Untoward Consequences of Tobacco and Cigarette Smoke with Regard to Plastic Surgery
Dr. Kenneth Benjamin Hughes is a Harvard-trained, board-certified plastic surgeon practicing in Los Angeles, CA. Dr. Kenneth Hughes has built a fully accredited, state-of-the-art surgery center in which he performs a wide range of cosmetic and reconstructive plastic surgeries. Dr. Kenneth Hughes performs tummy tuck, Brazilian... more
Dr. Kenneth Benjamin Hughes performs a great number of plastic surgery procedures in his surgical center in Los Angeles. The tobacco combustion from cigarette smoke increases the risk of complications following any type of surgery. Most surgeons typically recommend that patients who smoke should stop smoking for at least one month prior to elective surgery.
There are manifold reasons for this recommendation. Smoking contains several chemicals that are harmful to healing. Nicotine is a potent vasoconstrictor, which will decrease the blood supply to the healing tissue and result in greater complications, including poor wound healing and poor scarring. Additionally, cigarette smoke contains carbon monoxide, which decreases the ability of the blood to transport oxygen to the healing tissues. This chemical also results in poor wound healing. Finally, cigarette smoking contains hydrogen cyanide, which is essentially a cellular poison that increases complications through multiple processes. In addition to these chemicals, there are many other chemicals that are the combustion products of the tobacco that result in additional problems including the well-known correlation between smoking and various types of cancer.
Some of the chemical compounds in the tobacco smoke can be removed from the body in a few hours. Thus, smoking cessation just a few hours or days before surgery can result in significant reduction of complications. However, for the patient to return to more normal respiratory and immune system function, smoking cessation should occur at least a month prior to surgery. The cigarette smoke definitely reduces the ability of the immune cells to recognize and remove bacteria and other microbes that can lead to infection. The inability of the cells to perform the normal surveillance functions can obviously have grave repercussions. Cigarette smoke is also known to significantly reduce lung function, increasing the risk for lung-related complications, including asthmatic attacks. We also know that smoking increases the rate of platelet aggregation and clot formation, leading to the increased risk of heart attack and stroke.
There are some very specific complications related to plastic surgery. In addition to the wound healing complications that have already been delineated, these compounds can lead to poor scarring and higher scar revision rates. Also, smokers have a 50% higher rate of fluid collections (seromas), which can distort and totally destroy a very nice cosmetic result after liposuction or similar body contouring procedures. Patients who have breast reconstruction and who are smokers have a much higher rate of breast implant complications, requiring removal of those implants.
Although this has been a cursory review of smoking’s negative impact upon healing following surgery, specifically plastic surgery, it is very important to follow guidelines recommended by your surgeon. Most surgeons will recommend at least 2 to 3 days of cessation of smoking to reduce the short-term negative repercussions of the cigarette smoke, which is reflected by the nicotine and carbon monoxide. For patients who have a higher smoking burden, it is probably much more appropriate to recommend at least a month prior to any elective surgery including cosmetic surgery. It is also important to recognize that you should not just quit before surgery, but you should not be smoking throughout the postoperative period. This may be at least six weeks if not longer.
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