Almost every item on a facelift pre-operative checklist traces back to one of two risks: bleeding or impaired skin healing. Understanding which is which makes the instructions easier to follow and harder to forget. Nicotine should cease four to six weeks before surgery in most protocols; aspirin, NSAIDs and bleeding-related supplements are typically paused one to two weeks before. Blood pressure medication, by contrast, is usually continued — including on the morning of surgery.
Pre-operative instructions often arrive as a long list with no explanation.
Stop this. Pause that. Don’t take the other thing.
Lists like that are easy to half-follow, because nothing tells you which item matters most or why.
So this guide is organised differently. Every instruction is grouped by the risk it addresses — and once you see the logic, the list becomes much easier to remember.
The two risks everything comes back to
Facelift preparation is almost entirely about two things.
| Risk | What it means | Which instructions address it |
|---|---|---|
| Bleeding | Haematoma — a collection of blood beneath the skin, the most common complication requiring return to theatre | Blood pressure control, aspirin, NSAIDs, supplements, alcohol |
| Skin healing | Impaired blood supply to the repositioned skin, risking wound healing problems and in severe cases necrosis | Nicotine in all forms |
That is the whole framework.
If you remember nothing else: protect the blood supply, and keep the blood pressure steady.
Why haematoma matters so much in facelift specifically is covered in the article on risks and complications.
Six weeks before: nicotine
This is the earliest item, and the one with the longest lead time.
The mechanism
Published guidance is consistent on why: nicotine constricts blood vessels, restricts oxygen delivery to the skin, and significantly increases the risk of poor wound healing and, in severe cases, skin necrosis along the incision lines.
This matters more in facelift than in many other operations. A facelift repositions skin and deeper tissue — and that repositioned tissue needs an adequate blood supply to heal.
One source describes nicotine as the most significant modifiable risk factor for skin healing complications.
“Modifiable” is the key word. You can change this one.
How long?
Here the guidance genuinely varies between surgeons, and it is worth being honest about that.
| Published recommendation | Before surgery | After surgery |
|---|---|---|
| Most commonly cited | 4-6 weeks | At least 4 weeks |
| Some protocols | Minimum 2 months | — |
| Others | 1 week | 2-3 weeks |
The four-to-six week figure is the most frequently recommended and the more cautious position.
Your surgeon’s own protocol governs. Ask for it specifically rather than assuming.
The part most people get wrong
This deserves emphasis, because it is a common and consequential misunderstanding.
All forms of nicotine count. That includes:
- Cigarettes
- Vaping and e-cigarettes
- Nicotine patches
- Nicotine gum
- Nicotine pouches
- Heated tobacco products
Published guidance states this directly: products commonly used to help with smoking cessation — e-cigarettes, patches and gum — also cause wound healing complications after surgery.
So switching from cigarettes to vaping does not solve the problem. It changes the delivery method, not the vasoconstriction.
If you intend to use nicotine replacement to quit, discuss the timing with your surgeon — there may be a strategy, but it needs to be planned rather than assumed.
And one more
Sources note that second-hand smoke also raises nicotine levels in the blood and can cause complications.
If someone you live with smokes, this is worth discussing before surgery rather than after.
Cannabis
Published guidance notes that cannabis can have some of the same effects on flap survival as smoking, and separately affects blood pressure, sedation and the anaesthesia plan.
Typical advice is to stop at least two weeks before. Disclose use honestly — this is an anaesthetic safety matter, not a judgement.
Two to four weeks before: blood pressure
If nicotine is the skin-healing item, blood pressure is the bleeding item — and arguably the single most important thing on this list.
Published guidance puts it plainly: poor control increases bleeding risk while small vessels seal.
One surgeon’s guidance is specific: if systolic pressure remains in the 160-180 range, it must be brought under control with your own doctor before surgery proceeds.
The counterintuitive part
Most pre-op lists are about stopping things. This one is the opposite.
Blood pressure medication is usually continued — including on the morning of surgery.
One pre-operative manual instructs: take medications prescribed for blood pressure and heart on the morning of surgery, and inform the team that you have done so.
Do not stop or adjust blood pressure medication before surgery unless your surgical team specifically tells you to.
What to do
- If you have hypertension, ensure it is well controlled before the pre-operative appointment, not after
- Bring a record of recent readings if you measure at home
- Confirm the morning-of-surgery dosing instruction explicitly
- If your readings are unstable, say so — this changes planning
One to two weeks before: medications and supplements
This group is entirely about bleeding risk.
Aspirin and NSAIDs
Published guidance commonly advises pausing aspirin, ibuprofen, naproxen and other NSAIDs one to two weeks before surgery.
And there is a specific reason for the two-week figure with aspirin: the blood remains thinned for two weeks following a single dose, because the effect on platelets does not reverse quickly.
So “I only took one” is not a reason to skip the interval.
Important: if aspirin or another antiplatelet is prescribed for a cardiovascular condition, do not stop it without approval. This decision belongs to your surgeon and prescribing doctor together.
The same applies to anticoagulants — warfarin, clopidogrel and similar. Disclose them and let the team plan.
Supplements
This is where most patients are caught out, because supplements rarely feel like medication.
Commonly paused one to two weeks before facelift surgery:
- Fish oil and omega-3
- Vitamin E (including within multivitamins)
- Ginkgo biloba
- Garlic supplements
- Ginger
- Ginseng
- Turmeric / curcumin
- St John’s Wort
- Green tea extract
- Kava, echinacea, feverfew, bilberry, liquorice root, cayenne
- CBD
The common thread: these affect bleeding, or interact with anaesthesia, or both.
As one source puts it: “natural” doesn’t mean irrelevant to surgery.
Check your multivitamin
Vitamin E is present in many multivitamins. Guidance notes this specifically — a patient who has stopped their vitamin E capsule may still be taking it in another form without realising.
Don’t add anything either
Some pre-operative protocols include supplements to start — vitamin C, vitamin K or similar.
These vary between surgeons and are not universal. Do not start a new supplement on your own initiative because you read it aids healing. If your surgeon wants you taking something, they will tell you.
The principle works both ways: nothing starts or stops without the surgical team’s knowledge.
Weight-loss and other medications
Published guidance notes that some weight-loss medications can increase heart rate, raise blood pressure or interfere with anaesthesia.
Given how widely these are now used, disclose them specifically. They may require a particular protocol.
Two weeks before: alcohol
Typical guidance is to stop alcohol approximately two weeks before and two weeks after surgery.
Alcohol thins the blood, contributes to swelling, affects sleep quality and interacts with post-operative medication.
Nutrition and general condition
This section is less about restriction and more about giving the body what healing requires.
- Protein. Tissue repair depends on it. Maintain adequate intake in the weeks before and after.
- Hydration. Begin well before surgery rather than the day before.
- Stable weight. Avoid starting a restrictive diet in the weeks before surgery — healing is not the time for a calorie deficit.
- Sleep. Arrive rested rather than depleted.
- Dental and other infections. Address any active infection before, not after.
One detail worth noting: smoking deactivates vitamin C, which is one of the reasons healing is impaired in smokers. It is another argument for the nicotine interval rather than a reason to self-prescribe vitamin C.
Logistics: the week before
Clinical preparation gets most of the attention. Logistics gets forgotten — and then becomes stressful at exactly the wrong moment.
- Arrange someone to be with you for the first 24 hours. Published checklists specify this, and it is not optional. The first 24 to 48 hours is also the window in which haematoma typically presents.
- Fill all prescriptions before the day of surgery. Not on the way home.
- Confirm your arrival time.
- Confirm fasting instructions. Typically nothing to eat or drink after midnight, but confirm.
- Prepare the recovery space. Extra pillows for head elevation, straws, soft foods, ice packs, a thermometer.
- Arrange time off. Social return is usually measured in weeks, not days.
- Colour your hair beforehand if you intend to. Published guidance suggests the week before surgery; afterwards there will be an interval during which it is not advisable.
- Front-fasten clothing. Nothing that has to be pulled over the head.
If you are travelling for surgery
Two additions.
Build the stay around the haematoma window, not the itinerary. The first 24 to 48 hours is when the time-critical complication presents, and being monitored and reachable during that period is the point of the stay length.
Bring a written list of everything you take. Prescriptions, over-the-counter medication, supplements, with doses. Reconstructing this from memory in a consultation room is how things get missed.
Considerations for international patients are covered in a separate guide.
The day before and the morning of
- Follow fasting instructions exactly
- Take only the medications you have been told to take — typically blood pressure and cardiac medication, with a sip of water
- No makeup, nail polish, jewellery or contact lenses
- Wash hair as instructed
- Arrive on time with your companion
A downloadable checklist
This information is easier to act on as a dated checklist than as an article.
A useful format works backwards from the surgery date:
| When | Items |
|---|---|
| 6 weeks before | Stop all nicotine · Confirm blood pressure is controlled |
| 4 weeks before | Arrange time off · Arrange your companion · Book accommodation if travelling |
| 2 weeks before | Stop aspirin and NSAIDs (unless told otherwise) · Stop listed supplements · Stop alcohol · Stop cannabis |
| 1 week before | Fill prescriptions · Prepare recovery space · Colour hair if desired · Final pre-op appointment |
| Day before | Begin fasting as instructed · Pack · Confirm arrival time |
| Morning of | Take only approved medications · No makeup, polish, jewellery, lenses · Arrive with companion |
Two columns make this more useful: one for the date you will do it, one to tick when done.
Ask your surgeon for their own version. Where a clinic’s instructions differ from anything here, theirs apply — they are written for your procedure and your medical history.
The disclosure conversation
One final point, and it matters more than it sounds.
Published guidance notes that a forgotten anti-inflammatory, a concealed nicotine habit or an unreported herbal product can alter your surgical instructions.
Disclose everything:
- All prescription medication
- All over-the-counter medication
- All supplements, vitamins and herbal products
- Nicotine in any form, honestly
- Cannabis and recreational substances
- Alcohol intake
- Previous surgery and anaesthetic history
- Any bleeding tendency in you or your family
None of this is asked to judge you. It is asked because it changes the plan — and a plan built on incomplete information is a less safe plan.
In summary
Nearly every pre-operative instruction addresses one of two risks: bleeding or impaired skin healing.
For skin healing, nicotine is the item that matters — in all forms, including vaping, patches and gum, which published guidance notes also cause wound healing complications. Most protocols specify four to six weeks before and at least four weeks after, though recommendations vary and your surgeon’s own protocol governs.
For bleeding, blood pressure control comes first, with aspirin, NSAIDs, bleeding-related supplements and alcohol paused one to two weeks before. Aspirin’s two-week interval exists because the blood remains thinned for two weeks after a single dose.
And one instruction runs the other way: blood pressure medication is usually continued, including on the morning of surgery. Confirm this explicitly rather than assuming.
Logistics deserve the same attention as the clinical items — particularly arranging someone to be with you for the first 24 hours, which is also the window in which the most time-critical complication presents.
If you would like your own preparation plan discussed, you can arrange a free video consultation. The procedure itself is explained in the article on technique, and candidacy in a separate piece.
Frequently Asked Questions
How long before a facelift should I stop smoking?
Most published protocols specify at least four to six weeks before surgery and at least four weeks afterwards, though recommendations vary between surgeons — some advise two months, others shorter intervals. Nicotine constricts blood vessels and is described as the most significant modifiable risk factor for skin healing complications.
Does vaping count?
Yes. Published guidance states that products commonly used for smoking cessation — e-cigarettes, nicotine patches and nicotine gum — also cause wound healing complications after surgery. Switching delivery method does not remove the vasoconstriction. Second-hand smoke also raises blood nicotine levels.
Which supplements should I stop?
Commonly paused one to two weeks before: fish oil and omega-3, vitamin E, ginkgo, garlic, ginger, ginseng, turmeric, St John’s Wort, green tea extract and CBD, among others. Check multivitamins, as vitamin E is often included.
Why two weeks for aspirin?
Because the blood remains thinned for approximately two weeks following a single dose, as the effect on platelets does not reverse quickly. If aspirin is prescribed for a cardiovascular condition, do not stop it without approval from your surgeon and prescribing doctor.
Should I stop my blood pressure medication?
Usually no — the opposite. Blood pressure medication is typically continued, including on the morning of surgery, with the team informed. Poor blood pressure control increases bleeding risk. Confirm the specific instruction with your surgical team.
Can I start supplements to help healing?
Not on your own initiative. Some protocols include specific supplements to start, but these vary between surgeons. Nothing should start or stop without the surgical team’s knowledge.
Do I need someone with me afterwards?
Yes. Published checklists specify arranging a friend or family member to be with you for the first 24 hours. This is also the window in which haematoma, the most common complication requiring return to theatre, typically presents.
What if my surgeon’s instructions differ from this article?
Follow your surgeon’s instructions. They are written for your specific procedure and medical history. This guide explains the reasoning behind common instructions; it does not replace them.
Assoc. Prof. Dr. Emine Demir — Facial Aesthetic Surgeon specialising in deep plane facelift, neck lift and endoscopic facial rejuvenation. About Dr. Demir
This content is for informational purposes only and does not constitute medical advice. Pre-operative instructions vary by patient and procedure; your surgeon’s own protocol takes precedence. Do not start or stop any medication or supplement without the direction of your surgical team.
References
- How to Prepare for Facelift Surgery: A Pre-Operative Checklist — nicotine cessation intervals and supplement timing.
- How to Prepare for a Facelift: Complete Guide — blood pressure prioritisation and medication tables.
- Facelift Pre-Operation Manual — aspirin, vitamin E and morning-of-surgery medication instructions.
- Things to Avoid Before and After Plastic Surgery — nicotine replacement products and second-hand smoke.
