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Smoking and Facial Surgery Do Not Mix

Judith, who is 59, works in fundraising. In her profession, appearances matter. “It’s a very person-oriented business,” she says. “I’m the one out in front, the face of the project. Currently I’m working on a project to raise seven to eight million dollars, so people need to feel good about me, trust me. My appearance is the very first chance I have to make a strong and positive impression to a potential donor.”

“Judith,” before and after facial plastic surgery.

These were among the reasons Judith sought out Dr. Cynthia Gregg, one of the most highly respected facial plastic surgeons in the Triangle. “Judith came to me wanting to re-vitalize her appearance,” Dr. Gregg explains. “After an in-depth consul-tation and considering all the options, we decided that a face lift to address the sagging of the lower neck and lid was Judith’s best option.”

However, there was a complication. Judith was a smoker.

“There are certain surgeries I absolutely will not ever do for someone who’s currently smoking,” Dr. Gregg says emphatically. “And one of those surgeries is a face lift.”

The reasoning behind this policy is compelling. “Nicotine is a vasoconstrictor,” she explains, “which means that it constricts the size of your blood vessels. In other words, it causes the diameter of the vessels to get smaller. Once this happens, you now have less blood flowing through the vessels, and therefore less blood reaching the surface of the skin.”

Dr. Gregg

Simply from an aging perspective, Dr. Gregg explains, this chronic vasoconstriction speeds up the process 100-fold or more.

“In order to fight off the damaging environmental agents that we face every day—free radicals for example—along with things like sun damage or, in Judith’s case, healing from surgery, you need to have good blood flow. If you don’t have good blood supply to an area of injury—whether it’s a sun burn or surgical incision—your body cannot heal, it cannot repair itself.

Years of Experience

Relying on her extensive training, the latest technology, and years of experience, Dr. Gregg performs the full range of facial plastic surgery procedures, including forehead and brow-lift surgery, facial scar treatment, otoplasty (to correct protruding ears), rhinoplasty nasal surgery, blepharoplasty eyelid surgery, rhytidectomy facelift surgery, and mid-face lift.

She and her staff—which includes a surgical nurse, scrub assistant, nurse injectors, and an aesthetician—also offer a comprehensive range of skin care procedures and products, including treatment of sun damage and photo-aging, Botox cosmetic injections, laser hair removal, and use of natural cosmetic dermal fillers such as Restylane, Juvéderm, and Sculptra.

“So when people come to see me,” Dr. Gregg says, “any history of smoking first of all explains a good deal about why they are seeking treatment. Smoking is the fastest, most effective way to prematurely age the skin, to cause wrinkling around the mouth, and to cause you to lose the laxity in your skin more rapidly. Without laxity the skin is no longer taut on the face, and thus sagging occurs. Smoking furthermore causes a decline in the quality of the skin, and creates a generalized pallor.”

When Judith first came to see Dr. Gregg, all of these concerns were explained, and she would not schedule Judith for face lift surgery at that time.

“Wound healing is a major issue for smokers,” she says. “I can do the exact same procedure on two people, a smoker and a non-smoker, and the one who does not smoke will heal faster, with fewer complications, a less visible scar—and overall a far superior outcome. The non-smoker has nice, open, dilated blood vessels sending in all the reparative nutrients that the body needs to heal. The smoker’s ability to heal, by contrast, is severely limited.

“The risk in smoking and then undergoing surgery such as a face lift, is that the skin will die,” she says. “As a board examiner in my specialty, I see case studies in our literature in which a history and a photo of a woman’s face after facial surgery is presented, and the question is presented asking for a diagnosis.. In the photograph, part of the skin of the face is black. The correct diagnosis is that the patient was a smoker and probably didn’t tell the operating surgeon.”

Images of black, decaying facial skin is enough for most people to get the point. It was certainly enough for Judith. “I’d been smoking for decades,” she concedes. “I don’t know how many. I don’t smoke a lot, maybe seven or eight cigarettes a week. But Dr. Gregg said one cigarette causes vasoconstriction for up to eight hours, so I had to stop all together.”

And Judith did stop smoking. She stopped for a month before her surgery, and for a month after, and while quitting permanently would obviously have been ideal, it was enough to achieve her goal. “It was a good motivator,” she says. “I really wanted the surgery, and I understood what Dr. Gregg was saying. There’s no point in making that kind of investment just to shoot myself in the foot by continuing to smoke at the time of the procedure and lying about it.” And the effort was well worth it. Her surgical results pleased both patient and doctor. (see before-and-after photos).


Obesity is another self-inflicted condition that can have huge impacts on the outcomes of facial plastic surgery, and in this instance Dr. Gregg most often recommends waiting to perform major surgery.

“Most women—in fact, most men too—come in telling me they want or plan to lose weight. If a client wants to loose ten or more pounds, I really recommend accomplishing that goal first, before we do any kind of surgical procedure,” Dr. Gregg says. “When you lose 10 or more pounds, the face is often the first place you see that loss. If we do a face lift, and then you lose ten pounds, we’re going to be back at square one—because we’re going to tighten and then essentially you’re going to deflate. I want you to deflate first. Get happy, comfortable, and stable with your weight, and then you will enjoy the outcome we achieve with surgery for a much longer time. It’s going to be a much better return on your investment.”