Smoking is thought to retard wound healing through impairing tissue oxygenation (the good, wound healing fresh air "oxygen"), and relative hypoxia (too low of a level of oxygen) may also cause a sluggish neutrophil response to pathogens (which in English translates to your white blood cells are slowed way down and cannot fight the bad guys, bacteria that cause infection). This also leads to very poor wound healing. Face lift patients have had their cheek skin slough due to poor oxygen circulation.
Smoking is associated with an increased risk of wound infections even for simple wounds, let alone the complex wounds involved in facial plastic surgery. I have treated a patient with Fraxel re:pair laser who was refused face lift surgery until she quit smoking for at least 4 weeks. Even the Fraxel repair laser treatment patient had prolonged healing and excessive swelling. Studies have shown that at 4 weeks after quitting, smokers and non-smokers have equal rates of wound healing.
Quitting smoking at any point is one of the best things patients can ever do to help his or her general health and longevity. It is also an extremely difficult task, with smoking abstinence rates being well under 50% at 12 months after quitting in most studies. Today, physicians have more agents to help patients overcome nicotine addiction than ever before, and they are safe and effective. Buproprion therapy, nicotine patch, nicotine nasal spray, and nicotine gum are among the agents used to help smokers quit.
The best method of quitting is taking the bull by its horns and making up your mind that you will quit forever. Since smoking is a drug addiction, you will go through a difficult period of withdrawal symptoms.
Much good luck in quitting the habit.
Be well. Dr. P
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