On paper it is a straightforward matter to quit smoking before cosmetic surgery; in practice you will find it rather more of an ordeal. The way to go about it is to put an end to all nicotine and smoking products at the earliest opportunity, be forthright with your surgeon and make sure you have support in place. Most cosmetic surgeons in Australia will insist you are not touching cigarettes, vapes or anything of that nature for a good few weeks on either side of your operation. The reason is plain: smoking is a recipe for poor scarring, wound issues, infection and complications with anaesthesia.
For those who prefer the short version, do not smoke 4 to 6 weeks prior to the procedure or whatever your surgeon deems necessary. And do not think of “cheating” a pre-surgery nicotine test, a positive one will see your surgery put back or called off. As Isla North would put it, there is no point in wishful thinking when honesty is the order of the day.
Why You Are Better Off Quitting
It is not only what goes on in theatre that counts with cosmetic surgery. What matters is how your body gets on in the ensuing days and weeks as the swelling goes down and the incisions knit together. That is the time smoking can really get in the way.
A person putting in a search for how to stop smoking before surgery in Australia is generally as concerned with safeguarding his or her result as with health. One can understand that. After you have put your trust in a surgeon and put in the time and money, showing up with nicotine in your system is akin to heading out on the Gibb River Road with bald tyres and leaving it to chance.
What Smoking Does To Recovery
Tissues have trouble when they need it most because smoking impedes blood flow and oxygen delivery. Consequent to this you have a slower healing process and an elevated risk of infection. With cosmetic work where the viability of the skin is of concern, surgeons will be wary of skin flap necrosis and substandard scars. It’s important to understand nicotine effects on healing.
The Australian Government has information on quitting and its attendant health benefits, both immediate and otherwise, noting the effect of smoking on circulation and healing. See their site for national support at Australian Government quit smoking information.
Nicotine And Healing
People are under the misapprehension that the cigarette is the only problem. In fact the nicotine is the issue, along with the other chemicals involved in vaping and smoking. If your surgeon tells you to put them aside he means it.
You may be concentrating on the smoke in your lungs but what is of greater import around the time of surgery is the state of your tissues and blood vessels. The effects of nicotine on healing is what makes surgeons so uncompromising.
Oxygen And Blood Vessels
In simple terms, nicotine constricts the blood vessels so less of it is available to the tissue that is trying to heal. Then there is the carbon monoxide in a cigarette which takes away from the blood’s ability to carry oxygen. Tissue requires oxygen much as a billy does water to come to the boil, and without it recovery is impeded. This is of particular note with breast surgery, facelifts, abdominoplasty or any procedure with large incisions or skin flaps where reduced circulation can result in tissue loss or wound breakdown.
Complications
From chronic inflammation and protracted recovery to anaesthesia problems and unsightly scarring, these are the things on a surgeon’s mind. Patients doing some online research into the rules on smoking cessation will come across the names of Dr Jeremy Hunt, Dr Michael Kernohan, Dr Mark Kohout or Dr Eddy Dona in connection with pre-op care. Internationally Dr Karen Horton is another whose views on flap survival and avoiding nicotine are often put before patients. Clinicians will have their own policies but the medical view is unvarying: nicotine metabolites and a lack of oxygen will compromise the outcome.
When To Stop
I am asked how long one should desist from smoking before cosmetic surgery. The practical rule in Australia is 4 to 6 weeks, and you are likely to be told to hold off for 4 weeks after as well. But in the end your surgeon’s protocol is what prevails. The mistake most make is to put it off until the last minute. A few days before the operation they will have called it a day and felt good about it, only to be put out when the surgeon puts his foot down. Do not think a nicotine-free weekend is some kind of magic eraser.
Quit Timeline Before Surgery
For a preoperative smoking cessation guide that is realistic, see the table below. Take it as general information; it does not in any way replace what your surgeon tells you.
| Time Before Surgery | What To Do | What Improves | What Catches People Out |
| 6+ Weeks | Put an end to cigarettes, vapes and the like; get support from your GP | The best odds of lessening anaesthetic and wound healing risk | “Just one” will be fine, people tell themselves |
| 4 Weeks | Make sure you are off nicotine; ask the surgeon what his policy is on replacement therapy and surgery | Your circulation is better, carbon monoxide exposure is down | Social vaping at the weekend |
| 2 Weeks | Review your medicines and plan for cravings, do not go back to it | There is some advantage but not as much as if you had quit sooner | 2 weeks is thought to be sufficient |
| 1 Week | Be upfront with your surgeon should you have a lapse | An honest account makes for safer planning | Putting up a front before a pre-op nicotine test |
| After Surgery | For the duration your surgeon advises, do not smoke | Tissue survival, scars and blood supply are protected | “The hard part is done”, so why not restart? |
Vaping is no different in principle. Any nicotine in the vape is an issue and even without it the vapour can be an irritant to the airways, something of concern with anaesthesia. So do not consider vaping a harmless way around the rules.
How Nicotine Testing Works
Clinics vary; some will test routinely on higher-risk procedures, others do not. Should your surgeon refer to cotinine he is referring to the principal metabolite for finding nicotine exposure. You could have had a nicotine patch or gum, or used a vape, and it will still register, cigarette or no cigarette.
This is where one can come unstuck. On hearing “quit smoking” they put in a nicotine replacement without looking at clinic policy. Come the test and there is a positive result and an uncomfortable conversation all round.
What A Positive Result Can Mean
It may mean the surgery is put back or cancelled on account of smoking, or the plan is altered. It is a matter of the procedure, whether there is a skin flap or more to heal, and the surgeon’s own risk tolerance.
There is no art to passing a nicotine test prior to plastic surgery other than to stay away from nicotine for long enough to let your body clear it. Cotinine is not going to be washed out by a spot of extra water or a session at the gym. When your surgeon tests, transparency is the order of the day.
A Week-By-Week Plan
With surgery in the diary the plan has to be workable, not something for Pinterest. You are not after a new identity, just fewer triggers and a rule of no nicotine, period.
Isla North might compare it to packing for a walk on the Peninsula: forgo the basics in the hope of sunshine and the weather will prove you wrong. Quitting is of a piece with that.
- Make a stop date today, 4 to 6 weeks out if you can, and inform your GP and surgeon.
- Clear the house, car and work bag of lighters, spare cartridges, vapes and cigarettes.
- Put pen to paper on your five main triggers, be it stress, coffee, wine, mates, driving, boredom or after your meal.
- Have a counter measure for each: a text to someone, a walk, some deep breathing, sugar-free gum or cold water.
- Find out from the clinic if lozenges or patches are countenanced, policies being what they are.
- Get in touch with Quitline Australia or book some counselling before the urge takes hold.
- Logistics, not vibes, should govern your first week without a smoke: who is on hand to check on you, who is behind the wheel, where the old habits are wont to occur. And once the surgery is over, remain quit for as long as is recommended, the healing time is too important.
Medicines And Quit Supports
You need not white-knuckle it on your own. Medical supports exist and for a lot of people that is what separates intention from action. The trick is to have the right tool for the timeline and your surgeon’s rules. Some will allow certain aids, others will want all nicotine products gone for reasons of testing or blood flow. This has to be made personal.
Nicotine Replacement Therapy
There is a certain ambiguity when it comes to surgery and nicotine replacement therapy. While lozenges, gum or a patch will take the edge off a craving for a cigarette, they are still a source of nicotine. Should your surgeon insist on a negative cotinine reading, that can be an issue. It is something to verify in advance.
Do not mistake this for saying NRT is poor medicine; rather, it is not suited to all cosmetic surgery regimens. One finds different protocols in the clinics of Dr Turner, A/Prof Bish Soliman and Dr Mistry as one does with any surgeon. The treating team’s word on the matter should be heeded.
Prescription Options
For some, varenicline and bupropion are appropriate prescription medicines. Being free of nicotine they are of use where total abstinence is called for, yet a medical review is in order to put side effects, mental health and other medications in context and to time them right before anaesthesia.
Make your GP the first port of call. An operation is due in a month? Make the appointment now. Do not put it off till next Tuesday in the hope things will quieten down; they seldom do on cue.
Practical Ways To Stay Quit
Motivation has its limits once the newness is gone, and then it is a question of behaviour. Cravings tend to be of a piece with routine and are repetitive if short. There is no need to be monastic about it, just have better defaults at hand. Those who fare well make support a simple matter and smoking a nuisance. Not very glamorous but it works.
What you need day in and day out
Delay and distract yourself. Most cravings run their course in a few minutes so get up, put in a walk round the block, have a cold drink or brush your teeth. Occupy your hands if that is how the habit goes. If you are prone to smoke behind the wheel, try a different route for a week, put the lighter in the bin and give the car a good clean.
Then there is behavioural counselling. It is among the most effective support for quitting as it shows you how to deal with the times you would normally give in. Forget high minded inspiration, it is about getting through 3:40 pm on a Tuesday when your brain wants to make a deal.
- Best for: smokers with a history of relapse, those who vape, anyone booked for surgery in the next 8 weeks or so, and patients having a flap-based or otherwise higher risk cosmetic procedure.
- Leave to others: the heavy smoker, one with anxiety over the operation or who is not sure his quit aid will stand up to cotinine testing.
Some Australian Help
Your GP and Quitline Australia are where to begin if you are here. They are accessible and practical, unlike the forums where strangers will tell you they made it past a test by some contrivance with detox tea. For national information there are the Government health resources and Quitline is a mainstay. A local pharmacist will be of service with over-the-counter stock, but the plan has to conform to your surgeon’s policy on nicotine.
Who to put in touch with
The GP is able to coordinate with the surgical side, look at other health matters and put you on bupropion or varenicline if warranted. Quitline Australia has a structured plan and coaching over the phone. When funds are an issue it is more economical than experimenting with whatever is on offer.
And in the end the least expensive way is to avoid putting off the procedure. A delay means you may lose a deposit, have to reschedule leave and face new pre-op tests, not to mention time from work. Cosmetic surgery is not cheap, but a delay on account of smoking is hardly ever cost effective.
Act Quickly Over a Slip Up
There is no virtue in a slip, but to feign it never occurred is worse. Have you had a cigarette or put nicotine in your system via vaping since you quit? Then be straightforward and let the clinic know. Surgeons are not interested in a brave face when safety is at stake.
People are prone to think a single cigarette is of no consequence. They are mistaken. Whether or not it upsets the plan is a matter for your surgeon’s protocol, the procedure and the timing.
Surgery on the Horizon
With an operation a week or two off, do not try to handle things on your own. Put in a call to your surgeon to find out what he wants you to do and if there will be any testing. Some will tell you that while it is preferable to smoking right up to the day, stopping 2 weeks prior is not good enough for certain cosmetic work and runs counter to policy.
Take breast augmentation for example; one week before is too short a time to see the kind of risk reduction surgeons are after, even if you do quit. Should you have been slow to get on board, the only course is to be open about it and seek support.
A Matter of Healing
For a trouble free recovery one has to make a point of putting down the nicotine, be it in a vape or a cigarette, well in advance of the procedure and not pick it up again. That is as practical an answer as you will get on how long to abstain before cosmetic surgery and most surgeons would like patients to have made up their mind on it some time before the last minute.
In short, pre-op cessation is what stands between you and your safety and results. Make a straight forward plan with your GP and your surgeon and regard nicotine for the surgical risk it is. There is no room for any shortcuts.
FAQ
You will hear these from patients on a regular basis, often once the date of the surgery is nigh.
How does one go about passing a nicotine test for plastic surgery?
By being truthful and ceasing all exposure to nicotine at an early stage in accordance with your surgeon. The clinic must have given its nod before you use gum, patches or any other product. Do not be under the impression cotinine testing is for cigarettes alone.
Is 2 weeks before surgery sufficient to stop?
It is something, but cosmetic protocols may require more. Four to six weeks is the norm for many surgeons as it allows blood flow to improve and healing risk to be put to rights.
When is nicotine completely out of you?
You cannot put a hard and fast number on it. It is gone quicker than cotinine and the test will pick up on vapes or replacements as much as cigarettes depending on your metabolism. Leave the internet detox theories where they are and trust your surgeon’s window for testing.
Vaping before an operation?
If there is nicotine in the vape then yes. It is almost always advisable to stop. Nicotine gets in the way of healing and vapour can complicate the airways for anaesthesia.
Will smoking get my surgery called off?
It can. If the clinic is strict on nicotine or the procedure is of a high healing risk, such as a cosmetic one with large incisions or skin flaps where tissue survival is a concern, a positive test or evidence of smoking or vaping can lead to cancellation.
