Patient decisions
Can I Smoke if I'm Having Plastic Surgery?
Smoking increases risks around plastic surgery, including impaired wound healing, tissue loss and complications related to anesthesia and recovery. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains why discussing smoking early is part of planning an elective procedure.
In this episode.
Episode summary
Smoking increases risks around plastic surgery, including impaired wound healing, tissue loss and complications related to anesthesia and recovery. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains why discussing smoking early is part of planning an elective procedure.
The central issue is blood supply. Healing skin and tissue need oxygen and nutrients delivered through small blood vessels. The recording describes how smoking can interfere with that process, particularly when surgery has already changed the circulation supporting an area.
Key takeaways
🩹 Incisions depend on circulation to heal.
Dr. Smith uses a construction-site analogy: blood flow brings the materials needed for repair.
🩹 The concern extends beyond a delayed scar.
The episode discusses loss of skin or other soft tissue when its blood supply is inadequate.
🔎 Different operations create different demands.
Tummy tucks, breast reductions, breast lifts and facelifts are examples used to explain why tissue circulation matters.
⚠️ Heart, lung and clotting risks also matter.
Smoking is discussed in the wider context of anesthesia and recovery, not only the appearance of an incision.
🎯 Make a cessation plan with the surgical team.
Dr. Smith encourages using the preparation period as an opportunity to seek support for quitting.
Questions this episode answers
Why can smoking cause tissue loss after surgery?
The recording explains that tissue needs an adequate blood supply to survive. When a procedure changes that supply, smoking can further compromise circulation and increase the risk of serious healing problems.
How long before and after surgery does Dr. Smith discuss stopping?
In this 2020 recording, he describes approximately a month before and after a procedure. That is a historical practice example, not personal clearance to proceed or resume smoking. Your team should set the plan for your operation and health circumstances.
ℹ️ Current context
The ASPS 2024 smoking-risk guidance also addresses nicotine from vaping and other products, while noting that management varies by procedure and patient. Tell your team about cigarettes, vaping and nicotine replacement products so cessation support and surgical timing can be planned together.
🔗 Related information
Explore preparing for plastic surgery, patient guides, the practice and surgical setting, or request a consultation with Dr. Smith in New York City.
Originally released September 22, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.
Original show notes
A plastic surgery procedure is a great excuse to quit smoking. Board certified NYC plastic surgeon Dr. Darren Smith reviews why.
Read the conversation.
[00:08] I'm board-certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. Can I smoke if I'm having plastic surgery? Well, the short answer is you really shouldn't. And we're gonna go through a few reasons why it's not a great idea to smoke if you're planning on having a plastic surgery procedure and why your plastic surgery procedure can be a great reason to quit smoking. There are three categories of reasons that should prevent you from smoking when you're planning on having a plastic surgery procedure. The first is that smoking can cause issues with wound healing. The second is that smoking can actually cause soft tissue loss. And the third is that smoking can cause systemic health issues related to anesthesia and recovery from your surgical procedure. The first two problems with smoking and plastic surgery come down to the same basic issue, which is that smoking and the products contained in cigarettes and related items cause issues with the microvasculature. That is, they prevent blood from flowing freely through the tiny blood vessels that ultimately supply vital oxygen and nutrients to your skin.
[01:54] This is a problem for wound healing because the wound healing process depends on critical factors that are delivered to the edges and base of a wound that allow it to heal. And these are things like different kinds of blood cells and also the soft tissue and connective tissue cells that come together in a wound to allow it to properly close. If you want to Think of a healing wound or surgical incision as a construction site. The circulation is essentially the supply line for all of the materials necessary for the construction at that work site to happen. And smoking really effectively cuts off these supply lines. Examples of when this is a particularly problematic occurrence is after a procedure like an abdominoplasty or a breast reduction that has very long incisions that also might be relatively far away from their blood supply because when we perform an abdominoplasty or a breast reduction we are elevating tissue off of its normal blood supply and requiring it to live off a more limited blood supply. So if we then introduce smoking into the mix, we're further limiting the blood supply to those wound edges and making healing a very difficult proposition.
[03:32] Taking this problem one step further we get to actual soft tissue loss so every part of your body needs blood to live and As I just mentioned when we're performing procedures like an abdominoplasty or a breast reduction or even a facelift, and there are many others, where we are essentially altering the body's blood supply and asking your tissues to live off a new modified blood supply. Any insult or damage to that new blood supply could be catastrophic. So examples of this would be things like in a breast reduction or a breast lift Smoking can contribute to really potentially devastating complications like the loss of the nipple or the nipple areolar complex or in the case of an abdominoplasty the loss of a belly button and in the case of a facelift things like loss of the facelift flap which can lead to major cosmetic and sometimes even functional concerns.
[04:36] The last category of problems related to smoking and plastic surgery are those related to anesthesia and systemic health concerns. And this comes back to the fact that for all the reasons that smoking is unhealthy in general, these risks are all magnified in the context of surgery and anesthesia because this is a strenuous or stressful state for your system to be in. So when we're asking your body to heal a large wound or to recover from surgery or to undergo anesthesia, the risk of problems with your heart and lungs and other systems is increased by smoking. One very real way that smoking can be extremely dangerous in the context of surgery is in increasing the risk of a blood clot and a blood clot that forms in your legs which is called a DVT or a deep venous thrombosis can travel to the lungs which turns it into a PE or pulmonary embolism and that can block off blood supply from transferring oxygen in your lungs and that can be a very very dangerous event. So we recommend for really all plastic surgery procedures, not smoking for a good month before or after that procedure. So if you're a smoker, a plastic surgery procedure can be a great excuse to stop and I'd encourage you to speak with your board certified plastic surgeons about strategies to help you to achieve that goal. Thanks for listening and don't forget to subscribe, share the show, and head over to DarrinSmithMD.com for more real world plastic surgery talk.
Sources and context.
Original Captivate episode. Original release date: 2020-09-22. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.
Behind the conversation.
Darren M. Smith, MD, FACS