Smoking significantly increases the risks of cosmetic surgery. Nicotine narrows blood vessels and carbon monoxide reduces oxygen delivery, which slows wound healing and raises the chance of infection, wound breakdown, poor scarring, tissue loss and blood clots. Vaping and nicotine replacement also contain nicotine. Most surgeons ask patients to stop all nicotine for at least six weeks before and after surgery, and some procedures will not be performed on current smokers.
How smoking affects the body during surgery
- Nicotine: constricts small blood vessels, reducing blood flow to the skin and healing tissues.
- Carbon monoxide: binds to red blood cells in place of oxygen, so the tissues receive less oxygen.
- Clotting: smoking makes the blood more likely to clot, increasing the risk of deep vein thrombosis.
- Lungs: smokers are more prone to chest infections and breathing complications after anaesthesia.
- Immune response: the body’s ability to fight infection is reduced.
Complications linked to smoking
The effects are most noticeable where skin is lifted or its blood supply is reduced. Wounds may heal slowly or reopen, scars may be wider or thicker, and infection is more likely. In more serious cases, areas of skin or fat can lose their blood supply and die (necrosis), which may require dressings for weeks or further surgery. In breast surgery, the nipple and areola can be affected. Smoking may also increase the risk of implant complications such as infection and exposure.
Procedures most affected
- Tummy tuck and body lifts: large skin flaps are raised, so the blood supply to the lower abdomen is vulnerable; see tummy tuck.
- Breast lift and reduction: the nipple relies on a narrow blood supply once repositioned; see breast lift.
- Facelift: the skin of the face and neck is lifted over a wide area; see facelift.
- Arm and thigh lifts: long incisions under tension are prone to healing problems; see arm lift.
- Breast augmentation: the implant must be well covered by healthy tissue to reduce infection risk.
For some of these procedures, Mr Nassab may decline to operate until nicotine has been stopped.
Vaping, patches and cannabis
Many people switch to e-cigarettes or nicotine patches and gum before surgery, believing they are safe. While they avoid some of the harmful chemicals and carbon monoxide in tobacco smoke, they still deliver nicotine, which narrows blood vessels. For the safest healing, all nicotine should be stopped in the weeks around surgery. Cannabis smoking also affects the lungs and anaesthesia and should be avoided. Be honest at consultation; your surgical team can only protect you if they know.
How long to stop
Mr Nassab typically advises stopping all nicotine products at least six weeks before surgery and not restarting until wounds have fully healed, usually at least six weeks afterwards. Stopping for longer is even better, and stopping completely brings lifelong health benefits. Some patients may be asked for a simple test to confirm they are nicotine free. If you cannot stop, surgery may need to be postponed or a less extensive procedure considered.
Help to stop smoking
Stopping is easier with support. The NHS offers free local stop-smoking services, and your GP or pharmacist can advise on options. Setting a quit date well in advance of surgery, identifying triggers and telling friends and family about your plan all help. Many patients find that the motivation of an upcoming operation is the push they need to stop for good. Our guide on how to prepare for cosmetic surgery covers other practical steps.
Warning signs after surgery
Whether or not you have smoked, contact the surgical team the same day if a wound darkens, becomes increasingly red, opens or discharges, or if you develop a fever. Sudden calf pain or one-sided leg swelling needs a same-day GP appointment or NHS 111, and chest pain or breathlessness needs a 999 call. Cosmetic surgery is only for adults aged 18 and over. The £150 consultation is charged separately from any surgical fee.
Frequently Asked Questions
Can a smoker have breast augmentation?
Surgery may be possible after stopping nicotine for an appropriate period. Continuing to smoke increases the risk of complications.
Is vaping allowed before surgery?
Vapes usually contain nicotine, which affects blood flow and healing, so they should be stopped along with cigarettes.
Are nicotine patches safe before surgery?
Patches still deliver nicotine. Mr Nassab generally advises stopping all nicotine products in the weeks around surgery.
What happens if someone smokes after surgery?
Smoking during recovery increases the risk of wound breakdown, infection and poor scarring. Contact the team if a wound changes.
Does occasional smoking matter?
Even occasional smoking exposes the tissues to nicotine and carbon monoxide, so it is best to stop completely.
Related Guides
- Breast Asymmetry Correction Recovery
- Breast Asymmetry Correction: Risks and Safety
- Breast Asymmetry Correction: Questions to Ask
- Is Breast Augmentation Painful?
- The Inframammary Fold Explained
- Breast Augmentation Risks and Safety
- Who Is a Good Candidate for Breast Augmentation?
- Breast Augmentation: Questions to Ask Your Surgeon
