Overview
Doctors have long linked smoking with slow wound healing, though large controlled studies had not yet been done. The author reviews the known effects of three toxic parts of cigarette smoke and how each may impair healing. The review ends with advice for smokers facing surgery. The abstract reports no new patient data.
Findings
- Nicotine narrows blood vessels, reducing blood flow to the skin and causing tissue ischemia and poor healing.
- Nicotine makes platelets stickier, raising the risk of small-vessel clots and ischemia.
- Nicotine reduces the growth of red blood cells, fibroblasts and macrophages.
- Carbon monoxide reduces oxygen transport and use.
- Hydrogen cyanide blocks the enzymes cells need for oxygen use and transport.
- Slower healing is seen in smokers after trauma, disease and surgery.
- Compared with nonsmokers, smokers have more unsatisfactory healing after facelift and more complications after breast surgery.
- The author advises smokers to stop before elective surgery.
- The abstract gives no rates.
What it means for a patient
- If you smoke, your facelift skin is more likely to heal poorly. This review links smoking with a higher rate of unsatisfactory healing after facelift.
- Nicotine itself narrows blood vessels and reduces blood flow to the skin.
- Stop smoking before surgery. Ask your surgeon how many weeks before and after surgery you must be nicotine-free.
- This is a review of earlier work. The author notes that extensive controlled studies had not yet been done.
Why this paper matters
It sets out how smoking harms healing at the level of blood flow, clotting and cell oxygen use. It names facelift as an operation where smokers heal worse and supports advising patients to quit before elective surgery. Cited 429 times (NIH iCite, 2026-09-25).
Terms
- Vasoconstrictor: a substance that narrows blood vessels.
- Ischemia: too little blood reaching a tissue.
- Platelets: blood cells that help form clots.
- Thrombotic microvascular occlusion: blockage of tiny blood vessels by clots.
- Fibroblasts: cells that make collagen and help repair wounds.
- Macrophages: immune cells that clear debris and help control healing.
- Oxidative metabolism: the way cells use oxygen to make energy.