Plastic surgery patients who smoke
How do plastic surgeons feel about operating on patients who smoke?
Do plastic surgeons try and help patients quit?
Are more doctors actively trying to get patients to stop smoking or offer smoking cessation programs or patches or thing like that?
Answers (7)
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.
Plastic surgery and smoking cessation
Plastic surgeons are doctors of medicine first before they specialize in surgery. As such, the care of the whole patient is always their concern so efforts are directed at guiding their patients toward healthy lifestyle choices such as cessation of smoking, proper diet, exercise, and weight management.
Specifically, with regard to smoking, it is critical that patients be off all nicotine products for a month before and a month after certain kinds of surgeries. These are surgeries that require extensive undermining of the skin to achieve their results. The most common of these are facelifts, breast lifts and reductions, and tummy tucks. By undermining the skin to lift it, the blood supply to the skin is partially compromised but not to the point where it will die. In the smoker, however, the nicotine constricts the blood vessels and can tip the fine balance of blood flow in these procedures toward the point where the skin may die and result in terrible scars and an extremely poor result. It is the nicotine that is the culprit here so gums and patches are just the same as actually smoking.
Also second-hand smoke has been shown to potentially cause the same healing problems so avoiding other smokers is also critical.
In procedures where the risk of skin death is minimal even in a smoker, such as eyelid lifts and breast augmentations, the safe conduct of anesthesia is vastly improved by not smoking. If a doctor has instructed a patient to not smoke, they must take this seriously!
Plastic Surgery may curb the smoking habit
Smoking tobacco of any kind puts the plastic surgery patient at risk for severe complications. The goal of any board certified plastic surgeon is to minimize risk to our patients, especially for elective cosmetic surgery. Most patients understand this fact and will work with me to stop smoking, including referral to smoking cessation clinics, their primary doctor, or holistic approaches, such as acupuncture.
I have had several patients over the years come back to me, with their significant other, and thank me for helping them to stop smoking. One husband said, "The surgery was worth it to get my wife to stop smoking alone; I have tried everything! It has been more than a year and she looks great and does not smoke anymore!"
Plastic Surgery can be a powerful thing if patients do their homework; safety comes first!
Butt Out! Why Risk Having Your Plastic Surgery Results Go Up In Smoke?
Smokers are not good candidates for plastic surgery
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.
Smoking and plastic surgery
There is no question that when I am doing a flap of skin (tummy tuck, facelift, mastopexy or reduction of the breast), I require patients to stop smoking for three weeks before the procedure. The effects of smoking are almost gone in three weeks.
Smoking introduces carbon monoxide into your system, which steals oxygen from the tissues, as well as nicotine, which crimps down on the blood vessels. There are many side effects, including longer healing time, worsened scars and more complications in patients who smoke.
There are things that you can do to mitigate the effects of smoking, such as modify your SMAS facelift to pull more on the deep tissues and less on the skin, or take the tension off of the deep tissues of the abdominoplasty. But, we are trying to stack the deck in our favor, not in the favor of having more complications. I have for years put people on oxygen after a flap surgery just to increase the oxygen in the tissues for a few days.
Using patches or gum sounds good, but you still have the effects of the nicotine from these products. I remember a well-intentioned internist who tried to be very nice to my patient by ordering the patch after her tummy tuck, just to watch the lower area in the midline necrose a section of skin about the size of a baseball.
Complications that arise because of the choices that our patient makes is something that we would like to help avoid. Most board certified plastic surgeons and members of the American Society for Aesthetic Plastic Surgery who I know and respect really want their patients to have better outcomes, so they will require their patients to quit smoking for at least 3 weeks before the procedure in order to decrease the potential problems.
There are procedures that do not have flaps, such as liposuction, that I don't make as big a fuss over if patients smoke before surgery, even though they also have higher complication rates (like pneumonia after anesthesia, or spontaneous pnemothorax - dropped lung). There are no studies showing more capsular contractures with breast augmentation in those who smoke, but in my practice, I have noticed that patients who smoke seem to be more likely to end up with hard breasts after augmentation.
So the short answer is that you will get better healing and fewer complications if you maximize the oxygen going to your tissues by not smoking. Conversely, if you smoke and thus deprive your tissues of oxygen, you are at greater risk for more complications and worsened scarring.
Smoking cessation and cosmetic surgery
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

8/2/08
the interesting thing i,ve noticed is that a great many doctors and dentists smoke,and so obviously they too have a struggle to quit,and i know its not easy.
i never touch alcohol and yet the smoking ,ggggrrrrrr.!