Smoking, Alcohol and Blood Thinners Before Plastic Surgery: When to Stop

Before plastic surgery, stop smoking and every other nicotine product at least 2 weeks before the operation and stay off it for at least 2 weeks afterwards. Blood-thinning painkillers such as aspirin and ibuprofen, and supplements such as omega-3, vitamin E and ginkgo, should be stopped 1 week before; alcohol should be stopped at least 1 week before as well.

Every patient scheduled for surgery at Op. Dr. Göktuğ Esmer's clinic in Istanbul receives this list in writing, because the safety of the operation and the quality of the result are decided in the weeks before surgery as much as in the operating theatre. This article explains why each item matters, when to stop, and what to do about prescription medication.

Smoking and nicotine: the rule that matters most

Smoking is the best-known and most important cause of poor wound healing in plastic surgery. The problem is not only the smoke but nicotine itself:

• Nicotine constricts blood vessels. Blood flow to the skin and the tissue beneath it drops, so the incision line is starved of oxygen.
• Carbon monoxide reduces oxygen delivery. Part of the oxygen in the blood never reaches the tissue.
• The result: a higher risk of wound breakdown, delayed healing, wider scars, infection and, in operations that lift a skin flap such as a facelift, tummy tuck or breast lift, skin necrosis (tissue death).

Which products are included?

The rule applies not only to cigarettes but also to e-cigarettes and vapes, heated tobacco, shisha, nicotine patches, gum and nicotine pouches. All of them deliver nicotine and all of them narrow blood vessels in the same way. Cutting down is not enough; you need to stop completely.

When to stop

The minimum is 2 weeks before and 2 weeks after surgery. For procedures where skin circulation is critical, such as a facelift, tummy tuck or breast lift, your surgeon may ask for 4 weeks. The earlier you stop, the better your tissue recovers. Hiding the fact that you smoke is a risky choice: if your surgeon does not know, the plan cannot be adjusted to protect you.

Blood-thinning painkillers and prescription anticoagulants

Some medicines interfere with platelets, the cells responsible for clotting, and increase bleeding, bruising and the risk of a haematoma during and after surgery.

Over-the-counter medicines: stop 1 week before

• Aspirin and combination cold remedies that contain it
• NSAID painkillers: ibuprofen, naproxen, diclofenac and similar
• For pain during this period, paracetamol is usually the preferred option; still, tell your team about every medicine you take.

Prescription blood thinners: never stop on your own

Warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel and similar drugs are prescribed for heart, vascular or clotting conditions. Do not stop them on your own initiative. The surgical plan is made together with the cardiologist or haematologist who prescribed them, and a temporary bridging plan is arranged if necessary. For some patients, postponing or not having elective cosmetic surgery is the safer option, and that decision is made jointly with the relevant specialists.

The contraceptive pill and hormone replacement therapy can also affect clot risk, so please mention them too. Your surgeon will tell you what to do depending on the type of operation.

Alcohol: at least 1 week before

Alcohol causes problems before surgery in several ways:

• It can increase bleeding and make bruising more pronounced.
• It dehydrates you, which worsens swelling and slows healing.
• It changes how the liver processes anaesthetic drugs.
• It weakens the immune response and raises the risk of infection.

Stop alcohol completely at least 1 week before surgery and avoid it afterwards for as long as you are taking painkillers or antibiotics. If you drink regularly and heavily, say so openly at your anaesthetic assessment; stopping abruptly may itself need to be medically managed.

Supplements and herbal products: 1 to 2 weeks before

"Natural" does not mean safe for surgery. The following supplements can increase bleeding or interact with anaesthesia and are usually stopped 1 to 2 weeks before the operation:

• Omega-3 / fish oil
• Vitamin E (high dose)
• Ginkgo biloba
• Garlic, ginger and turmeric (curcumin) capsules
• Ginseng
• St John's wort (interacts with anaesthetic drugs)
• Standard multivitamins are usually fine, apart from very high-dose vitamin C; share your list anyway.

The amounts found naturally in food are not a concern; the issue is capsules and high-dose formulations. Tell us about every supplement you take, including the dose, at your first consultation.

What to stop and when: summary table

Fasting rules on the morning of surgery

A full stomach under general anaesthesia is a serious risk. For that reason:

1. Solid food, milk and juices are usually stopped 6 to 8 hours before surgery.
2. Clear fluids such as water are allowed under most protocols until 2 hours before.
3. Chewing gum and sweets also break the fast, so avoid them on the morning of surgery.
4. The exact cut-off times are given to you by the anaesthetic team; the clinic's instructions always take priority over general guidance.

Whether regular medicines such as blood pressure or thyroid tablets should be taken with a sip of water on the morning of surgery is also confirmed at your anaesthetic assessment.

Why we take this list so seriously

Cosmetic surgery is elective surgery performed on healthy people, which makes the responsibility to minimise risk even greater. For our international patients, preparation begins at home, which is why we ask you to share your full list of medicines and supplements at the online assessment stage. You can read how the preparation process works on our international patients page.

For operations that lift large areas of skin, such as a facelift or a tummy tuck, the no-smoking rule is a condition of surgery rather than a recommendation. A surgeon may decide to postpone the operation of a patient who is still smoking; that decision is made to protect the result.

If you are planning surgery and want to know whether any of your medicines or supplements could be a problem, send us your list and your photos for an online assessment on WhatsApp.

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