Review on the impact of smoking on wound healing following facial procedures.

Abstract

Optimal aesthetic and functional outcomes in facial surgery depend on effective wound healing. Although the impact of cigarette smoking on postoperative healing has been widely studied, its specific influence in the context of facial procedures remains debated. This review evaluates how smoking compromises wound healing and increases the risk of postoperative complications by synthesizing current evidence on its influence in facial surgical procedures. This scoping review included original observational studies (cross-sectional, case-control, and cohort) published in English that examined associations between cigarette smoking and wound healing following facial procedures. Eligible participants included patients of any age or sex undergoing facial surgery or sustaining facial trauma. Exposure was defined as active smoking or a history of smoking and was compared with non-smokers or those with documented cessation. Primary outcomes included complications such as skin slough, wound dehiscence, infection, and flap or graft necrosis. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. Of 129 screened records, nine studies met the inclusion criteria. Across various facial procedures, active smoking was consistently associated with impaired wound healing, with reported complication risks ranging from 1.8-fold to 12-fold higher among smokers. Commonly reported adverse outcomes included flap necrosis, infection, and wound dehiscence, although several studies reported no statistically significant association in specific procedural contexts. Smoking is strongly associated with poorer wound healing following facial surgery, particularly in flap-based procedures. These findings emphasize the importance of perioperative smoking cessation to improve healing and reduce preventable postoperative complications.