Smoking and Elective Facial Plastic Surgery
Nearly 50 million Americans are smokers. Each year, 40 to 45 percent of smokers nationwide try to quit, but only 5 percent succeed. In recent years, as the number of aesthetic surgical procedures has skyrocketed with nearly 12 million procedures performed nationwide — a 400% increase in the last decade, vanity and the desire for cosmetic surgery should now be added to the reasons to quit smoking.
The threat of not being able to get a coveted new face, stomach or pair of breasts carries great weight among patients. It is unfortunate that when someone hears an intangible and long term risk from their internist or cardiologist that they tend to dismiss the threat if they’re feeling well.
With elective plastic surgery, the risks are more immediate. it’s a little bit different. Cosmetic surgery candidates are highly motivated and desirous of an elective procedure. In my experience, this has proven to be a strong motivation for smoking cessation in order to obtain something they truly want.
In my practice, I refuse to perform aesthetic surgery on smokers or those who use nicotine or tobacco products, especially those seeking a face-lift and procedures that require skin to be shifted. Such patients are required to quit smoking for a minimum of two weeks prior to surgery and two weeks subsequent to surgery. In addition, they are required to attest to quitting smoking and to sign an informed consent that details the risk of continuing to smoke in the perioperative period. This legal waiver states that they have stopped smoking and acknowledges the postoperative risks and potential complications of continuing to smoke.
Nicotine causes the small vasculature of the skin to constrict, which compromises the vital blood supply to the skin. Complications include poor wound healing, increased risk of infection, longer-lasting bruises, and raised, hypertrophic scars. Smokers also bear the increased risk of infection and respiratory complications during anesthesia.
Smoking cessation crutches such as nicotine gum and patches also predispose to skin flap related complications. Smoking cessation plans that include prescription medications such as Wellbutrin or Chantix, hypnotisis and support groups are strongly recommended. Patients recognize that cosmetic surgery is an investment and that the patient should participate and do his or her part to ensure the best possible outcome.
Since most plastic surgery is elective, facial plastic surgeons have time on their side. You can establish quitting smoking as a requirement to proceed with surgery and many patients are strongly motivated talk to comply. And then there’s the matter of the cosmetic surgeon’s reputation — in elective surgery, the threshold for complications is zero and none of us wants an unfavorable outcome as our marketing billboard.
It is our experience that many patients who quit smoking for four to six weeks in the periopertative period remain long term non-smokers. Since fewer than one in ten smokers are successful in becoming long term non-smokers, it is our hope as surgeons that we can benefit the health of our patients but encouraging smoking cessation in a positive and supportive fashion.
Ross A. Clevens, MD, FACS
Published in FloridaMD Magazine, Jan 2011