Key points
- Smoking is described as able to slow wound healing by reducing the oxygen supply to tissues and weakening the function of inflammatory cells and the cells involved in repair [1].
- In a 2025 meta-analysis that pooled 55 studies covering many types of surgery, people who stopped smoking at least 4 weeks before surgery had a 33% lower risk of wound complications than those who kept smoking [2].
- A literature review of cosmetic surgery patients suggested stopping smoking completely for 4 weeks before surgery and staying smoke-free until the surgical site has gone through its initial (primary) healing [3].
- Quitting for a short time does not make all the effects of smoking disappear, so when to quit and when to schedule surgery should be decided with your specialist based on how much you smoke and the type of surgery [1, 2].
How smoking affects wound healing
During a consultation for cosmetic surgery, you will be asked in detail whether you smoke and how much you smoke each day. Surgical sites heal with the oxygen and nutrients carried by the blood, so your smoking habits are important information for predicting how your recovery will go.
According to a 2012 systematic review of 177 studies, smoking temporarily lowers the oxygen supply to tissues and their metabolism [1]. It was also summarized that smoking weakens the ability of inflammatory cells to gather in a wound and deal with bacteria, and that it reduces the movement and multiplication of fibroblasts as well as collagen production [1]. The review concluded that these changes lead to delayed wound healing and complications [1].
A 2015 literature review of cosmetic surgery patients also explained that the low-oxygen state (hypoxia), reduced blood supply to tissue (ischemia), and immune abnormalities caused by smoking alter the wound-healing process [3]. The review also considered that some of these effects can be reversed by quitting [3].
What changes when you quit?
According to the 2012 review, after quitting, the oxygen supply to tissues and their metabolism recover quickly, and the response of inflammatory cells partly recovers within 4 weeks [1]. In contrast, the proliferative response that builds new tissue was summarized as remaining impaired even after that [1]. This means it takes time for the benefits of quitting to appear, and not all of the effects disappear right away.
A 2025 systematic review and meta-analysis pooled 55 studies to examine the relationship between how long people stopped smoking before surgery and complications [2]. Compared with continuing to smoke, quitting for at least 2 weeks reduced lung (pulmonary) complications by 27%, quitting for at least 4 weeks reduced them by 29%, and quitting for at least 8 weeks reduced them by 37% [2]. People who quit for at least 4 weeks had a 33% lower risk of wound complications and a 31% lower risk of complications overall [2].
However, quitting for a short time had no clear effect on surgical site infection or bleeding, and people who had quit still had more lung complications than people who had never smoked [2]. This analysis covered adults having many types of surgery, so it cannot be concluded that a difference of the same size occurs in cosmetic surgery.
Suggested smoke-free periods before and after surgery
A 2015 literature review of cosmetic surgery patients summarized that the existing literature recommends stopping smoking 3 to 8 weeks before surgery and for up to 4 weeks after surgery [3]. The review concluded that stopping completely for 4 weeks before surgery and staying smoke-free until the surgical site has gone through its initial healing (2 weeks) appears to create better conditions for surgery [3].
In a 2021 systematic review of patients having weight-loss (bariatric) surgery, smoking within 1 year before surgery was an independent factor that increased the risk of death within 30 days and of major complications, particularly wound and lung complications [4]. The review considered that smoking even further back than the minimum of 6 weeks of quitting recommended by guidelines may be linked to complications [4]. Because it concerns a different field of surgery, its findings are hard to apply directly, but they point in the same direction as the meta-analysis in which results improved the longer people had quit [2].
Risks reported in other fields of surgery
In a 2021 meta-analysis of head and neck reconstruction with a free flap, in which skin and tissue are moved together with their blood vessels, smoking was associated with a 19.12% higher risk of hematoma and a 4.57% higher risk of surgical complications overall [5]. In contrast, there was no significant difference between smokers and nonsmokers in flap failure, surgical site infection, or fistula [5]. For this surgery, which is mainly used to repair defects left by head and neck cancer, the authors considered that advice to quit smoking is still important, but that there is no need to delay surgery to allow a smoke-free period in order to prevent the complications they examined [5]. Because 18 of the 19 included studies were retrospective, the authors stated that higher-quality studies are needed to reach firm conclusions [5].
A 2019 review of foot and ankle surgery summarized that orthopedic surgery patients who smoke have more pain, lower overall satisfaction, and significantly more wound-healing complications [6]. In terms of level of evidence, this review corresponds to expert opinion [6]. The fact that findings pointing in a similar direction have been reported across many fields of surgery is why your smoking status is checked carefully during your consultation.
Ways to help you quit, and care after surgery
The 2015 review of cosmetic surgery summarized that nicotine replacement therapy doubles the short-term success rate of quitting, and considered that patients who are highly dependent would benefit from the help of a smoking cessation specialist [3]. Which method to use depends on your health, so decide on it after discussing it with your medical team.
It is not uncommon for people to start smoking again after surgery. In the review of weight-loss surgery, up to 17% of patients were reported to keep smoking after surgery [4]. Staying smoke-free while your wounds heal is also part of your recovery plan.
What to tell your surgeon during your consultation
If you understate how much you smoke or keep it hidden, it is difficult to assess your risk properly. Besides smoking, how quickly you recover differs from person to person depending on the extent of surgery, your constitution, and any other medical conditions, so it is best to share the following honestly and work out a quitting schedule that suits you together with your specialist.
- Whether you currently smoke, how much you smoke a day, and how long you have smoked
- Whether you use nicotine products other than cigarettes, such as e-cigarettes or heated tobacco products
- If you have already started quitting, when you stopped
- Any past attempts to quit and what made them difficult
- Other medical conditions and the medications you take
Frequently asked questions
- How many weeks before surgery should I stop smoking?
- A literature review of cosmetic surgery patients suggested stopping smoking completely for 4 weeks before surgery and staying smoke-free until the surgical site has gone through its initial healing [3]. In a meta-analysis that pooled many types of surgery, results also improved the longer people had quit [2]. The actual period can vary with the type of surgery and how much you smoke, so it is best to follow your surgeon's instructions.
- Does it help to quit for just a few days right before surgery?
- It was summarized that after quitting, the oxygen supply to tissues recovers quickly, but the response of inflammatory cells only partly recovers within 4 weeks, and the response that builds tissue remains impaired even after that [1]. The smoke-free periods for which the meta-analysis reported fewer complications were also at least 2 weeks, at least 4 weeks, and at least 8 weeks [2]. If you started quitting late, it is safer not to hide it but to tell your medical team so the schedule can be adjusted together.
- Are e-cigarettes or other nicotine products okay?
- The sources reviewed did not look at e-cigarettes separately. In the literature review that summarized how smoking affects the mechanisms of wound healing, nicotine did not affect the oxygen environment of tissues but appeared to weaken the inflammatory response, and that effect was summarized as small [1]. This does not mean e-cigarettes are safe, so it is best to tell your medical team about any nicotine products you use and follow their judgment.
References
- Sørensen LT. Wound healing and infection in surgery: the pathophysiological impact of smoking, smoking cessation, and nicotine replacement therapy: a systematic review. Ann Surg. 2012.PubMed 22566015DOI
- Tang E, Rodriguez RM, Srivastava A, et al. Impact of short duration smoking cessation on post-operative complications: A systematic review and meta-analysis. J Clin Anesth. 2025.PubMed 40840082DOI
- Pluvy I, Garrido I, Pauchot J, et al. Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations. Ann Chir Plast Esthet. 2015.PubMed 25447216DOI
- Chow A, Neville A, Kolozsvari N. Smoking in bariatric surgery: a systematic review. Surg Endosc. 2021.PubMed 32524412DOI
- Garip M, Van Dessel J, Grosjean L, et al. The impact of smoking on surgical complications after head and neck reconstructive surgery with a free vascularised tissue flap: a systematic review and meta-analysis. Br J Oral Maxillofac Surg. 2021.PubMed 33546845DOI
- Beahrs TR, Reagan J, Bettin CC, et al. Smoking Effects in Foot and Ankle Surgery: An Evidence-Based Review. Foot Ankle Int. 2019.PubMed 31423824DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
