Cigarette Smoking and Cosmetic Surgery-A Pain in the Ash

We live in a society that is rapidly becoming completely non-smoking.  This is a good thing but we’re not there yet.  As of 2007 43.4 million adults or 1 in 5 smoked.  This is astonishing.  And what’s more interesting is the number of patients that come to me for cosmetic surgery that smoke cigarettes.  These are patients that want to improve their appearance yet are doing the worst thing they can for it.  So let’s take a look at why cigarette smoking and cosmetic surgery don’t mix.

Cigarette smoke contains who knows, maybe 100 plus different chemicals that penetrate the body raking havoc with different systems.  First the nicotine attacks the blood vessels leading to the growth of new blood vessels withing the existing ones.  In addition fat released by nicotine’s effect on the brain becomes plaque in the blood vessels.  Combined, over time, this leads to a significant reduction in blood flow by constricting the vessels.  In addition the second major ingredient of cigarette smoke, carbon monoxide binds to the molecule that transports oxygen in red cells and displaces the oxygen.  This reduces the amount of oxygen that gets to healing tissue (ischemia).  In addition the third major ingredient in cigarette smoke, hydrogen cyanide, decreases the number of collagen producing cells and other inflammatory cells.

To put it in a little better perspective, smoking one cigarette significantly reduces blood flow to the skin for 30-50 minutes.  This means that for most of the day a smoker is ischemic or has significantly decreased blood flow to the skin.  The plastic surgery literature is filled with studies that have demonstrated the detrimental effects of cigarette smoking on wound healing.  But what does it mean to each patient.  For example if a patient smokes and desires a breast reduction, augmentation, mastopexy, abdominoplasty or any other surgery the risk of tissue loss, such as the nipple/areola, abdominal skin or belly button is incredibly high.

So, first stop smoking.  If you desire cosmetic surgery see your surgeon and your internist so you can get the help you need to quite.  I am a conservative surgeon and will request that patients quit at least 1 month prior to surgery.  In addition I will check a nicotine level at the time of surgery and if elevated will cancel the surgery.  A bad outcome from cosmetic surgery, because of smoking, isn’t worth the pain and aggravation to both the patient and the physician.