Q: Dr. Eppley, I am 55 years old and am interested in doing some with my aging face. I think I need a facelift or something along those lines. I do have numerous medical problems including rheumatoid arthritis which is under control at this time. I am taking Methotrexate, Arava and Plaquenal for it. I also take medications for high blood pressure, high cholesterol, underactive thyroid and I smoke one pack of cigarettes per day. I would be willing to quit. I am 5’ 2” and weight 180 lbs. I also have restless leg syndrome and back pain. I also take Xanax, Xanaflex and a sleeping pill.
A: Thank you for your interest in facial rejuvenation surgery which may possibly include a facelift. You are correct in assuming that you would need to quit smoking at least one month before surgery and for at least one month after any procedure. In addition, however, you have multiple other medical problems that need to be addressed before you should consider any type of elective facial surgery. It would be best that you loss some weight before surgery, getting you down to at least the 155 lb to 160 lbs range. This may also help your high blood pressure and back pain. Because of your rheumatoid arthritis medications, they do place you at risk for healing problems. I would have to talk to both your primary care doctor about your general health and your rheumatologist about your medications and their dosages to see if any of these can be reduced for a short period of time around surgery. You would also need to be done some supplements to help with collagen production and healing, such as temporary high doses of Vitamin A and C. While you may benefit greatly by a facelift, you have numerous medical issues that must either be improved or management strategies implemented for them for you to have a successful and uncomplicated outcome from any type of facelift surgery.
Dr. Barry Eppley
Q: How soon should I quit smoking before my facelift? I have smoked for nearly 30 years and I know it has not helped me age well. I think a facelift will really help me look better but I don’t want to have any problems after surgery. On the flip side of that coin, when after my facelift can I start smoking again?
A: There are some things in plastic surgery that don’t go well with it…and smoking is at the top of the list. Besides the obvious deleterious effects on aging that smoking causes, it has its worse effects on skin flap-driven operations. These include facelifts, breast reductions and tummy tucks to name the top three of cosmetic procedures. Because these operations raise long skin flaps that rely on small vessel perfusion from the dermis, anything that impedes or constricts blood flow decreases oxygen delivery to the injured tissues. Without oxygen, survival of healing of the edges of the skin flaps is impaired. It is the carbon monoxide (steals a space on the hemoglobin of red blood cells where oxygen can occupy) and nicotine (causes blood vessel constriction_ which together really hurts tissues from getting what they need to heal.
One should ideally quit three weeks before facelift surgery. If you can’t, and it is important to be honest with your plastuc surgeon, then he or she can modify their facelift technique to lessen the risk of healing problems.
If you are going to invest in a facelift, it makes little sense to keep on smoking. One should use a major event and expense like a facelift to be the motivation to finally quit smoling.
Dr. Barry Eppley