When a patient who smokes decides to schedule certain surgical procedures such as a face-lift or abdominoplasty (tummy tuck) with my practice, I have historically insisted that they quit smoking for at least two weeks, but preferably, one month prior to the procedure. As we all know, smoking poses an enormous number of health risks, but it also creates numerous additional problems peri-operatively.  Cigarette smoke decreases blood flow to tissues by constricting blood vessels.  Less blood flow leads to less oxygenation which can lead ultimately to complications such as skin necrosis.   Obviously, for a medically necessary, emergency surgery, it is not always possible to insist upon a 4-week pre-operative smoking cessation period.  An elective, cosmetic procedure can be scheduled, however, after an appropriate amount of smoke-free time, thereby obviating any added and unnecessary risks. 

Recent research (Manchio, JV, et. al. Duration of Smoking Cessation and Its Impact on Skin Flap Survival [Plastic and Reconstructive Surgery 2009 (124): 1105-1117]) has actually shown that the impact of cigarette smoke on  surgically impacted tissue lasts much longer than initially thought.  Researchers exposed rats to cigarette smoke, then removed them from smoke exposure for 0 days, 2 weeks, 4 weeks and 8 weeks to emulate the duration of a patient's smoking cessation.  After the rats' appropriate smoke-free period, the researchers then performed a procedure not unlike that performed during a face lift or abdominoplasty. They surgically created skin flaps to study residual effects of cigarette smoke of the flap survival. The researchers found that all the smoke-exposed rats experienced statistically significantly greater amounts of tissue necrosis than rats not exposed to smoke.  The increase persisted up to 8-weeks after smoke exposure.  

Based on these findings and my own professional experience, I am increasing my recommendation of a pre-operative smoking cessation duration to two months.