Dr Scott J Turner | Specialist Plastic Surgeon (FRACS) | Sydney
Key Takeaways Smoking and nicotine narrow your blood vessels and cut the oxygen your tissues need to heal, which raises the risk of wound breakdown, infection, tissue death and poor scarring. I ask patients to stop all nicotine, including vaping and patches, for at least six to eight weeks before and after their operation. Surgery may be postponed if you have not stopped. Quitting is the single most effective thing you can do to lower your surgical risk.
Of everything within your control before an operation, stopping smoking matters more than almost anything else. Nicotine is not a harmless background habit when it comes to surgery. It changes how your blood flows, how much oxygen reaches your skin, and how well a wound can close. For a procedure that depends on healthy tissue healing in a precise and predictable way, that is a serious problem. And an avoidable one.
I am direct with patients about this, because the stakes are real and the risk is avoidable. As a Specialist Plastic Surgeon (FRACS) consulting in Sydney at Bondi Junction and Manly, I would rather delay an operation than perform it on someone whose healing is already compromised before they reach the theatre. This guide explains why nicotine causes problems, how long you need to stop, which procedures carry the most risk, and what genuinely helps you quit.
How nicotine works against your healing
Healing depends on blood. A fresh surgical wound needs a steady supply of oxygen and nutrients delivered through tiny vessels to the skin and tissue at its edges. Nicotine attacks exactly that process.
When you smoke or vape, nicotine causes your blood vessels to constrict and stay narrowed for hours. Less blood reaches the wound. At the same time, the carbon monoxide in cigarette smoke binds to your red blood cells in place of oxygen, so the blood that does arrive is carrying less of what your tissues need. The result is a wound trying to heal while partly starved of oxygen.
There is more to it than blood flow. Smoking impairs the immune cells that fight infection, and it disrupts collagen, the protein your body uses to knit a wound back together and form a strong scar. Reduced oxygen. Weaker immune response. Slower collagen. Each one alone would matter. Together, they explain why smokers heal so differently from non-smokers.
The complications that smoking makes more likely
These are not theoretical risks. They are real. They are the problems plastic surgeons see again and again in patients who keep smoking around the time of their surgery.
Wound healing problems are the most common. Start there. Incisions that should be closing instead pull apart, drain, or stall. Tissue necrosis is more serious, where skin or tissue that has lost its blood supply dies and may need to be removed, sometimes requiring further surgery to repair. Infection risk climbs too, partly because of the weakened immune response and partly because a wound that is already struggling to close becomes an open door for bacteria, and the scarring that follows tends to be wider, thicker and far more noticeable than it would otherwise have been. And under general anaesthetic, smokers face a higher rate of breathing and lung complications, along with extra strain on the heart.
None of this is meant to frighten you. It is meant to be honest about why surgeons treat smoking as a genuine surgical risk. Not a lifestyle footnote.
Every form of nicotine counts
This is where patients are often caught out. The harm is driven by nicotine itself, not only by cigarette smoke, so switching your delivery method does not remove the problem.
Vaping and e-cigarettes deliver nicotine directly, which means they cause the same blood vessel constriction as cigarettes. Same nicotine, same effect. They are not a safe substitute before surgery. Nicotine replacement products, such as patches and gum, sit in the same category. They are excellent tools for quitting in everyday life, but because they still contain nicotine, they still narrow your vessels. For the weeks immediately around surgery, I ask patients to be completely nicotine-free, by whatever route. If you are using replacement therapy to help you stop, we simply plan the timing so you are fully clear well before your operation.
How long you need to stop: the timeline
The single most common question I am asked is how long beforehand you need to quit. My answer is at least six to eight weeks before surgery, and at least six to eight weeks after. Both windows matter.
The weeks beforehand give your circulation and oxygen-carrying capacity time to recover, so your tissues arrive at surgery in a position to heal. The weeks afterwards protect the wound through the period when it is most fragile and most dependent on good blood flow. Stopping the night before, or even a few days before, does not undo the damage, because nicotine’s effects on your vessels and the lasting changes from long-term smoking do not reverse overnight. The earlier you stop, the better your position. If you are reading this and thinking about surgery down the track, the best time to quit is now. Today, ideally.
Why some procedures carry more risk
Smoking raises risk across the board. But some operations depend far more heavily on a reliable blood supply to delicate tissue than others, and these are the ones where smoking does the most damage.
Breast procedures, particularly lifts and reductions, rely on preserving the blood supply to the nipple and the repositioned tissue. Smoking puts that at real risk. Facial surgery, including facelift procedures, depends on thin skin flaps surviving on their blood supply, which nicotine directly undermines. Body contouring, such as abdominoplasty, involves long incisions and large areas of tissue that must heal together, so compromised circulation shows up quickly as wound problems. For all of these, I will not proceed on a current smoker. The consequences are simply too significant. Not worth the risk.
How we confirm you have stopped
Because the safety case is so clear, surgeons need to know your smoking status is accurate, not optimistic.
We rely first on an honest conversation, and I would always encourage you to be straight with me. No judgement. Because I am on your side here, and operating safely depends on knowing what is actually happening with your body. In some cases, particularly before higher-risk procedures where a compromised blood supply could be catastrophic, a simple cotinine test can be used to confirm your non-smoking status before we commit to a date. Cotinine is a marker the body produces from nicotine. We are on the same side here. The point of testing is never to catch you out. It is to make sure we are not operating on tissue that cannot heal, which protects you from a complication you would have to live with.
Practical help to quit before your surgery
Knowing why to quit and actually quitting are two different things. If smoking were easy to stop, far fewer people would do it. So be strategic. A few approaches genuinely help.
Set a firm quit date with your surgery in mind, and work backwards so you are well clear of the six-to-eight-week mark. Identify the moments that trigger you, the coffee, the drive, the break at work, and plan something to do instead. Talk to your GP about medications and structured support, because for most people a combination of practical tools and clinical backup works far more reliably than willpower alone ever does. Lean on the people around you, and tell them you have stopped so they can help you hold the line. And use the national Quitline on 13 7848, a free and confidential service staffed by people who do this every day. Quitting for surgery is also one of the most common reasons people finally stop for good.
What stopping does for you
The first reward is the one this whole guide is about. Safer healing. Your wound has the oxygen and blood flow it needs, your infection risk falls, and your scars have the best chance of settling well.
The second reward outlasts the surgery entirely. Within weeks of stopping, your circulation and lung function begin to recover, and over the following months and years your risk of heart and lung disease falls substantially. Many patients tell me that being made to stop for an operation became the moment they finally quit for good. The push they needed. If that is the one good thing that comes out of planning your surgery, it may be the most valuable.
Taking the next step
If you smoke and you are considering surgery, the most useful thing you can do is start the process of stopping now, well ahead of any date. Sooner is better. At our Sydney clinics in Bondi Junction and Manly, we will talk you through a realistic timeline and the support available to help you get there. You are welcome to contact us to arrange a consultation.
Frequently asked questions
How long before surgery do I need to stop smoking?
I ask patients to stop all nicotine for at least six to eight weeks before surgery, and to stay nicotine-free for at least six to eight weeks afterwards. The weeks beforehand let your circulation and oxygen levels recover so your tissues are ready to heal, and the weeks afterwards protect the wound while it is most vulnerable. Stopping the night before is not enough, because the effects of nicotine on your blood vessels persist far longer than a single day.
Can I smoke before surgery?
No. Smoking in the weeks before surgery meaningfully raises your risk of wound breakdown, infection, tissue death and complications under anaesthetic. Even occasional or social smoking counts, and so does vaping. If you smoke close to your operation, your surgeon may postpone it for your own safety. The aim is not to judge you, it is to make sure your body can heal.
What happens if I don’t quit smoking before surgery?
If we know you are still smoking, your surgery is likely to be delayed until you have stopped, because operating on compromised tissue is not safe. If you smoke without telling us and it is later detected, the same applies. Patients who continue to smoke face higher rates of healing problems, more visible scars, and in some cases tissue loss that needs further surgery to correct. Being honest about your smoking protects you.
Does vaping or using nicotine patches count?
Yes. The problem is nicotine itself, not just cigarette smoke. Nicotine narrows your blood vessels and reduces oxygen to your healing tissues whether it comes from a cigarette, a vape, a patch or gum. For that reason I ask patients to be completely nicotine-free before and after surgery. If you are using nicotine replacement to help you quit, talk to me and your GP about timing it so you are fully clear well before your operation.
Is it dangerous to have surgery if I smoke?
Smoking raises the risks of any operation. It increases the chance of breathing and lung complications under general anaesthetic, places extra strain on your heart, and slows the healing your recovery depends on. Serious outcomes remain uncommon in otherwise healthy patients, but the added risk is real and avoidable, which is exactly why surgeons take smoking so seriously. Stopping well before surgery brings your risk much closer to that of a non-smoker.
About Your Surgeon
Dr Scott J Turner is an AHPRA-registered Specialist Plastic Surgeon (FRACS) consulting in Sydney (Manly and Bondi Junction), Brisbane and Canberra. His practice focuses on facial aesthetic surgery, rhinoplasty and cosmetic breast surgery, performed at accredited private hospitals in Sydney. Dr Turner emphasises individual patient assessment, surgical planning and clear information on risks, recovery and costs, holds Fellowship of the Royal Australasian College of Surgeons.
