Smoking and Plastic Surgery...They Don't Mix

By Elana Pruitt © 2007
PlasticSurgery.com Editor

"I shouldn’t have assumed that I knew more than my doctor," says Tessa S. from Mission Viejo, Calif. "If he says don’t smoke, don’t drink – then don’t! They aren’t saying that for their health, they’re saying it for ours."

Desiring a beautiful façade with the help of plastic surgery, yet remaining a “smoker” and disregarding the harm it causes on the inside…hmmm…sound familiar? Despite the fact that more than 400,000 people die each year from a smoking-related illness or disease, permanently quitting can be a relentless and exhaustive struggle. So can the challenge of temporarily giving up nicotine during the pre- and post-op period.

But risks are risks, and whether you are regularly exposed to secondhand smoke, rip open two packs a day, or believe yourself to be a “social smoker,” you are susceptible to prolonged healing complications. According to Northern California board certified plastic surgeon Dr. Gary Friedman, smokers already have some degree of permanent constriction of blood vessels, which is known as "vasoconstriction." So these patients are already at a disadvantage as compared to non-smokers when heading into surgery, such as being open to increased risks associated with sedation and general anesthesia, as well as a decreased blood supply to the skin and deeper tissues.

But it is still a wise decision to follow your doctor’s instructions. Should you not abstain from nicotine-related products for at least the recommended two weeks before and after your procedure, you are vulnerable to numerous complications, such as:

• Poor and/or delayed wound healing
• Increased risk of infection
• Longer bruising period
• Skin loss
• Hypertrophic or keloid scarring
• Increased risk of pulmonary problems
• Flap necrosis (as with “flap” procedures) or tissue breakdown

Tessa, a 25-year-old former fitness trainer with rock hard abs and a tight backside, “partied” almost immediately after surgery. She thought that with her usual healthy lifestyle, casual smoking and drinking two days afterwards wouldn’t affect her body. But what followed were months of agony and embarrassment.

“I was very sick, and never quite got back on my feet,” she says, having waited about three months before she decided to go in for her second post-op visit; meanwhile, blaming her doctor for the problems associated with her breast enhancement surgery. “I had low energy levels especially. It was like my body was using all of my energy elsewhere. My bruising stuck around for months instead of weeks.”

Most importantly, the type of surgery you undergo plays a major role in the success of your results. A “flap” procedure, which involves the isolation of live tissue (or the separation), is rarely performed on a smoker patient. Carbon monoxide in cigarette smoke reduces the blood’s ability to carry oxygen, so with the use of a “flap,” the wound site will have an even difficult time healing – if at all.

According to a 2002 American Society of Plastic Surgeons (ASPS) study, doctors were more likely to perform non-flap procedures on a smoker than a flap procedure: “Eighty-eight percent of plastic surgeons surveyed said they would perform procedures that did not involve skin flaps or skin separation, such as nose reshaping, breast augmentation or liposuction. However, only 39 to 54 percent of plastic surgeons would perform procedures involving more skin manipulation, such as breast reduction, tummy tucks, or facelifts.”

(Dr. Brian J. Reagan, a San Diego board certified plastic surgeon, is one such surgeon who will not perform these “flap surgeries” on smokers.)

Dr. Friedman explains that even if a patient gave up smoking two years ago, traces of nicotine have already affected the body and can still negatively affect the healing process. Still, the majority of doctors would agree that giving up cigarettes and any other nicotine product two weeks before and after surgery is a positive method towards ensuring a healthy recovery.

"Generally, this is what we tell patients," says Dr. Friedman. "But there is no magic about the two weeks." He says that this number is the bare minimum; quitting two weeks prior helps to rid about 90 percent of the nicotine from the body, while the remaining 10 percent is flushed out during the initial period following surgery.

"Only you know your body and its healing capabilities. Don’t rush, and if it’s possible, take the extra time," Tessa advises, admitting that she hasn’t picked up a cigarette since her complications started. "I wish I would have respected my body a little more and not put harmful toxins into it, like nicotine and alcohol, when I’m asking it to heal."

Finding a good doctor who specializes in the procedure you’re considering is always a good move, especially when it comes to learning about the risks associated with smoking and plastic surgery.

"Patients rely on their physicians to do the right thing. I am not willing to perform an elective operation unless the patient is willing to do their part to ensure optimal results. They must stop smoking."
Adds Dr. Reagan, "They need to know that nicotine gum or nicotine patches will also put them at risk." Finally, Dr. Reagan reinforces the value of close post-operative follow-up for all patients.