How Does Smoking Affect Healing and Scarring After Plastic Surgery?

I'm a smoker. They (any facial surgeon) say you MUST quit smoking 2-6 weeks before and I'm having a real problem. I went from 20 to 24 cigs. a day down to 2 and still its a problem. Perhaps someone could elaborate on the why and how it effects the healing process, scaring whatever. Thank you.

Doctor Answers (6)

Quit Smoking and Remember, "You're a Puff Away From a Pack a Day!"

+7

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


Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Smoking and Surgery

+5

I agree with the answers listed below but would like to elaborate on other issues with smoking.

For wound healing there are actually two factors.

First - Nicotine causes blood vessel constriction, reducing blood supply to the skin. When we perform surgery the incisions we leave reduce normal blood flow. We count on the remaining blood supply that we haven't cut to keep skin and soft tissue alive. Smoking works directly against this.

Second - Smoking also causes small vessel damage (which takes longer to reverse) which compromises blood flow.

In addition to wound healing issues, smoking also makes anesthesia more complicated. Smoke actually paralyzes your cilia (little hair like structures in your lungs that help move debris out of the smallest parts of your lungs). This is why when you wake in the morning you have a cough that is quieted by a nice cigarette. Overnight you haven't smoked and some of those cilia have recovered and have been moving junk out of your lungs and you cough it out. That AM cigarette stops the cilia motion again and you don't need to cough because the debris stays in the lungs.

This as well as many other problems with smoking can significantly increase anesthesia complications which can lead to prolonged intubation, pneuomonia, etc.

All of these reasons are why most plastic surgeons will ask people to stop smoking prior to surgery.

I hope this helps!

Steven H. Williams, MD
San Francisco Plastic Surgeon
5.0 out of 5 stars 22 reviews

The problem with smoking and facelift surgery is that...

+5

The problem with smoking and facelift surgery is that the nicotine constricts the blood vessels that are critical to keeping your lifted skin alive as you heal from surgery. Inadequate blood flow will lead to skin death, with the skin turning black and sloughing off leaving substantial scars on your face that are permanent. The nicotine is the culprit, not the actual smoke so nicotine gums and patches are equally bad.

A period away from all nicotine of one month before AND another month after surgery will take your risk down to almost normal and might also help you kick the habit permanently as a side benefit.

Included in this time is the need to avoid second hand smoke as this has been shown to also harm healing.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 47 reviews

Smoking and Facelift Surgery

+3

Much of my objection to smoking has been well covered by the previous answers.  One of the major acute  problems with active smokers is the carbon monoxide affect (from smoking) on oxygen carrying capacity in the blood stream.  This adversely affects recovery on a variety of levels, most specifically wound healing. Therefore, a non-smoking period of at least 2 weeks, but preferably 6 weeks is required.

The major chronic problem with smoking is that Nicotine constricts the pipelines for blood flow to the skin provided by a network of blood vessels known as the sub dermal plexus.  Over time, the nicotine effect permanently affects these blood vessels, leading to diminished cutaneous blood supply.  This helps explain why a long term smoker's skin typically looks older than a non-smoker's skin. Because many patients seeking Facelift tend to be age 50 and older, many with at least a 10 year plus history of smoking before quitting, I have adopted a modified deep plane, composite elevation technique for many of my Facelifts. This helps to minimize the "random" flap component of the Facelift, minimizing the "dead space"  by keeping SMAS and skin attached.  This technique helps give an aesthetically pleasing, predictable result

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

How does smoking affect healing and scarring after plastic surgery?

+1
Hello! Thank you for your question! The issue with nicotine is that it also acts as a vasoconstrictor, clamping down of blood vessels. Blood supply is always of great concern during any surgical procedure, but especially in such procedures as breast procedures and a tummy tuck where the viability of the nipple, belly button, and skin flaps are obviously important. Since the vascularity to the area is already tenuous with the dissection of the abdominal tissue as well as cutting around the areas, maximizing blood flow to the tissue is critical.

Typically, we recommend at least 6 weeks of smoking cessation prior to and at least 6 weeks after any surgical procedure. The longer, the better. Nicotine always increases the risk for infection, skin flap necrosis, and wound complications, as well as other health consequences. There is an increase pulmonary risk with the anesthesia and postop lung infections. The most devastating consequence of infection, especially since the tissue is tightened, is increased. This along with wound healing and scarring. Some surgeons will refuse to operate on smokers and often check urine or blood levels prior. I would discuss this with your surgeon prior to your procedure. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 11 reviews

How does smoking affect healing

+1
There are 2 reasons that smoking interferes with the healing process.  First, nicotine causes constriction of small blood vessels which decreases the amount of blood flow to the surgical area.  Less blood flow means less oxygen so healing is impaired.  The second reason is because of carbon monoxide as a by-product of smoking.  Carbon monoxide also constricts blood flow.   Therefore even 1 cigarette or even the nicotine gum and patches can impair wound healing.  Hope this helps

Jeffrey Antimarino, MD
Pittsburgh Plastic Surgeon
5.0 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.