Smoking increases risks around plastic surgery, including impaired wound healing, tissue loss and complications related to anesthesia and recovery. In this episode, Darren M. Smith, MD, a plastic surgeon in New York City, explains why discussing smoking early is part of planning an elective procedure.

The central issue is blood supply. Healing skin and tissue need oxygen and nutrients delivered through small blood vessels. The recording describes how smoking can interfere with that process, particularly when surgery has already changed the circulation supporting an area.

Key takeaways

🩹 Incisions depend on circulation to heal.

Dr. Smith uses a construction-site analogy: blood flow brings the materials needed for repair.

🩹 The concern extends beyond a delayed scar.

The episode discusses loss of skin or other soft tissue when its blood supply is inadequate.

🔎 Different operations create different demands.

Tummy tucks, breast reductions, breast lifts and facelifts are examples used to explain why tissue circulation matters.

⚠️ Heart, lung and clotting risks also matter.

Smoking is discussed in the wider context of anesthesia and recovery, not only the appearance of an incision.

🎯 Make a cessation plan with the surgical team.

Dr. Smith encourages using the preparation period as an opportunity to seek support for quitting.

💬 Questions answered

Why can smoking cause tissue loss after surgery?

The recording explains that tissue needs an adequate blood supply to survive. When a procedure changes that supply, smoking can further compromise circulation and increase the risk of serious healing problems.

How long before and after surgery does Dr. Smith discuss stopping?

In this 2020 recording, he describes approximately a month before and after a procedure. That is a historical practice example, not personal clearance to proceed or resume smoking. Your team should set the plan for your operation and health circumstances.

ℹ️ Current context

The ASPS 2024 smoking-risk guidance also addresses nicotine from vaping and other products, while noting that management varies by procedure and patient. Tell your team about cigarettes, vaping and nicotine replacement products so cessation support and surgical timing can be planned together.

🎧 Episode chapters

00:58 — Three categories of smoking-related risk

01:25 — Blood supply and wound healing

03:32 — Why tissue can be lost

04:36 — Anesthesia and systemic risks

06:02 — The original cessation recommendation

🔗 Related information

Explore preparing for plastic surgery, patient guides, the practice and surgical setting, or request a consultation with Dr. Smith in New York City.

About the host — current biography

Darren M. Smith, MD, FACS is a board-certified plastic surgeon in Manhattan specializing in mommy makeover surgery, breast surgery, and body contouring. He was named to Newsweek’s America’s Best Plastic Surgeons 2026 and has co-authored authoritative peer-reviewed publications on combined breast surgery and abdominoplasty and the surgical care of postpartum patients.

Originally released September 22, 2020. Show notes updated September 30, 2026. This is general education. Current recommendations, suitability, risks and expected results require an individual assessment.

Full transcript and related resources