Butt Out! Why Risk Having Your Plastic Surgery Results Go Up In Smoke?

Every responsible Plastic Surgeon advises his patients to quit smoking at least three weeks before and two weeks after an anticipated surgical procedure. Ideally, patients should quit smoking entirely, or better still should never take up the habit in the first place. I find it confounding that otherwise intelligent people in this day and age begin or continue to smoke in seeming total disregard of the wealth of information available which directly links smoking to premature death as a consequence of heart and lung disease. Nevertheless, this public health issue also has a direct bearing on a patient’s readiness for cosmetic or reconstructive surgery.

 

Many plastic surgery procedures, including face lifts, breast lifts and reductions, and tummy tucks, involve elevation of large areas of skin which are supplied in some cases by a fragile circulatory system of small arteries and veins. Cigarette smoke and its various toxic components cause constriction of these small blood vessels as well as reduced oxygen carrying capacity, thereby compromising this fragile circulation within these elevated flaps of skin. Under normal circumstances (that is, before the flaps are raised), smoking does not create any noticeable decrease in circulation, however after surgery, the diminished blood flow can have catastrophic effects in terms of loss of skin or underlying tissue.

 

Besides the risk of skin or tissue loss as a consequence of smoking, there are additional risks that smoking poses for the patient contemplating plastic surgery. Smokers generally have more mucus production and reactivity of their airways, and coughing in the post-operative period after delicate surgery such as eyelid surgery, rhinoplasty, and face lift surgery may be associated with a greater risk of post-operative bleeding or hematoma. The diminished oxygen carrying capacity of the blood may result in delayed or compromised wound healing. In addition, smokers are more likely to develop Deep Venous Thrombosis (DVT) which can lead to Pulmonary Embolus (PE), a potentially life-threatening complication, the risk of which increases in women using birth control pills who also smoke.

 

Nicotine patches or nicotine gum are no less harmful to the patient than smoking, and should be included in the policy of strict abstinence from all nicotine-containing products, including cigarettes, at least three weeks before and two weeks after a plastic surgical procedure. If there is enough lead-time before the surgery, and patients wish to quit smoking, there are other medications and behavioral therapy modalities that are available to assist the patient through the detoxification process, and I recommend these to all smokers.

 

Human nature being what it is, some patients will continue to smoke up to and through the surgery and recovery process. As part of my informed consent, I require patients who smoke to sign an acknowledgement that continued smoking may result in wound healing complications beyond my control, for which the patient assumes personal responsibility. For high-risk patients and procedures, I reserve the right to cancel the operation.

 

When it comes to plastic surgery, every precaution should be taken by both the patient and the surgeon to insure that the beautiful and hard-earned results don’t go up in smoke. So when it comes to smoking, the best policy is to “Butt Out!”