Do you actively try to get your patients, who are smokers, to stop smoking? Please elaborate.
Do Plastic Surgeons Try to Get Their Patients to Stop Smoking?
Doctor Answers 7
Planning cosmetic surgery is a strong motivator to stop smoking
As a plastic surgeon, I am not an expert on nicotine addiction, which is an extremely difficult conditon to treat.
Many people who smoke (about 65%) are not physically addicted to nicotine, and these patients are often able to stop smoking when they understand that they cannot have the cosmetic surgery they want (typically a face lift or a tummy tuck) unless they do stop smoking. If a person absolutely cannot stop smoking (one of the 35% who is truly addicted), then I refer them to an expert for treatment.
It is gratifying to note that, in my patient population, there are many fewer smokers today than there were ten years ago. Education and social pressure are making an impact.
I have a number of patients who feel that the most important thing I did for them was get them to stop smoking (even though they are happy with their surgical result).
I will not perform conventional facelifts or abdominoplasties on people who smoke - but modified techniques (such as subperiosteal facelift), that do not require skin undermining, may be considered, especially in younger, thin patients with no other risk factors.
Breast reductions and breast lifts have to be individualized. Liposuction only (scarless) breast reduction can be performed safely on smokers. But any breast operation where the blood supply might be at risk should not be done if the patient does not stop smoking.
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I tell all patients who smoke that I will not perform...
I tell all patients who smoke that I will not perform their surgery if they don't stop all nicotine exposure for one month before and after surgery.
This is especially important in surgeries where the skin is lifted to tighten it and the blood supply is partially compromised by this. These procedures include facelifts, breast lifts and reductions, and abdominoplasties or tummy tucks.
Nicotine gums, patches, and even secondhand smoke must also be avoided. The nicotine causes the blood vessels to constrict and may result in skin death, terrible healing problems and, eventually, very bad scars.
Some doctors will do a urine nicotine test before surgery to be sure the patient has complied with this recommendation, but I have not done this. However, I have postponed surgery on several patients who admitted that they have not complied with this program and the rescheduling of their surgery has been at extra cost to them.
Many plastic surgeons limit the type of procedure they...
Many plastic surgeons limit the type of procedure they perform on smokers. Tobacco smoke contains more than 3,800 identified substances, of which nicotine and carbon monoxide are two of the most detrimental to wound healing and may cause pulmonary complications. This impaired wound healing may dramatically decrease the final cosmetic out. That is why, most plastic surgeon would recommend to their patients to decrease or quit smiking prior to their procedures.
However many plastic surgeons would opt to perform a less invasive technique on smokers.
I recommend limiting anesthesia for smokers. I always offer no anesthesia for smokers. In some cases I recommend oxygen therapy before the procedure.
Active measures to help patients quit
Yes. The ways that I, and likely many other plastic surgeons, actively take a role in getting patients to stop smoking is as follows:
1. Setting a quit date 2-3 weeks before the anticipated elective surgery date.
2. My nurse or I keeping in touch with the patient to check on smoking status and success in quitting.
3. Referring the patient to a support group or psychotherapist who may aid in this process, which is often multidisciplinary or involving several providers (even things like hypnotherapy, acupuncture, and Reiki have been known to help some). Not so sure about laser, though, as the jury is still out on that!
4. Collaborating with the patient's primary care provider or internist to arrange for a prescription drug such as Chantix or Zyban to be prescribed and the patient maintained on it well in advance of the surgical procedure and afterwards.
5. Positive feedback from my staff and myself.
6. Raising the possibility of cancelling surgery if the goal of stopping smoking is not reached. This usually serves as one of the biggest motivators given the nature of elective, cosmetic surgery and the patient's emotional investment in going through with a procedure that has likely been contemplated and planned for a long time and intended to improve appearance and sense of self.
Many good studies in the medical literature indicate...
Many good studies in the medical literature indicate that risks of complications after surgery increase in those patients who smoke. In patients undergoing cosmetic surgery, specifically facelifts, the risk of killing the skin which is elevated is signficantly increased in smokers over non smokers.
In my practice, if a patient will not quit smoking for two weeks before surgery and two weeks after surgery, I will not perform a cosmetic procedure on them. With cosmetic surgery, patients are interested in looking and feeling better and smoking brings an unnecessary set of risks into the equation. Instead of looking and feeling better there is a fair chance that the patient may end up with a complicated reconstructive problem.
Of note, patients who are on nicotine-containing smoking cessation programs are also at increased risk of complications. For my patients who are interested in smoking cessation, I will either prescribe medications which do not contain nicotine or put them in touch with support groups and other smoking cessation methods.
In the end, I want my patients to get the best results possible and unfortunately smoking often interferes with those results.
Smoking and surgery
1. There is nicotine in tobacco, but not in marijuana. However, most joints are rolled with marijuana and tobacco combination. Nicotine is a vasoconstrictor that decreases blood flow to the tissues. This is the major problems that can cause a very bad outcome in some surgeries. In a breast augmentation, there is not a lot of risk as there are not a lot of incisions which decrease blood flow to the tissues. In a breast lift or tummy tuck, on the other hand, there is much longer and more involved incisions. The decrease in blood flow to the tissues in combination with the decrease in blood flow from the nicotine can cause tissue to die. This can cause part of the breast or nipple, or in the case of a tummy tuck, part of the belly tissue to die, resulting in a very bad outcome. This is especially bad in breast reductions or face lifts. In a rhinoplasty the tip of the nose and the columella, the area between the tip and the lip, is at risk. Your skin and tissue can turn black and fall off if this happens. Marijuana without tobacco does not cause this problem, or marijuana in an edible fashion. Vaporizers do not decrease the amount of nicotine in tobacco, only decrease the smoke. Hookah also does not decrease nicotine.
2. There is carbon monoxide in both tobacco smoke and marijuana smoke. Carbon monoxide decreases the oxygen carrying capacity of hemoglobin in the blood. This is different from the vasoconstrictor effect, but has the same result of having the risk of tissue death in conjunction with surgeries that decrease the blood flow to tissues such as breast lifts and tummy tucks, as opposed to an augmentation alone that does not decrease blood flow to as great of an extent. Again, edible forms of marijuana do not have smoke, and thus carbon monoxide poisoning.
3. Coughing. Both tobacco and marijuana smoke disrupt the lining of the lungs and bronchi and can lead to coughing episodes. Coughing episodes can lead to internal bleeding after surgery that can lead to hematomas and complications, and again a bad outcome. Again, edible forms of marijuana does not have this effect.
4. Anesthesia effects. Marijuana can have drug interactions with certain anesthetic drugs. Thus it is important to tell your anesthesiologist about your marijuana use.
In conclusion, Smoking, whether it be tobacco or marijuana, is detrimental to your surgery outcome. Edible marijuana is much less so, but be honest about your use with your surgeon and anesthesiologist so that you can have the best outcome. In general, you should quite smoking many weeks, ideally 6 weeks before surgery, and not smoke for at least 2 weeks after surgery.
Pablo Prichard, MD
Yes, I encourage my patients to stop smoking completely....
Yes, I encourage my patients to stop smoking completely. Several studies suggest that the complication rate of smokers compared to non-smokers can be as high as 50%.
I inform patients that they should stop smoking at least 3-4 weeks prior to surgery and continue to not smoke for at least 3-4 weeks post-operatively. Nicotine patches or nicotine gum are not acceptable because the nicotine can cause vasconstriction (choking of the vessels).
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.