Short answer
Because smoking reduces the oxygen reaching healing tissue, slows wound healing and raises the risk of infection, lung and heart complications after surgery. In plastic surgery, where skin is lifted and moved, smokers are more likely to have wound breakdown and areas of skin that die. Stopping about 4 weeks or more before surgery is linked to fewer complications, and the longer the gap, the better; how much it matters depends on the type of operation and how much skin is undermined.
Key points
- Nicotine and carbon monoxide reduce oxygen delivery to tissues.
- Smokers have higher rates of wound infection and delayed healing after cosmetic surgery.
- Skin necrosis is especially linked to facelifts, tummy tucks and some breast operations.
- The WHO reports that quitting about 4 weeks or more before surgery lowers complication risk.
- In small trials, intensive support with nicotine replacement more than halved complications.
How smoking affects surgery and healing
The World Health Organisation (WHO) explains that nicotine and carbon monoxide in cigarettes reduce oxygen levels, raising the risk of heart-related complications. Smoking also damages the lungs and restricts airflow, and it impairs immune function and slows wound healing, which increases the risk of wound infection.1 According to the WHO, smoking even one cigarette reduces the body’s ability to deliver the nutrients needed for healing.1
An NHS hospital leaflet adds that smoking can mean extra anaesthetic and oxygen are needed during and after the operation, and lists chest infections, slow wound healing, deep vein thrombosis (blood clots in the leg veins) and poor bone healing among the risks that quitting reduces.4
Why it matters even more in plastic surgery
Many cosmetic operations lift skin away from the tissue beneath it, leaving the skin dependent on a reduced blood supply while it heals. That is where the effects of smoking show most.
A 2015 systematic review and meta-analysis of 60 observational studies found that, in cosmetic surgery, smokers had about 2.3 times the odds of surgical site infection and 2.5 times the odds of delayed wound healing. After skin-removal surgery following bariatric (weight-loss) surgery, smokers had about 3.3 times the odds of delayed healing and 3.1 times the odds of cutaneous necrosis (death of an area of skin).3 The authors highlighted operations with major skin detachment, such as facelifts, skin-sparing mastectomy and abdominoplasty (tummy tuck).3
| Outcome in smokers | Setting | Approximate odds compared with non-smokers |
|---|---|---|
| Surgical site infection | Cosmetic surgery | 2.3 times |
| Delayed wound healing | Cosmetic surgery | 2.5 times |
| Delayed wound healing | Body contouring after bariatric surgery | 3.3 times |
| Skin necrosis | Body contouring after bariatric surgery | 3.1 times |
These figures come from observational studies, which cannot fully separate the effect of smoking from other differences between smokers and non-smokers. The link is consistent, though, and the evidence that smoking raises wound complications is Moderate. It is one reason the American Society of Plastic Surgeons (ASPS) lists not smoking among the features of suitable candidates for operations such as a breast lift.5
How early to stop
Earlier is better. A WHO-supported study reported that smokers who quit approximately 4 weeks or more before surgery have a lower risk of complications and better outcomes six months later, and that each additional tobacco-free week after 4 weeks improves health outcomes by 19%.1 The NHS leaflet advises stopping at least 4 to 6 weeks before the operation if possible, while noting that even a short quit helps recovery.4
The WHO suggests that minor or non-urgent surgery can be postponed to give people time to quit.1 For planned cosmetic surgery, a surgeon may reasonably delay an operation until someone has stopped.
Does helping people stop actually reduce complications?
Randomised trials suggest it can, if the support is intensive enough. A Cochrane review of 13 trials found that intensive programmes, starting at least four weeks before surgery with weekly counselling and nicotine replacement therapy (NRT), increased quitting and reduced any postoperative complication (risk ratio 0.42) and wound complications (risk ratio 0.31).2 Brief advice alone increased quitting slightly but did not significantly reduce complications.2
The complication results for intensive programmes came from only two small trials with 210 people, and the reviewers stated that the best intensity of support remains unknown.2 The evidence that structured support reduces complications is therefore Limited, though consistent with the observational data.
Nicotine replacement and vaping
NRT is available from pharmacies or through a GP or stop smoking service, often as a 12-week course. Oral NRT products cannot be used on the day of the operation because of fasting, though patches may still be possible, which is a question for the anaesthetist.4
Some NHS trusts support vaping as a way to stop smoking, describing e-cigarettes as less damaging than cigarettes.4 The WHO notes that nicotine, not only smoke, contributes to lower oxygen levels, so whether nicotine products should also be stopped before a particular operation is worth asking the surgeon.1
Common questions
Is it worth stopping if my operation is only a week away?
Yes; NHS advice is that even a short quit helps recovery, although 4 weeks or more gives a greater reduction in risk.41
When can I start smoking again after surgery?
Ideally not at all, because smoking slows wound healing and raises infection risk.1 Surgery is often a good opportunity to stop for good, with support.2
Should I tell my surgeon if I smoke occasionally?
Yes. Rigorous assessment of smoking before surgery is what allows the risk to be reduced, and even one cigarette affects healing.31
Bottom line
Smoking roughly doubles to triples the odds of wound problems after cosmetic surgery, with the greatest risk where skin is lifted widely. Stopping at least 4 weeks before surgery, ideally with structured support, is one of the most effective things a patient can do to lower that risk.
Related reading
- Plastic surgery overview
- How to prepare physically for surgery abroad
- What is recovery like after a tummy tuck?
- Options for loose skin after major weight loss
Sources
- World Health Organisation. Smoking greatly increases risk of complications after surgery. WHO; 2020. https://www.who.int/news-room/detail/20-01-2020-smoking-greatly-increases-risk-of-complications-after-surgery. Accessed 5 November 2026.
- Thomsen T, Villebro N, Møller AM. Interventions for preoperative smoking cessation. Cochrane Database of Systematic Reviews; 2014, Issue 3. Art. No.: CD002294. doi:10.1002/14651858.CD002294.pub4. https://cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002294.pub4/pdf/CDSR/CD002294/CD002294_abstract.pdf
- Pluvy I, Panouillères M, Garrido I, et al. Smoking and plastic surgery, part II. Clinical implications: a systematic review with meta-analysis. Annales de Chirurgie Plastique Esthétique; 2015;60(1):e15–e49. doi:10.1016/j.anplas.2014.09.011. https://www.em-consulte.com/article/954147/resume/smoking-and-plastic-surgery-part-ii-clinical-impli
- North Tees and Hartlepool NHS Foundation Trust. Preparing for your surgery: stopping smoking. NHS. https://www.nth.nhs.uk/resources/preparing-for-your-surgery-stopping-smoking/. Accessed 5 November 2026.
- American Society of Plastic Surgeons. Breast lift candidates. ASPS. https://www.plasticsurgery.org/cosmetic-procedures/breast-lift/candidates. Accessed 5 November 2026.
Article history
- — First published.