeks, but at the bare minimum two weeks before your procedure and not recommence for an equal amount of time afterwards.

If you slip up and start smoking at any of these times, you must be honest and tell your surgeon. If you don’t, you may risk suffering any number of complications.

Tips For Quitting Smoking Before Surgery

Read up on the detrimental effects of smoking – By educating yourself on the dangers and complications of smoking, you’ll be more inspired to quit.

Tell friends and family – Committing to others helps make your pledge real, rather than a passing thought.

Talk to your doctor – They may prescribe non-nicotine-based prescription medications that can help you quit smoking before surgery.

Avoid other smokers – Keep yourself in smoke-free zones and avoid others who may tempt you.

Avoid triggers – If you smoke in the car, try substituting cigarettes for gum or a water bottle. If you relax with a cigarette, think of other ways of relaxing, such as exercising or taking a bath.

Get busy – Find hobbies or activities that keep you from smoking. It’s impossible to smoke if you’re swimming in the ocean, at a movie cinema or busy shopping, so create a list of things you can do to distract yourself.

Reach out to Quitline – This government-based organisation gives you expert cessation tips and help when needed. Plus, there are plenty of convincing statistics, charts and reading material to keep you focused and motivated.

Discuss Your Smoking With Dr Dona.

If you’re smoking or taking any nicotine-based products, please be honest and tell Dr Dona. He understands that quitting can be extremely challenging and is there to make sure your health and well-being are prioritised. If you can’t quit immediately, or relapse at any time, he’ll appreciate being informed so he can adjust your surgical date accordingly. And remember, quitting smoking will do more than improve your chances of a successful surgical outcome; it will improve your health and life in myriad ways.