Smoking and cosmetic surgery at a glance
- Stop beforeAt least 1 month (ideally 6 to 8 weeks)
- Stop afterAt least 1 month
- Carboxyhaemoglobin7% on average in smokers
- Carbon monoxideEliminated in 12 to 48 hours
- RisksHealing, infection, phlebitis
- HelpTabac info service, 39 89
Smoking reduces the oxygen supply to the tissues: nicotine narrows the small blood vessels of the skin, and the carbon monoxide in smoke takes the place of oxygen in the blood. Around the time of cosmetic surgery, it increases the risk of wound-healing problems, infection, prolonged swelling (oedema) and phlebitis. You must stop smoking completely at least one month before the procedure, ideally 6 to 8 weeks before, and for at least one month afterwards. Your GP, a smoking cessation specialist or Tabac info service (39 89) can help you. [Note: Tabac info service is the French national stop-smoking helpline; 39 89 is a French number.]
Article from 2014, updated and brought into line with the procedure pages.
1. What does smoking do to your tissues?
Two mechanisms reduce the oxygen supply to the tissues. Nicotine causes the blood vessels and capillaries of the skin to spasm, narrowing them. The carbon monoxide in smoke binds to haemoglobin in place of oxygen (carboxyhaemoglobin): the blood carries less oxygen. In smokers, the carboxyhaemoglobin level averages 7%; in heavy smokers it can exceed 15% by the end of the day. Smoking also increases platelet aggregation, which promotes blood clots.
2. What are the risks for your procedure?
Wound-healing problems
Smoking can delay healing, cause skin damage or skin necrosis (tissue death), and inflamed scars that are red or even pigmented.
Infection
It increases the risk of infection after the procedure, which may require antibiotics, readmission to hospital or further surgery.
Swelling (oedema)
It can increase swelling of the operated area and make it last longer.
Phlebitis and pulmonary embolism
By promoting platelet aggregation, it increases the risk of phlebitis (deep vein thrombosis) after the procedure, and therefore of pulmonary embolism.
The procedures most at risk
These are the ones in which the skin is extensively lifted away from the underlying tissues: abdominoplasty, facelift, breast lift and breast reduction. The lifted skin then depends on small blood vessels, which smoking narrows.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and in some cases eliminates them.
3. When should you stop smoking?
Stop smoking completely at least one month before the procedure, ideally 6 to 8 weeks before, and do not start again until at least one month afterwards, while healing takes place. The surgeon will tell you the exact period for your procedure (6 weeks before and after for a rhinoplasty, for example). Dr Médard de Chardon and the anaesthetist will remind you of these instructions.
Even late, stopping is worthwhile: carbon monoxide disappears from the blood within 12 to 48 hours. But only stopping for several weeks really reduces the risks to healing and of infection.
4. Patches and e-cigarettes
Patches, gum and e-cigarettes deliver neither carbon monoxide nor tar: they are far less harmful than cigarettes and help people to stop. But the nicotine they contain also narrows the blood vessels of the skin: their use around the time of the procedure is decided with the surgeon.
5. What about cannabis?
When smoked, cannabis also produces carbon monoxide: it must be stopped in the same way as tobacco. Tell the anaesthetist if you use it.
6. Getting help to stop
- your GP, who can prescribe nicotine replacement therapy;
- a smoking cessation specialist or a stop-smoking clinic;
- Tabac info service: 39 89 and tabac-info-service.fr.
Frequently asked questions
How long before the operation should I stop smoking?
At least one month before the procedure, ideally 6 to 8 weeks before, and for at least one month afterwards. The surgeon will tell you the exact period for your procedure.
Is cutting down enough?
No. The risks only really decrease if you stop completely; a few cigarettes a day are enough to narrow the blood vessels and add carbon monoxide.
Can I use patches or an e-cigarette?
They are far less harmful than cigarettes, but nicotine also narrows the blood vessels. Talk to the surgeon about it: he decides on their use around the time of the procedure.
What happens if I smoke anyway?
The risk of wound-healing problems, infection and phlebitis increases. Tell the surgeon: he may decide to postpone the procedure.
When can I smoke again after the procedure?
Not until at least one month afterwards, while healing takes place. It is also an opportunity to stop for good.
Sources
- Société française d’anesthésie et de réanimation (SFAR). Smoking and anaesthesia. National Congress of Anaesthesia and Intensive Care 2007, update lectures, pp. 79-89.
- SFAR, Office français de prévention du tabagisme (French Office for Smoking Prevention). Expert conference: perioperative smoking. 2005.
See also: normal scar healing · anaesthesia in cosmetic surgery · How to prepare your skin before cosmetic surgery