Are Smokers Eligible For A Facelift?
19 March 2020 onur
Yes, they are.
However, some risks are increased.
However, the limitations of the surgery increase.
Smoking causes vasoconstriction of micro-vessels in tissues and a slowdown in blood flow in capillaries. Already slowed down since the lung capacity is reduced, the oxygen level in the blood is low while the carbon monoxide level is high. As a result, the blood flow that animates tissues just slows down.
Under normal conditions, this slowdown in blood flow may not affect the person’s life significantly.
However, things are different in facelift. The facial skin is lifted after being mobilized from the floor and surrounding tissues. When the tissue is dissected and lifted like a leaf, its blood supply also drops to a critical level. We know how much tissue dissection will result in how much blood supply decrease in facelift, and we design the surgery accordingly.
Since the tissue blood supply is reduced in smokers, it gets dangerous to dissect tissues too much during surgery. The blood supply of the dissected tissues may be impaired, resulting in tissue death and tissue loss. The quality of scars is reduced in patients who smoke. The scars tend to be wider, more bulging and darker in color and heal later. In surgical techniques extending into the scalp, blood supply of hair follicles may be impaired. Temporary or permanent hair loss may be observed.
Tissue dissection is essential in all types of facelift. Regardless of the patient’s smoking behavior, there is a risk of tissue loss in all facelift techniques. However, smoking increases this risk by 20 times.
In facelift, we choose a technique according to the patient’s face shape, form of aging and surgical goals. Surgery is individualized.
Smoking reduces your options for facelift.
Smoking patients cannot be operated using surgical techniques in which the facial skin is dissected from the underlying tissues. That is too risky. For instance, a smoking patient is not eligible for options such as subcutaneous facelift, extended subcutaneous facelift, lamellar facelift and subcutaneous neck lift.
Deep plane facelift is a more reasonable option for smokers. As of today, I have experience with this surgical procedure in over 90 smoking patients. In only 3 patients, we experienced tissue loss behind the ear. The largest of the tissue losses was 3 millimeters wide. Healing was complete within 3-4 weeks after tissue loss. A wider and paler scar than normal which could be hidden by hair remained in the behind-the-ear area suffering from tissue loss. I have never had a case of tissue loss in front of the ear. Although the literature offers no clear data on this, other surgeons dealing with deep plane facelift also talk about similar rates.
Some smokers have to settle for a “sub-ideal” result due to limitations in technique selection. The vast majority of smokers present superficial signs of aging. In this group, the ideal treatment option is usually the lamellar facelift and the lamellar neck lift techniques. However, smokers cannot be operated with these techniques due to tissue circulation risks. If they want to have surgery, deep plane facial and deep plane neck surgeries may be performed. However, these procedures do not treat superficial signs of aging as effectively as lamellar techniques. Additional surface treatments such as dermabrasion, chemical peeling, laser and nanofat may be required for the remaining superficial signs of aging after deep plane facelift.
In summary, you don’t have the option of both smoking and having the best facelift procedure available.
My patients who smoke and want to have a facelift must do the following:
1: Understand and accept the increased risk of tissue loss,
2: Consent to a lower surgical effect on the face and neck due to limitations in the choice of surgical technique,
3: Understand that additional treatments for superficial aging may be required after the surgery and these treatments will be charged additionally,
4: Accept that the curved scar behind the ear may be at a lower level and more visible,
5: Know that the scar quality may be lower.
In this post, I’m not even talking about the harms and risks of smoking in terms of your overall health. You already know them very well.
Various studies in the medical literature indicate that complications related to wound healing are dramatically reduced in individuals who completely quit smoking 4-8 weeks before surgery. An individual who has smoked for years quits smoking for a month and reduces the risks related to wound healing to a reasonable level, but this does not still make it possible for me to apply lamellar techniques or large subcutaneous dissections. Patient safety is always our first priority in plastic surgery.
I recommend that my smoking patients do the following before facelift:
- Quit smoking at least 1 month before the surgery,
- Completely quit smoking cigarettes, other tobacco products and electronic cigarettes and chewing nicotine gum,
- Do not restart until 2 weeks after the surgery.
Who knows, maybe you will not take up smoking again.
Come on, quit smoking.
After your face gets beautiful, your teeth should not continue to turn yellow, and your hands and clothes should not continue to smell.
Take good care…
of your health…
… of yourself and your beauty.