Besides the adversarial effects of smoking on the skin, lung, heart, brain, and kidney which are well known and established, the carbon monoxide that is inhaled during cigarette smoking decreases the oxygen content within blood. Oxygen, as we well know, is necessary for survival and the healing process. Thus, smoking inhibits wound healing, increases the possibility of infection, and can result in a poor result in cosmetic surgery. Life expectancy is shorter (mortality) and quality of life is decreased (morbidity). For all of the above reasons, I do not operate on active smokers in my practice. If smoking is continued without my knowledge and complications occur, the patient should bare some of the responsibility. I usually advise patients to stop smoking at least 6 weeks prior to any elective procedure and refrain from smoking until the healing process and resolved.