Smoking and Alcohol Use after Aesthetic Surgery

After aesthetic surgery, the use of cigarettes and alcohol is strictly prohibited for the duration determined by your doctor, as it directly endangers the success of the operation and patient safety. These substances interfere with the body’s delicate healing process by disrupting blood flow and hindering tissue repair. Nicotine in particular constricts blood vessels, increasing the risk of serious complications that can lead to tissue death (necrosis). Alcohol, on the other hand, raises the likelihood of bleeding, excessive edema, and infection. To safely achieve the desired aesthetic outcome and navigate the recovery period smoothly, it is essential to completely avoid these substances.

Why is smoking such a major risk in aesthetic surgery?

The key factor determining the outcome of an aesthetic surgery is trouble-free wound healing. Regardless of how it is taken (traditional cigarettes, e-cigarettes, cigars, hookah), nicotine is the biggest and most dangerous obstacle to this process. The harms of nicotine are not theoretical; they are proven medical facts that directly attack the biological necessities of tissue repair. We can think of the damage caused by smoking as a three-pronged assault: it constricts vessels and prevents blood supply to tissues, causes a general oxygen shortage in the body, and directly impairs the function of the cells responsible for healing. When these three assaults combine, they create an extremely unfavorable—almost hostile—environment for wound healing and fundamentally undermine the success of the surgery.

How does nicotine disrupt the body’s blood flow?

Nicotine is a substance that instantly and strongly constricts blood vessels throughout the body. Think of it like stepping on a garden hose you use to water your plants. When the hose is compressed, the amount of water reaching your flowers drops dramatically. Nicotine does this to the body’s smallest vessels. This is of vital importance especially in aesthetic surgeries where large areas of tissue are lifted and reshaped, such as facelifts, abdominoplasty, and breast lifts. In these procedures, countless small vessels that supply the skin must already be cut. The survival of the tissue then becomes completely dependent on the blood coming from the few remaining weak vessels.

Nicotine targets precisely these critical vessels, effectively cutting off the tissue’s sole source of nutrients and oxygen. For the tissue, this is a “double hit”: the surgically weakened blood flow is further reduced by chemically triggered vessel spasm. When blood flow falls below a critical level, tissues cannot be nourished, and the result is necrosis, or tissue death. This can lead to irreversible, disastrous aesthetic outcomes—such as partial death of the cheek skin, loss of the nipple, or darkening of the abdominal skin—and may require far more challenging additional surgeries to repair.

How does cigarette smoke deprive the body of oxygen?

The damage caused by reduced blood flow due to vessel constriction is compounded by a reduction in the blood’s oxygen-carrying capacity. Cigarette smoke contains not only nicotine but also thousands of toxic chemicals such as carbon monoxide. Carbon monoxide binds to hemoglobin, the molecule that carries oxygen in our blood, with a strength 200 times greater than oxygen. Once it enters the body, it takes oxygen’s place and displaces it from the blood. This permanently reduces the ability of the blood to deliver oxygen to the tissues.

As a result, the tissues face a two-front attack: not only does less blood reach the surgical area, but the amount of oxygen in that blood is also much lower than normal. This profound oxygen shortage is one of the leading causes of delayed wound healing, infection, and tissue death.

How does smoking sabotage wound healing at the cellular level?

In addition to their effects on the vessels, nicotine and other tobacco toxins directly damage the cells that are the building blocks of wound healing. Healthy wound healing is like a construction project in which cells work in harmony. Nicotine prevents the key workers of this project from doing their jobs. Some of these workers include:

• Fibroblasts: These are the cells that produce collagen, the protein that gives the wound its strength and elasticity. Nicotine hinders these cells from reaching the wound area and producing quality collagen.
• Macrophages: These are the cleanup crew that remove dead tissue and microbes from the wound site. Nicotine also reduces their performance.

Consequently, due to poor-quality and insufficient collagen production, wounds close more slowly, are weaker, and leave wide, red, raised scars that are aesthetically displeasing. In fact, stitches may sometimes spontaneously open (wound dehiscence).

What do scientific data say about smoking and complication risk?

All of the above is supported by large scientific studies involving tens of thousands of patients. The numbers clearly show how much smoking increases risks. Compared to non-smokers, some observed risk increases in smokers are as follows:

• 37% higher likelihood of experiencing any surgical complication.
• 24% higher likelihood of serious medical complications such as pneumonia or blood clots.
• 49% higher likelihood of a wound healing problem.
• 84% higher risk of wound dehiscence (the risk nearly doubles).
• 40% higher likelihood of developing a surgical site infection.

These figures show that smoking is not a minor hiccup but a major threat that endangers every phase of surgery.

In which aesthetic surgeries is the smoking risk the highest?

While smoking is risky for all surgeries, the magnitude of danger increases exponentially in certain procedures. The risk peaks particularly in surgeries where large areas of skin are elevated and blood supply becomes limited.

• Facelift: This is one of the riskiest operations for smokers. Scientific data show that smokers are 12.5 times more likely than non-smokers to experience skin necrosis (tissue death) after a facelift. This is a catastrophic complication that can completely ruin the aesthetic result and leave permanent scars. For this reason, many surgeons refuse to perform facelifts in active smokers.
• Abdominoplasty: Because a large area of abdominal skin is elevated in this procedure, its blood supply becomes fragile. In smokers, tissue death on the abdominal skin or around the navel can reach alarming rates of up to 27.5%. Overall, smoking increases the total complication risk in abdominoplasty more than fivefold.
• Breast Surgeries (Reduction, Lift, Reconstruction): In these operations, the viability of the nipple depends on the delicate vessels that supply it. In smokers, the risks of partial or total nipple loss, wound dehiscence at suture junctions (especially at the T junction), and infection are significantly increased. In implant-based breast augmentation or reconstruction, implant loss rates of up to 33% have been reported in smokers.

Are e-cigarettes (vapes) or nicotine patches a safe alternative before surgery?

This is one of the most common and most dangerous misconceptions among patients. The primary problem is not the other toxins in tobacco smoke but nicotine itself. Nicotine is the main culprit responsible for the vessel constriction that leads to tissue death. Therefore, it does not matter how you introduce nicotine into your body.

• E-cigarettes (vapes)
• Nicotine patches
• Nicotine gum
• Cigars or hookah

All of the above deliver nicotine into your bloodstream and all carry the same fundamental risk as traditional cigarettes—namely, the vessel constriction that can lead to tissue death. Switching to e-cigarettes after quitting smoking before surgery does not reduce the risk. The only safe path is complete avoidance of all forms of nicotine.

However, there may be an exception regarding nicotine replacement therapies (patches, gum). The ideal situation is to be entirely nicotine-free. But for a highly dependent patient who finds quitting extremely difficult and who would otherwise relapse into smoking, taking only controlled nicotine is considered a less harmful option than absorbing the thousands of toxins found in cigarettes. This is a “harm reduction” strategy and should be considered only under medical supervision when no other option remains. Remember, this does not mean it is “safe,” only that it is “less bad.”

While the risks of nicotine focus primarily on tissue perfusion, alcohol consumption leads to a completely different yet equally dangerous set of problems. Alcohol’s effects are systemic and directly sabotage the goals of an aesthetic surgery (a safe operation, smooth recovery, excellent result).

How does alcohol consumption affect aesthetic surgery outcomes?

Alcohol endangers surgical outcomes in many different ways. When combined, these effects can significantly disrupt the recovery process. The main problems caused by alcohol are:

• It impairs blood clotting and increases the risk of bleeding.
• It dilates blood vessels, causing excessive swelling and bruising.
• It dehydrates the body, reducing skin quality and healing capacity.
• It weakens the immune system, increasing the risk of infection.

Does alcohol increase the risk of bleeding during and after surgery?

Yes, alcohol is a known “blood thinner.” By disrupting the blood’s clotting mechanisms, it significantly increases the risk of bleeding both during and after surgery. Postoperatively, this can lead to a collection of blood under the skin known as a hematoma. A hematoma is not a simple bruise; it stretches the skin, causes pain, and—worst of all—by disrupting perfusion with the pressure of accumulated blood, can lead to tissue death (necrosis) just like smoking does. Draining a large hematoma often requires returning to the operating room, which both prolongs recovery and negatively affects the aesthetic result.

What does alcohol have to do with postoperative swelling and bruising?

In contrast to nicotine, alcohol dilates blood vessels (vasodilation). This effect causes postoperative swelling (edema) and bruising to be much more severe. Excessive swelling not only causes discomfort but can also place pressure on suture lines, impairing wound healing and delaying the final result by months. In addition, alcohol acts as a diuretic, dehydrating the body. A dehydrated body cannot efficiently deliver the nutrients necessary for healing to the tissues, and skin quality declines.

Why does alcohol consumption increase the risk of infection?

It is a proven fact that regular alcohol consumption weakens the immune system. The immune system is the body’s defense army against microbes. Alcohol reduces the strength of these soldiers (immune cells). A surgical incision is a breach in the body’s defensive line. In a patient with a weakened immune system, the risk of microbes penetrating through this breach and causing infection increases manyfold. An infection at the surgical site can lead to wound dehiscence, prolonged antibiotic treatments, additional surgeries, and unsightly scars that permanently ruin the aesthetic result.

Why is alcohol so dangerous during the anesthesia process?

The interaction of alcohol with anesthetic drugs is one of the most critical safety issues in surgery. A patient’s alcohol consumption habits create an “anesthesia paradox” that makes the anesthesiologist’s job extremely challenging. Being dishonest with your doctor about this poses a life-threatening risk.

Alcohol Consumption Right Before Surgery (Acute Use): The central nervous system of a person who has consumed alcohol shortly before surgery is already depressed. In this situation, a standard dose of an anesthetic drug can have a much stronger-than-expected effect, leading to overdose. This carries serious risks such as respiratory arrest, bradycardia, and very delayed emergence from anesthesia.

Regular Alcohol Consumption (Chronic Use): Conversely, the body of a person who drinks regularly develops a tolerance to anesthetic drugs. In this case, much higher-than-normal doses are required to induce anesthesia. These high doses place additional strain on the heart and other organs, increasing risks.

Therefore, even if only a single drink was consumed in the last 24 hours—or if there is a long-standing habit of alcohol use—it is vital to share this information fully and honestly with the anesthesiologist.

Can alcohol be consumed with medications used after surgery?

Absolutely not. This is one of the most important rules of the postoperative period.

• Painkillers: Opioid (morphine and similar) painkillers prescribed after surgery can be deadly when combined with alcohol. Both are respiratory depressants. Taken together, they can cause complete respiratory arrest. This is a life-threatening risk, not to be taken lightly. You must strictly avoid alcohol for as long as you are taking prescription painkillers.
• Antibiotics: Alcohol can reduce the effectiveness of many antibiotics or cause unpleasant side effects such as nausea, vomiting, and headaches.

What are the correct steps during the surgical process?

Given all these risks, avoiding cigarettes and alcohol is not a “recommendation” but a “requirement” for safe and successful aesthetic surgery.

What information should be shared with the doctor before surgery?

Effective management begins with honest communication. During your initial consultation with your doctor, it is critically important to describe your substance use habits in full detail and with complete honesty.

• Nicotine: It is not enough to answer only “do you smoke?” You must share details such as how long you have smoked, how much you smoke per day, and whether you use other products such as e-cigarettes, hookah, cigars, or nicotine patches.
• Alcohol: You should clearly state what type of alcohol you consume, how often, and in what quantity. This information enables your doctor and anesthesiologist to create the safest plan for you.

Why is a nicotine test (cotinine test) performed?

Unfortunately, the desire to undergo surgery can sometimes lead patients to be less than truthful about nicotine use. Studies show that a significant portion of patients who claim they do not smoke are found to have used nicotine (cotinine) in urine tests performed on the day of surgery. This creates an unacceptable safety gap, especially in high-risk surgeries such as facelifts and abdominoplasty. For this reason, many surgeons prefer to perform a nicotine test on the morning of surgery as a safety measure. This is not a sign of distrust; it is a precaution taken to protect you from a potential disaster. If the test is positive, surgery is definitively postponed for your safety.

How long before surgery should cigarettes and alcohol be stopped?

There are clear, scientifically established timelines to minimize risk:

• Nicotine (All forms): The body needs time to start repairing the damage caused by nicotine:
• Before Surgery: To achieve a meaningful reduction in complication risk, all forms of nicotine should be completely stopped at least 4 weeks prior—ideally 6 to 8 weeks before surgery.
• After Surgery: To protect tissues during the most critical phase of wound healing, nicotine must be strictly avoided for at least 4 to 6 weeks after surgery.
• Alcohol: The goal is to normalize the body’s fluid balance, coagulation mechanisms, and liver functions.
• Before Surgery: For light use, at least 1 week; for regular use, ideally 2 to 4 weeks of complete abstinence from alcohol is recommended prior to surgery.
• After Surgery: To prevent bleeding and swelling, alcohol should not be consumed for at least 2 weeks. This period may be extended by your doctor depending on the extent of the surgery. Alcohol is strictly prohibited for as long as you are taking prescription painkillers.

What should those who have difficulty quitting smoking or alcohol do?

You are not alone in this process. Quitting smoking or alcohol can be difficult, and seeking professional help is not a weakness but a sign of the importance you place on your health. Your doctor can guide you toward medications or counseling services that facilitate smoking cessation. The motivation to undergo surgery can be a powerful opportunity to permanently break free from these harmful habits.

In particular, abruptly stopping alcohol in individuals with heavy consumption can lead to a dangerous condition called “alcohol withdrawal syndrome.” This is a medical emergency that may involve tremors, sweating, hallucinations, and seizures. If you are at risk for this, your aesthetic surgery must be postponed, and you should first undergo alcohol withdrawal treatment under specialist supervision. Your safety comes before everything else.

Dr. Erman Ak

Op. Dr. Erman Ak who is one of the best cosmetic and plastic surgeon in Turkey, completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.