In a review that pooled studies of cosmetic surgery, smokers had higher odds of surgical site infection and delayed wound healing than non-smokers[1]. A separate meta-analysis of smoking in elective plastic surgery covered facelift, abdominoplasty, breast reduction and breast reconstruction, not liposuction[2]. An evidence-based guide to smoking and plastic surgery reported that level one evidence supports the benefits of quitting, with an optimal cessation period of four weeks or longer before surgery[3].
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Liposuction was not among the procedures covered by a meta-analysis of smoking in elective plastic surgery, which searched for studies on facelift, abdominoplasty, breast reduction and breast reconstruction[2].
One database study included adults having common facial, breast or abdominal contouring procedures as outpatients[4]. Another report reviewed body-contouring surgery in former obese patients after major weight loss[5].
Ask your surgeon how these findings apply to the specific procedure you are planning, especially if liposuction will be combined with a tummy tuck. You can read more about that pairing in Liposuction and Tummy Tuck Surgery: An Ideal Pairing.
Smoking interferes with several steps of wound healing, according to a systematic review of pathophysiological studies[6]. That review found that smoking temporarily lowers tissue oxygenation and aerobic metabolism[6]. Smoking also weakens the inflammatory healing response, including the ability of immune cells to move to a wound and kill bacteria[6].
The same review reported that smoking reduces the migration and proliferation of fibroblasts and lowers collagen synthesis and deposition[6]. A separate review of smoking and plastic surgery described hypoxia (low oxygen), tissue ischemia and immune disorders caused by tobacco as drivers of altered healing[7].
Cigarette smoke contains over two hundred and fifty known toxins, including nicotine, carbon monoxide, hydrogen cyanide and nitric oxide, which are known to impair wound healing[3]. The link between smoking and delayed wound healing after surgery has been shown across a wide range of surgical disciplines, including many common plastic surgery procedures[3].
In pooled data from cosmetic surgery studies, smokers had more than twice the odds of infection and delayed healing[1]. That systematic review of sixty observational studies calculated a combined odds ratio of 2.3 for surgical site infections and 2.5 for delayed wound healing in its cosmetic surgery group[1].
In the same review, patients having surgery for the after-effects of bariatric (weight-loss) surgery who smoked had a combined odds ratio of 3.3 for delayed wound healing and 3.1 for cutaneous necrosis, meaning death of skin tissue[1]. The authors concluded that smokers run a significantly higher risk of skin necrosis, particularly in operations with major skin detachment such as facelift, skin-sparing mastectomy and abdominoplasty[1].
For abdominoplasty (tummy tuck), tobacco use significantly increased total postoperative complications, with an odds ratio of 5.43[2]. The same meta-analysis found significant increases for breast reduction, with an odds ratio of 2.36, and breast reconstruction, with an odds ratio of 1.91[2].
Smoking history did not significantly affect total complications after facelift in that analysis, with an odds ratio of 3.36 and a confidence interval that crossed one[2]. The authors still concluded that smoking predisposes patients to surgical site infections, delayed wound healing and skin necrosis in the most common aesthetic plastic surgery procedures[2].
In a study of patients having outpatient facial, breast or abdominal contouring procedures, those with a smoking history needed more hospital-based care afterwards[4]. Among 214,761 patients from four US states, 7.1% of those with a smoking history versus 3.4% of those without had a hospital admission or emergency department visit within thirty days[4].
Serious adverse events within thirty days occurred in 2.2% of patients with a smoking history versus 0.9% of patients without one in that outpatient study[4]. On average, these events added $1826 in healthcare charges per patient with a smoking history[4].
In a prospective study of 415 patients in one plastic surgeon's practice, smokers had significantly higher overall complication rates, with an odds ratio of 3.7[8]. Smokers in that study also had higher rates of tissue necrosis, with an odds ratio of 4.3, and were more likely to need another operation, with an odds ratio of 3.7[8].
In a report on body-contouring surgery in seventy-eight former obese patients, the authors noted a close relationship between adverse events and cigarette smoking[5].
Yes, there is general agreement that stopping smoking reduces the surgical risks linked to smoking, according to a review focused on plastic surgery[9]. A review of surgical site infection prevention listed smoking cessation before elective surgery among the strategies with strong evidence for reducing infection[10].
In a meta-analysis of randomised trials in major elective surgery, smoking cessation interventions reduced wound infections, with a risk ratio of 0.28[11]. That meta-analysis was limited to adults having major elective surgery, curative or palliative[11].
In one outpatient surgery center study of plastic surgery patients, people who stopped smoking and tested negative for nicotine on the day of surgery had a complication risk equivalent to people who had never smoked[12]. That finding came from urine testing for cotinine, a breakdown product of nicotine, in 470 patients[12].
Two reviews of smoking and plastic surgery point to stopping about four weeks or more before surgery[3][7]. One evidence-based guide reported that level one evidence suggests the optimal period of cessation before surgery is four weeks or longer[3].
A literature review on smoking and plastic surgery reported that published recommendations range from three to eight weeks of cessation before surgery and up to four weeks afterwards[7]. Those authors proposed total smoking cessation for four weeks before surgery, continuing until the wound has healed, which they put at about two weeks[7].
A systematic review of wound-healing studies found that quitting restores tissue oxygenation rapidly and partly reverses the inflammatory cell response within four weeks[6]. The same review found that the proliferative healing response remained impaired after cessation[6].
A meta-analysis of fifty-five studies across many types of surgery found that progressively longer cessation periods were linked with better outcomes[13]. Compared with active smokers, cessation for at least four weeks was linked with a 33% lower risk of wound complications in that analysis[13].
Short-term cessation did not seem to have a significant impact on surgical site infections in the same meta-analysis[13]. The authors still concluded that cessation of at least two to four weeks showed benefits for reducing postoperative complications[13].
Your surgeon can tell you what stop date fits the procedure you are planning. For more on preparing, see Am I A Liposuction Candidate? for more on preparing.
One study found that nicotine replacement carried similar risks to continued smoking in plastic surgery patients around the time of surgery[12]. In that outpatient surgery center study, patients who said they had quit but tested positive for nicotine had significantly more complications than patients who had quit and tested negative[12]. The authors concluded that nicotine replacement is not as safe as abstinence in the perioperative period[12].
A systematic review of pathophysiological studies found that nicotine did not affect the tissue microenvironment, and that nicotine and nicotine replacement seemed to dampen inflammation and enhance proliferation, with effects that appeared marginal[6]. A review of nicotine replacement in plastic surgery said that much debate remains about these products and that randomised trials are still needed[9].
Nicotine replacement can still help people quit: one review reported that it doubles short-term abstinence rates[7]. Another guide described nicotine replacement therapy and smoking cessation medications as effective aids for quitting[3]. The rise of electronic cigarettes has been described as an added challenge for minimizing surgical risk[9].
If you use patches, gum or vapes, ask your surgeon whether they should be stopped before surgery as well.
Self-reported smoking status was not always accurate in a study that tested plastic surgery patients' urine for nicotine on the day of surgery[8]. In one plastic surgery practice, fifteen patients who denied current tobacco use had urine results showing active smoking[8]. Patients who said they had quit were more likely to have given inaccurate answers than those who said they had never smoked[8].
The authors of that study concluded that a methodical approach to detecting and managing tobacco use can help optimize outcomes[8]. Tell your surgeon about any smoking, vaping or nicotine use.
If you develop a fever, a wound that opens, skin that turns dark, or increasing redness and pain after surgery, contact your surgeon right away. If you have chest pain or shortness of breath, call emergency services immediately. For what is typical during recovery, see Swelling and seroma after liposuction: what's normal and how long does it last?.
Bring your full smoking and nicotine history to your consultation with a board-certified surgeon, and consider asking these questions:
For more ideas, see Questions to Ask Before and After Liposuction.
In pooled cosmetic surgery studies, smokers had a combined odds ratio of 2.3 for surgical site infection compared with non-smokers[1]. That figure applies to the review's combined cosmetic surgery group[1].
An evidence-based guide to smoking and plastic surgery puts the optimal cessation period at four weeks or longer before surgery[3]. One review proposed staying smoke-free from four weeks before surgery until the wound has healed[7]. Your surgeon can set a stop date for your procedure.
In one study of plastic surgery patients, nicotine replacement carried similar risks to continued smoking and was not as safe as abstinence around the time of surgery[12]. Other reviewers note that the debate is not settled and that randomised trials are needed[9].
In one outpatient plastic surgery study, patients who stopped smoking and tested negative for nicotine had a complication risk equivalent to those who had never smoked[12]. A broader surgical meta-analysis found that pulmonary complications were still more common in former smokers than non-smokers[13].