Background: Smoking's impact on tissue perfusion and wound healing is particularly relevant in rhinoplasty, where precise tissue healing is crucial for functional and aesthetic outcomes. While the nasal region's robust vascular supply mitigates smoking's detrimental effects, concerns remain about postoperative complications. This study investigates whether smoking should be contraindicated for rhinoplasty by comparing infection and revision rates between smokers and nonsmokers.

Methods: A retrospective review was conducted on 1884 rhinoplasty cases from 2014 to 2022. Patients were categorized as active smokers, former smokers, or nonsmokers. Only patients with at least 12 months of follow-up were included. All procedures were open rhinoplasties conducted under general anesthesia. Primary outcomes analyzed included infection and revision rates. Between group statistical comparisons were performed.

Results: 1884 patients consisted of 80 active smokers, 39 former smokers, and 1765 nonsmokers. Average follow-up was 23.8 months. The overall revision rate was 3.3%, with 3.8% in smokers and 3.3% in nonsmokers. 3.8% of smokers required additional antibiotics for cellulitis compared to 1.6% of nonsmokers; all cases resolved without long-term complications. There were no significant differences between smoker and nonsmoker rhinoplasty patients in rates of revision, postoperative infection, or wound complications.

Conclusions: Active smoking does not appear to be a strict contraindication for rhinoplasty. Smoker and nonsmoker primary and revision rhinoplasty patients exhibited similar revision, postoperative infection, and wound complications rates. This suggests that, with proper perioperative optimization, rhinoplasty can be safely performed in smokers. While smoking cessation should still be recommended, it may not be mandatory for satisfactory outcomes.