If you smoke, even if you smoke just a little, and you have a facelift or another large skin flap performed, your skin may die and develop a terrible scar. This is because smoking interferes in several ways with the skin's blood supply. A facelift is a form of large flap, i.e., skin that is moved after being surgically separated from some, but not all, of the surrounding tissue. This surgical separation also means separation from much of the neighboring tissue's blood supply. Therefore, by definition, a flap is sensitive tissue since its blood supply is subject to compromise and possible insufficiency. If patients interfere with an already-poor blood supply by smoking, then they run the risk of the flap's suffocating and dying, resulting in a large unsightly scar. Other forms of flaps are browlifts, necklifts and some reconstructions following skin-cancer removal.

Grafts are even more sensitive than flaps to the effects of smoking. A graft is skin that is completely removed from one part of the body and placed on another area of the body. Therefore, a skin graft has lost its entire blood supply. A graft is very fragile and delicate. The graft must generate new blood-vessel buds in the first four days following placement. If the graft fails to send out these buds or if the graft is damaged by even the slightest trauma or by SMOKING, it may be attacked by bacteria and die. Graft death will usually result in a visible scar.

SMOKING POSES A SERIOUS THREAT to many types cosmetic and reconstructive surgery. Therefore, for the best chance of a good result, please DO NOT SMOKE. "Cheating" when your doctor tells you not to smoke, by smoking only one or two cigarettes per day, can still harm your result. Many prudent surgeons often draw patient's blood for nicotine measurements just prior to facelifts or other significant procedures. Some may have seen firsthand, severe scarring following facelifts in some of their own smoking patients, other doctors have seen it in fellow doctors' patients, and others have seen the widely distributed medical literature discussing such an important problem.

At present, it is difficult to tell whether passive smoking (being around other smokers) can cause the problems similar to those related to active smoking. Until studies are available, it may be reasonable to assume that being around heavy smokers would carry risks. Nicotine-containing gums may pose similar problems to cigarettes, as it is the nicotine in the cigarettes that constricts the blood vessels so gums may not be a quick fix to a surgical or post surgical problem..

Therefore, the author requests that patients DO NOT SMOKE FOR SEVERAL WEEKS BEFORE A FACELIFT. If reducing your smoking by half is all you can do for skin-cancer flap repair, then your doctor may accept this alternative based upon the amount of surgery and type of surgery being done. Please advise your doctor honestly if you were not able to avoid cigarettes and related items for the proscribed times so he/she can reschedule the surgery or make some necessary changes to avoid serious problems.