Smoking and Cosmetic Surgery – The impact of smoking on Plastic Surgery
Smoking before or after Cosmetic Surgery is a really bad idea. The adverse effect of smoking is not limited to the respiratory system, its restriction of bloodflow effects and carcinogenic impact can have widespread effects when you are recovering. With regards to cosmetic surgery, the negative effects of smoking on wound healing are of particular concern. Smoking can also deplete your body’s reservoir of Vitamin C. A Deficiency of Vitamin C can impair collagen synthesis, which can result in disfiguring scar formation after your cosmetic surgeries.
Multiple studies over the last few decades have confirmed that smokers suffer from impaired wound healing, which can be particularly concerning for smokers who plan to undergo cosmetic surgery.
The Harmful effects of Smoke and Smoking
Tobacco smoke contains various chemicals, including nicotine, hydrogen cyanide, lead, arsenic and so on that is harmful to the human body, and can eventually result in life-threatening complications.
Risks of smoking on your surgery results
Research has shown that smokers are at an increased risk of developing perioperative and post-operative complications. In fact, most people cannot be considered an ideal candidate for cosmetic surgery unless they completely quit smoking (at least for a period of time before and after surgery). Most surgeons will insist and help their patients stop smoking before performing any surgery on them.
Smoking during the post-operative period can result in impaired wound healing due to poor oxygen supply and utilization. Moreover, collagen deposits are also disrupted, further impacting the wound healing process. This can result in wide and prominent scars that can negatively affect your body’s aesthetics.
Some of the other potential side-effects of smoking on surgery, especially in the post-operative period, are mentioned below:
- Increased risk of Infections
- Fat cell necrosis (death of cells)
- Loss of skin, nipples, or tummy skin after breast lift, facelift, breast reduction, tummy tuck surgery.
- Life-threatening complications like thrombosis or PE (pulmonary embolism), which can lead to stroke and other infarctions.
- Increased pain
- Implant rejection which may require re-operation.
Consequences of Smoking when having Cosmetic Surgery
Tissue hypoxia and skin necrosis
In 1966, research that was conducted and published by Dondero et al showed that smoking decreased cutaneous blood flow. Trying to further understand this decrease in blood flow, a study was performed in 1991, by Goldmine and Bennett where they used a Doppler flow meter to measure the microcirculation of skin surface. Results of the study showed that smoking caused vasoconstriction of the blood vessels, hence, decreasing blood flow.
Another study performed with the purpose of understanding the pathophysiology behind the vasoconstrictions associated with cigarette use found that nicotine causes vasoconstriction directly by stimulating catecholamine release from the adrenal gland.
The eventual decrease in blood flow causes the oxygen levels to drop and results in tissue hypoxia. Nicotine disrupts the balance between prostacyclin and thromboxane A2, a vasodilator and vasoconstrictor respectively. Overall high action of thromboxane A2 leads to tissue hypoxia.
Thrombosis and its complications
Tissue hypoxia leads to increased haemoglobin production which results in increased viscosity of the blood. Ultimately, this can lead to potential thrombogenesis. This thrombus can then be introduced to the bloodstream and lodge in different blood vessels in different organ systems and can lead to the infarction, or infarction-like condition, of the associated organs such as stroke, cardiac arrest, and so on.
Wide and prominent scars
Smoking impairs the normal function of myofibroblasts and fibroblasts; cells that are required for normal wound healing.
A study performed by Wong and his team showed that cigarette smoking hindered the normal migration of fibroblasts. He observed that fibroblasts initially failed to migrate to the wound site and those that had migrated, remained in the wound site promoting excess scar formation.
Furthermore, excessive nicotine use can block TGF-B1, hence, transforming growth factors that induce separation of myofibroblasts. This results in a decrease in the contractile function of normal healthy skin.
Cosmetic Surgery, Smoking, and the Consequences
Smoking has a negative effect on the healing of all surgical procedures; cosmetic and medical. In cosmetic surgery, smoking severely impairs the healing process of surgeries that are performed for undermining of skin flaps. The removal of excess tissue and the healing of the remaining tissue is determined by the proper blood supply.
Since smoking reduces the dermal blood flow, healing will be significantly impaired, leaving behind scars that make the cosmetic surgery procedure redundant.
Research on Smoking & Surgery
Various research has been conducted with the main purpose of understanding the several consequences of smoking on the surgical and the post-surgical, healing processes.
Nolan et al Research
- Nolan and his team of researchers studied the impact of perioperative exposure of smoke in 344 animal models that underwent random skin flap elevation. The study showed a reduced rate of survival in rats that were exposed to cigarette smoke in the pre-operative and post-operative phases.
Craig & Rees Research
- Similar to Nolan, researchers in this study observed a 60 percent incidence of flap necrosis in hamster animal models exposed to smoke during the preoperative and postoperative phases. They also found that 20 percent of the hamster animal models who were exposed to cigarette smoke in the pre-operative period only developed skin flap necrosis.
- In this study, the researchers found that smokers were 12.5 times more prone to suffer from skin necrosis after facelift surgery than non-smokers. More than 70 percent of skin sloughs were found to be related to smoking cigarettes.
There is scientific evidence explaining how smoking can affect the results of your cosmetic surgery. However, these consequences can be avoided by the cessation of smoking.
A joint new study conducted by WHO (World Health Organization), WFSA (Australia and the World Federation of Societies of Anesthesiologists), Newcastle University has shown that smokers who quit approximately 4 weeks or more before surgery have a decreased risk of developing complications. They are also most likely to see the results of their surgery within 6 months.
How to Stop Smoking when having Cosmetic Surgery
It is a well-known fact that cessation of smoking is not an easy task. You can opt for one of the following methods which will prove to be quite beneficial in helping you quit smoking.
Non- Nicotine Therapy
- This alternative to smoking includes the drug, Bupropion which was initially developed as an antidepressant but has recently been used to help smokers quit smoking. Although the use of Bupropion for this purpose is still being studied and reviewed, this smoking alternative has become quite popular and is widely used.
- Hypnosis, behavioral therapy, and psychotherapy are also used to control and moderate smoking habits. The success of this modality, however, depends on the patient specifically and the results may vary from patient to patient.
Counseling and self-help programs
- The main aim of these programs is to help smokers quit smoking by exploring several different lifestyle choices and understanding the negative effects of smoking itself.
Nicotine Replacement Therapy
- Nicotine Replacement Therapy has become a new method of getting rid of tobacco smoking. It helps to reduce the withdrawal symptoms such as anxiety, irritability, decreased concentration power, increased hunger, and restlessness. There are varieties of replacement methods. Some of them include chewing gums, nasal spray, and nicotine patch, also known as transdermal patch. This patch has become the most commonly used technique followed by the use of nicotine chewing gums. Discuss the specific nicotine replacement modality and its specific doses with your surgeon to achieve the best results.
Postponing your surgery
- Quitting smoking may take time and hence, you may consider postponing the surgery till you have quit smoking altogether. Discuss all these options along with the intensity of your cigarette use with your surgeon and counselors to evaluate the time you will need to quit smoking and the duration for which the surgery needs to be postponed.
FAQs about Smoking & Cosmetic Surgery
How long do I have to stop smoking before going for surgery?
- Most plastic surgeons suggest at least 4 weeks of no smoking in the pre-operative phase and 4-6 weeks after. However, some data shows that this time period is not enough to overcome the effects of these toxic products, especially in heavy smokers
Will my surgeon do the surgery if I continue to smoke?
- Given that smoking can negatively affect your healing process, and even complicate the surgery itself, most surgeons would prefer not to operate unless you have stopped smoking for a specific amount of time. For any other questions or clarifications, book an appointment now with Dr. Carmen Munteanu, a specialist plastic surgeon.
Dr. Carmen Munteanu MD. FRACS(Plas) is a well-trained and highly skilled plastic surgeon specializing in aesthetic breast surgery and body contouring. She has over 25 years of experience and is best known for her high patient satisfaction rates. She approaches all surgeries with up-to-date approaches to help her patients achieve their dream look.
Further Reading – Medical References