Some cosmetic operations can be done safely on smokers

I am afraid I have a prejudice that people who smoke are not very smart. (I myself smoked two packs of Camels a day for fifteen years!) But the key is not to be judgemental. True nicotine addicts cannot help it, anyway. It's only about surgical safety. So it depends on the operation.

Breast augmentation, liposuction, rhinoplasty (nose surgery), and eyelid surgery can be performed safely in smokers. I do not do face lifts, tummy tucks, breast lifts, or breast reductions in smokers except in unusual circumstances.

Of course, plastic surgeons try to help their patients quit smoking. But this is too much of a generalization. You are dealing with two distinct groups of smokers:

• People who are physically addicted to nicotine are pretty intractable. (Some experts feel that nicotine is more addictive than heroin.) Even addiction specialists have a high failure rate with this group. So they are probably going to be beyond what a well intentioned plastic surgeon can do.

• On the other hand, there are many smokers who are not physically addicted, and it is fairly easy to motivate this group to stop smoking - at least during the pre- and post-operative period. I explain that I am only concerned with their health and that I will not operate on them unless they stop smoking for at least one month.

Any patient who comes to me for elective, cosmetic surgery who smokes receives education on smoking cessation. Usually, the information and recommendations imparted to patients depends upon their medical status, the type of operation they are seeking, and their age.

For example, a healthy 28-year-old woman for breast augmentation is counseled that smoking is harmful to her health in many ways, including the way her scars will heal because of the blood vessel constriction caused by nicotine. But smoking in her case is not an absolute contraindication for surgery given the nature of breast augmentation, well vascularized nature of the breasts and absence of any "flap" dissection in this procedure. The most important thing, I tell her, is that this is definitely a habit that she does not want to keep, as it can cause permanent damage to her lungs, heart, skin and peripheral blood supply to her legs and arms.

On the flip side, a 60-year-old woman who is a two pack-a-day smoker who comes to me for a facelift is counseled on smoking cessation and told that without stopping at least two to three weeks before surgery, I may not perform the surgery. This is because the skin flaps that are created during a facelift can actually die from the harmful effects of nicotine and smoke, leaving scars on the face and open wounds that can be devastating to both the patient and surgeon. 

A nicotine test done by urine sample can be used to check to see if a patient is still smoking, but I generally trust my patients and what they tell me with regard to when they quit; otherwise, I may not deem them a suitable surgical candidate if I feel communication is not open and trust is an issue.

Psychotherapy, nicotine patches and gum, Chantix, and Zyban have all been described and used for smoking cessation. I usually help my patient set a stop date and coach them to use their upcoming surgery as a motivation to really quit for good, and have the patient's primary care doctor help out with prescribing any medication like Chantix or Zyban given the need for monitoring side effects and their general medical status. I have referred patients for psychotherapy, biofeedback, and meditation, as I believe these holistic approaches can help greatly; we all tend to do better with things when we get our mind on the right track.

Since my father is a smoker and has been for many, many years, I am especially sensitive to this issue as I have witnessed his premature physical decline over the past years. With my patients, I am sensitive and aware that it is "easier said than done" for me to tell them to quit cold turkey two weeks before surgery, and that they need a lot more than just a verbal dictum.

The best part about quitting is getting rid of the harmful toxins that are delivered every day to the lungs and vital organs of the smoker; this is a habit that is extremely addictive but can really cause a myriad of  health problems. I try to be there to support their smoking cessation and really provide positive reinforcement because in the end, they are the ones who will end up feeling better, looking healthier, and having a successful surgery with much less risk of complications.

Hope this helps!

Dr . Jennifer Walden

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Smoking is a definite no no for surgery. I always review this with patients. Patients that smoke have a significantly higher risk of complications as compared to those that do not. 

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