Smoking and Cosmetic Surgery:
A Dangerous Combination

Reviewed by Neil Schachter, MD

The negative health effects of smoking cigarettes are well publicized, yet more than 46 million American adults still smoke, according to the Centers for Disease Control and Prevention, and nearly one in five deaths in the United States is due to smoking. Smoking increases your risk for many cancers, including those of the lungs, throat, mouth, esophagus and stomach. Tobacco smoking is also a known risk factor for other conditions, including heart disease, aneurysms, bronchitis, emphysema and stroke.

Clearly, there are many good reasons to quit smoking. However, if you are planning to undergo surgery, including cosmetic procedures such as tummy tuck, breast augmentation or face lift, you have additional incentives to kick the habit. Aside from all its other ill effects, smoking can increase the risks and severely compromise the results of your cosmetic surgery procedure.

Risky Business: Smoking and Surgery

Smoking constricts your blood vessels and inhibits the binding of oxygen, which reduces the amount of oxygen that is available to your cells. Without sufficient oxygen, you won't heal as well after your surgery. Risks of poor healing include skin necrosis (skin death), raised, red scars and wound separation. Smokers are also more likely to experience anesthesia complications and develop infections after surgery. Across all surgical specialties, smokers tend to have longer hospital stays, are at higher risk of readmission, are more likely to be admitted to an intensive care unit and have an increased risk of dying while in the hospital.

Many surgeons will not perform certain elective surgeries on smokers due to these risks.

Besides increasing the risks of surgery, smoking can affect the outcome of your treatment. Many cosmetic surgery procedures are done to put the brakes on the aging process, but smoking causes premature wrinkling, so it can offset the effects of your procedure.

Quit Smoking Before Your Cosmetic Surgery

Although the best option would be to quit smoking for good as soon as you can, there are benefits to quitting for the two weeks before and after your surgery. Such short-term smoking cessation will have a positive effect on the outcome of your procedure and decrease your risk of complications. Ask your surgeon for specific instructions regarding the timing of your smoking cessation prior to surgery.

E-cigarettes are growing in popularity and plastic surgeons now recommend that "vapers" avoid smoking e-cigarettes for at least four weeks before their procedure. While some suggest that e-cigarettes may be safer than traditional cigarettes, there's also some concern about the potential harmful health effects. The issue is that they may increase the same complications associated with traditional cigarette smoking.

Aids to Help You Quit

Whether your goal is to quit for surgery or permanently, more smoking cessation tools are available than ever before. Discuss your options with your board-certified plastic surgeon or internist in advance of your scheduled surgery.

Nicotine replacement products such as nicotine patches, gum and lozenges are available over the counter. A nicotine nasal spray and inhaler are currently available by prescription. These products can help relieve nicotine withdrawal symptoms.


While nicotine patches and other nicotine replacement systems can be used to quit well in advance of your procedure, they can't be used immediately before or during surgery because they cause some of the same problems with wound healing as cigarette smoking. Tell your surgeon if you are using any nicotine replacement products.

Drugs such as bupropion (Wellbutrin, Zyban) and varenicline tartrate (Chantix) are non-nicotine pills that may help you quit smoking. Talk to your doctor about a prescription.

Hypnotherapy or acupuncture may help some people quit smoking. In hypnotherapy, the smoker is placed in a hypnotic state in which he or she is more amenable to messages that encourage smoking cessation. Acupuncture involves placing extremely thin needles into the skin along specific acupuncture points to help curb the desire to smoke.

Your doctor can also refer you to local or online support groups to bolster your efforts.

All available smoking cessation products have their own set of advantages and disadvantages. Finding the method or methods that best match your lifestyle can help guarantee that you quit for good this time. If you smoke, make sure you tell your board-certified plastic surgeon during your initial consultation. 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.