Smoking—including traditional cigarettes, vaping, and all nicotine products—represents the most significant modifiable risk factor affecting plastic surgery outcomes. At Dr Scott J Turner’s clinics in Sydney, Brisbane, and Canberra, complete smoking cessation is required for all surgical patients to help ensure optimal safety and results.
Smokers have significantly higher complication rates compared to non-smokers after plastic surgery, which is why most surgeons will not perform procedures on active smokers. Patients may be declined for surgery if they smoke or refuse to quit for the specified time period. This requirement exists to protect patient safety and help achieve the best possible outcomes.
How Smoking Affects Surgical Outcomes
Nicotine from any source—cigarettes, vapes, patches, or gum—may fundamentally interfere with your body’s ability to heal properly after surgery. Smoking may weaken your immune system, delay the healing process, and lead to various post-surgical complications, including infections, wound breakdown, and tissue death. Understanding these effects can help you make informed decisions about your surgical journey.
Reduced Blood Flow and Oxygen Delivery
Nicotine causes blood vessels to constrict, potentially reducing blood flow by up to 30% within minutes. This constriction may reduce oxygen supply to healing tissues and is particularly concerning for procedures requiring skin flaps, such as facelifts, abdominoplasty, and breast surgeries. Carbon monoxide from smoking may also reduce the oxygen-carrying capacity of blood.
Impaired Wound Healing
Research indicates that smoking may significantly impact wound healing. Studies have documented higher rates of wound separation (dehiscence) and increased risk of chronic non-healing wounds among smokers. The healing process, including epithelialisation and collagen synthesis, may be delayed. This can potentially result in wider, more visible scars due to disorganised tissue repair.
Compromised Immune Function
Smoking may reduce neutrophil function—the cells responsible for fighting infection—by as much as 60%. This can lead to higher rates of surgical site infections, decreased antibody production against common surgical pathogens, and extended vulnerability to complications during recovery.
Disrupted Collagen Production
Smoking depletes vitamin C reserves essential for collagen formation. This may result in weaker scars with reduced tensile strength. Research has shown higher incidences of hypertrophic (raised) scarring in smokers compared to non-smokers.
Common Complications in Smokers
Wound Healing Problems
Smokers may face significantly delayed or incomplete wound healing after surgery. Wound separation occurs at higher rates in this population, and studies indicate an increased risk of requiring reoperation. Chronic non-healing wounds are also more common, potentially creating prolonged recovery periods and necessitating additional medical interventions.
Tissue Necrosis
Tissue necrosis—the death of skin, fat, or surgical flaps—represents one of the most serious complications for smokers. This condition may require debridement or revision surgery to remove dead tissue. The risk is particularly concerning in breast procedures, where tissue death can potentially lead to contour irregularities and compromised aesthetic outcomes.
Infection Risk
Surgical site infections occur more frequently in smokers compared to non-smokers. These infections typically require extended courses of antibiotic treatment and may necessitate additional surgical procedures. Beyond the immediate health risks, infections may significantly delay overall recovery and can compromise surgical results.
Poor Scarring
Smokers demonstrate higher rates of hypertrophic (raised) scars compared to non-smokers. Their scars tend to be wider and more visible, often exhibiting irregular texture and pigmentation concerns. Scar revision procedures may be required to address these issues.
Cardiovascular Complications
Smoking creates substantial cardiovascular risks during the surgical period. Patients may face higher risk of deep vein thrombosis and increased likelihood of pulmonary embolism. Studies show smokers have elevated odds of experiencing heart-related complications during or after surgery, making cardiovascular events a serious concern for this patient population.
All Forms of Nicotine Must Be Avoided
A critical misconception is that vaping or switching to e-cigarettes is safer for surgery. Research indicates otherwise—vaping and e-cigarettes contain nicotine and carry similar surgical risks to traditional cigarettes. These must be ceased along with all other nicotine products before any surgical procedure.
Vaping and E-Cigarettes
Vaping products may cause similar surgical risks to traditional cigarettes. Studies have documented higher wound dehiscence rates in vapers, and there are documented cases of extensive skin flap necrosis in vaping patients. The majority of vaping fluids contain nicotine concentrations equal to or exceeding those found in cigarettes.
Nicotine Replacement Products
Even therapeutic nicotine, including patches, gum, and lozenges, may cause continued vasoconstriction affecting tissue perfusion, potentially delayed wound healing, and increased complication risks. These products must be discontinued before surgery.
Critical Timelines for Smoking Cessation
Before Surgery
It is recommended to quit smoking and stop consuming anything containing nicotine for at least six to eight weeks before plastic surgery. While nicotine generally leaves your blood within 1 to 3 days after you stop using tobacco, Dr Turner advises quitting for 6 to 8 weeks to allow your body adequate time to recover its healing capacity.
Research demonstrates specific recovery milestones after quitting smoking:
- 8 hours: Heart rate and blood pressure may begin normalising
- 48 hours: Nicotine and carbon monoxide levels may drop dramatically
- 2 weeks: Lung function may start improving
- 4 weeks: Small airways function may improve
- 6-8 weeks: Blood flow may improve, and surgical risks may substantially diminish
Dr Scott J Turner, Specialist Plastic Surgeon, requires all patients to cease smoking for a minimum of 6-8 weeks before surgery.
After Surgery
Remaining smoke-free for at least 3 months post-surgery is critical for proper healing. Initial wound healing continues for 12 or more months, and resuming smoking may cause complications even months after surgery. Early nicotine exposure can potentially reverse healing progress achieved. The timing for when patients may resume smoking depends on the surgeon’s specific instructions and the individual’s healing progress.
How Smoking Impacts Specific Procedures
Breast Procedures
For patients considering breast augmentation, breast reduction, or breast lift procedures, smoking may significantly increase complication risks. Smokers who undergo breast procedures may be at greater risk of nipple blood supply complications. In severe cases, nipple tissue death (nipple necrosis) may occur, where the nipple changes colour progressively before tissue loss.
Facial Procedures
Most plastic surgeons, including Dr Turner, will not perform facelifts on patients who are active smokers or are using nicotine in any form. Facial procedures involve extensive skin mobilisation and rely heavily on adequate blood supply for healing. Nicotine testing may be performed before surgery begins.
Body Contouring Procedures
Abdominoplasty (tummy tuck) and body lifting procedures carry significant risks for smokers. Smoking before these procedures may increase the risk of poor wound healing, skin necrosis, infections, thick and wide scars, blood clots, increased pain, and permanent small vessel damage.
Verification of Non-Smoking Status
Surgeons can determine smoking status through medical tests that detect nicotine in blood, saliva, urine, and hair. To help ensure patient safety and optimal outcomes, Dr Turner may request urine cotinine testing before surgery, perform nicotine screening on the day of surgery, postpone procedures if nicotine is detected, or require documentation of smoking cessation efforts. Most practices conduct nicotine testing as part of pre-operative assessment.
Tips for Quitting Smoking Before Surgery
Get Inspired to Take Action
Consider what you hope to achieve with your surgery. Visual reminders of your goals can help when you feel the urge to smoke.
Identify and Avoid Your Triggers
If you smoke when you’re with a particular group of friends, consider avoiding those gatherings temporarily. If you smoke in the car, keep gum or alternatives handy instead. Recognising your triggers is the first step to managing them.
Develop Alternative Activities
Spend time nurturing hobbies and other activities that might help take your mind off smoking. This could include hiking, gardening, reading, watching films, or other engaging pursuits.
Seek Smoke-Free Environments
Try to spend your leisure time in smoke-free zones such as shopping centres or cinemas, with friends and loved ones who don’t smoke.
Discuss Medication Options
Talk to your GP about non-nicotine prescription medications such as Bupropion or Varenicline that may help you quit smoking before surgery. Starting this process well in advance is advisable.
Commit to Others
Tell your friends and family that you’re quitting smoking to gain support. A support network can be invaluable when breaking a daily habit.
Learn About the Effects
Understanding the facts about smoking’s effects on surgery can help solidify your commitment. Knowledge empowers informed decision-making about your health.
Get Professional Help
If you’ve tried quitting before without success, professional support can be beneficial. Consider joining a support group, visiting a counsellor, or seeking advice from your doctor.
Long-Term Benefits of Quitting
Research indicates that approximately 40% of cosmetic surgery patients remain smoke-free 5 years post-surgery. Beyond surgical benefits, quitting smoking may contribute to improved overall health, reduced cancer risks, better skin quality, and improved outcomes from any future procedures.
Next Steps
Smoking cessation is not optional for plastic surgery—it is essential for minimising surgical complications, achieving optimal results, ensuring safe anaesthesia, and protecting your surgical investment. The requirement to quit smoking 6-8 weeks before surgery and remain smoke-free for at least 3 months afterwards is based on extensive scientific evidence demonstrating substantially improved outcomes for non-smokers.
If you’re considering plastic surgery and currently smoke, we encourage you to begin your cessation journey well before scheduling your procedure. For more information about preparing for surgery, please get in touch with us to schedule a consultation with Dr Scott J Turner, Specialist Plastic Surgeon.
Disclaimer: All prices listed are estimates as of January 2025 and are subject to change. Final costs are confirmed following consultation and development of your personalised surgical plan. Individual results vary, and all surgical procedures carry inherent risks. A comprehensive discussion of risks, benefits, and expected outcomes will occur during your consultation. A second opinion from a qualified health practitioner is recommended before proceeding with any surgical procedure.
