If you are one of the over 22% of the global population who smoke [1], you may be wondering if smoking can truly impact your hair transplant results. That is understandable, since the thought of having to go weeks without a cigarette when having hair restoration surgery can be daunting.
However, it is good to know that this is not a mere precaution, there are compelling reasons to stop smoking during the weeks surrounding your hair transplant. Even with minor surgery, smoking has been found to interfere with local anaesthetic, slow down healing, and favour post-operative complications [2][3][4]. And that is not limited to cigarettes, it also includes vaping and using other nicotine products [5].
That is why it is recommended to stop smoking at least 3-6 weeks before and after your hair restoration surgery (this period may be longer for patients who are more advanced in age, have pre-existing conditions which can interfere with healing or have a weakened immune system).
A hair transplant is a delicate procedure and it is crucial for your grafts to get sufficient nutrients, to be protected from infection and allowed to heal as well as possible. While it can be difficult to give up smoking even for a short while, take heart at the thought that a hair transplant is permanent and abstaining from nicotine can increase its chances of success.
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A meta-analysis of 82 studies conducted on different kinds of plastic surgery revealed that smoking poses a serious risk of complications in the vast majority of them [5]. This finding was confirmed by another, similar review of 53 studies, as well as by a study conducted on 415 plastic surgery patients [4]. Here are some of the main ways smoking can interfere with your hair transplant success:
Smoking can affect your body’s ability to grow new cells and repair damaged tissue. That is because it inhibits the growth of cells which contribute to the formation of connective tissue, as well as red and white blood cell production. It can also alter the body’s immune and inflammatory response [2].
On average, a cigarette contains over 4000 toxic substances, but mainly 3 of them have been associated with slower healing rates: nicotine, carbon monoxide and hydrogen cyanide [6]. Nicotine causes your blood vessels to constrict and reduce oxygen supply to the skin, while carbon monoxide binds to your red blood cells, reducing the oxygen quantity they carry. At the same time, hydrogen cyanide inhibits certain enzymes which are necessary for cells to utilise oxygen [6].
Since an adequate oxygen supply is crucial to a number of wound-healing processes, not receiving enough can slow this process down. That is why smoking around the time of your surgery can increase how long it takes your hair transplant to heal.
Some of the most serious post-transplant complications are infection and necrosis (tissue death). Smoking during the weeks before and after your hair transplant can weaken your immune system [6], making it easier for bacteria to develop on your donor or transplant area. This can lead to folliculitis after a hair transplant and potentially compromise the affected hair grafts.
Tissue necrosis is not as common a risk in hair restoration surgery as it is in other, more extensive types of plastic surgery (e.g. abdominoplasty). However, it can occur in both donor and recipient areas, regardless of whether you are using FUT or FUE surgery, due to low blood flow to the area [7][17][18].
Research found that 74% of skin necrosis incidents in facelift surgery were influenced by nicotine use and that smokers were 12.5 times more likely to develop tissue death than non-smokers [2]. While no similar studies have been performed on hair transplants, it may be safer not to take this chance.
For your grafts to stay healthy and your transplant to be successful, they need to receive adequate levels of oxygen and nutrients, as the hair diagram above shows. As previously shown, smoking can make the blood vessels in your scalp constrict, reducing the blood flow to your hair grafts. That leads to a decreased amount of oxygen and nutrients they can use to become securely fixed and start growing new hair [6].
Moreover, the blood that does reach them often carries less oxygen in smokers than in non-smokers, due to the excessive carbon monoxide in cigarettes, which binds to your red blood cells, replacing oxygen [6].
This means that smoking can prevent nourishing substances from adequately reaching your hair grafts, jeopardizing their viability and development.
Hair transplants are largely painless because a local anaesthetic is injected into your scalp before harvesting and reimplanting the hair grafts. However, research shows that smoking can interfere with local anaesthetics.
That is because reduced blood flow caused by constricted blood vessels can make it more difficult for the anaesthetic to be distributed. This means smokers may require a higher dose of numbing agents than normal so they don’t experience any pain during the procedure [8][9].
So if you decide to keep smoking before your hair restoration surgery, make sure to be open about it with your surgeon so that they can adjust the dose of anaesthetic you receive and keep the procedure pain-free
A meta-analysis of 16 studies, conducted in 2021 [10], has found that smoking accelerates hair loss due to androgenetic alopecia (male pattern baldness or female pattern baldness) through multiple mechanisms. These include:
A different study, conducted on 3427 men, showed that smokers had 15% higher overall testosterone levels and 13% higher free testosterone levels than non-smokers [19]. This made them more susceptible to androgenetic alopecia.
Moreover, a study conducted on 1000 men [11] revealed that male pattern baldness was substantially more prevalent among smokers and that smoking may accelerate the progression of androgenetic alopecia, leading to faster hair shedding.
The implications of these findings for your hair transplant are that smoking after your hair restoration surgery can speed up your hair thinning in areas not covered by the transplant. This can lead to visible discrepancies between your fuller transplanted area and the thinning surrounding areas.
If that happens, you may need to get a second hair transplant to make up for the additional baldness, provided you have sufficient healthy hair follicles left in your donor area.
The American Association of Plastic Surgeons recommends that you stop smoking 3-6 weeks before and another 3-6 weeks after a cosmetic surgery [12]. However, different transplant clinics make their own recommendations.
It is a good idea to discuss this matter with your trichologist or hair transplant surgeon before scheduling your procedure. Generally speaking, you will likely be recommended to stop smoking for at least 2 weeks before and after your procedure. That is because failing to do so can jeopardize your hair grafts’ survival and the overall result of your procedure.
It is also advisable to avoid second-hand smoke during this period, as it can also have a detrimental effect on your blood vessels, even if you yourself are not smoking.
Vaping is not considered as harmful for your body as smoking a traditional cigarette [13] But would it make a safe replacement for smoking before and after your hair transplant? Sadly, it is still recommended that you abstain from e-cigarettes with nicotine as well for at least 3-4 weeks prior to and post-hair restoration surgery [14].
That recommendation is partly made because nicotine has a detrimental effect on wound healing and post-surgery complications. But it is also because e-cigarettes contain some other substances the effect of which has not been sufficiently studied to be deemed safe to use before a surgical procedure [15]. Find out more about whether vaping can cause hair loss.
The short answer is no, it is not recommended to use nicotine patches or any other forms of nicotine replacement (e.g. nicotine gum) before and after your hair transplant surgery.
A study performed on 470 participants revealed no significant differences in plastic surgery outcomes between patients who smoked traditional cigarettes and those who used nicotine patches, nicotine gum or vaped [16].
Aftercare is very important for your hair transplant success and graft survival. That is why it is recommended to wait for a certain period before engaging in the following activities after your procedure:
Light exercise (e.g. light jogging, light cycling): 10 days after your hair transplant
Heavier exercise (e.g. weight lifting, swimming): about 1 month after your hair transplant – it is best to discuss the best resuming time with your surgeon
If you are ready to say goodbye to your hair woes permanently, book a consultation now with one of the best hair transplant surgeons in the UK. You will be reassured to know that Wimpole Clinic has a 97-100% success rate for hair restoration surgery and a before and after hair transplant gallery that speaks for itself.
If you are concerned about whether the result will be conspicuous, rest easy. You can now get a hair transplant without anyone knowing. Besides, this procedure has become more and more mainstream, as numerous celebrities have had hair transplants and many of them have spoken openly about it.
So if you are tired of your M-shaped hairline, your bald spot on the crown or simply worrying about your hair falling out don’t hesitate to contact us. Our top-tier team looks forward to answering any further questions you might have about getting a natural-looking hair transplant.
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