"Minimal to none" is like "a little pregnant" or "almost dead to dead."Even one cigarette or second-hand smoke (and that includes e-cigarettes that use nicotine liquids) can create ischemic conditions in the cells furthest from the blood supply--i.e., those at the edges of the wound that are trying to heal to those on the other side at the edges of the opposite wound.Since skin is much more durable than the fatty tissue just beneath the skin surface, you would be shocked to see what might be dead fat and necrosis just beneath the surface due to your smoking.Open wounds become exposed to and contaminated with bacteria from the air and your normal skin bacteria, but poor healing caused by ischemia starts the open wound that becomes secondarily infected, not infection causing poor healing!Honestly, I can hardly contain my feelings of anger, since you will blame your surgeon if this all falls apart, and will want him or her to "fix it" and will complain about costs of re-operation or loss of implants if they become infected from the open wounds. "If you had only told me how important not smoking is, or how serious the problems could be, I would have listened" is what I have had patients tell me. Trust me, I tell them. I hope that this is clear to you as well. Surely your surgeon told you not to smoke. I know you've read this online as well, as you tried to minimize it by saying "minimal to none." At what point did you decide it was OK to ignore your surgeon's advice?Stop smoking completely, NOW. Do not be around second-hand smoke either. Avoid nicotine patch, gum, spray or any other source including e-cigarettes. Leave your steri strips in place. See your surgeon and ask if prophylactic antibiotic coverage is recommended. Keep your hands away from your open wounds. If you have cats, please do not touch your cats and try to establish a cat-free zone in your bed and bathing areas. It may already be too late, but please stop smoking and see your surgeon for more advice. Good luck. Dr. Tholen
