Did I Affect the Final Result of my Rhinoplasy During One Week of Smoking and Sun Exposure 11 Days Post Op?

The day of my cast removal my nose looked small, however the day after when i traveled i started to smoke and i had sun exposure every day in the beach and sometimes my nose really swells after the sun. Fortunately after my one week vacation i stopped smoking and stopped going out in the sun so i am worried i damaged my results because i have more swelling in one side so my nose appears a little bit assymetric. I am 4 weeks post op and I had medial and lateral osteotomies endonasally.

Doctor Answers 3

Smoking and surgery

Dear Jimmy,
Thank you for your post.  Smoking and sun exposure are detrimental to surgery, especially rhinoplasty.
Here are the major points of smoking Tobacco or Marijuana before or after 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. In fat transfer, the constricted blood flow can cause the fat to not get a blood supply and die. 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.
Best wishes,
Pablo Prichard, MD

Phoenix Plastic Surgeon
5.0 out of 5 stars 47 reviews

Did I Affect the Final Result of my Rhinoplasy During One Week of Smoking and Sun Exposure 11 Days Post Op?

       You should be examined by your surgeon, and you should explain your actions to him or her.




Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Your nose could die and fall off.

Well, not really, but what were you thinking? That circulation for healing was no longer necessary? Or that a mostly numb nose could be safely sun-exposed when there is reduced or absent protective sensation?

I'm sure your surgeon would be appalled, and you should be rightly concerned that your results could be compromised. There is a reason your surgeon told you to avoid smoking for AT LEAST 2 weeks before and after surgery.

Asymmetry can be the result of more scar tissue on one side as compared to the other, and this may be more related to excessive vacation activity than sun or tobacco. None of which are good, BTW, this early after surgery.

Talk to your surgeon; s/he will need to examine you to see if there is any permanent damage. You spent good money, time, and effort to obtain improvement in your nose, and I'm sure your surgeon expended maximum effort to achieve your desired results. Why do stupid things and ask if you may have ruined your result? Perhaps you think it's OK to join a fight club? No; so why would you think smoking and sun exposure is "no problem" when we all specifically advise against this? I truly hope you consider your ongoing choices more carefully. Good luck. Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 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.