Smoking and Surgery: Impact of Smoking on your results

Q: 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 and longer would be better.

Smoking or vaping nicotine before or after Plastic Surgery may increase complications. Smoking restricts blood flow and impacts healing and has other widespread effects when you are recovering from surgery.

Dr Carmen, like ALL Surgeons, will recommend you stop smoking and vaping for many weeks before and after surgery to support healing and reduce the risk of complications. You may also consider taking the opportunity to quit altogether.

WHY STOP SMOKING & VAPING NICOTINE?

Smoking affects Healing

The negative effects of smoking on wound healing are of particular concern. 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.

Smoking affects your Scars

Smoking can also deplete your body’s reservoir of Vitamin C. A deficiency of Vitamin C can impair collagen synthesis, which may contribute to abnormal scar formation or delayed healing.

The Harmful Effects of Smoke and Smoking

Tobacco smoke contains various chemicals, including nicotine, hydrogen cyanide, lead, arsenic and so on that are harmful to the human body, and can eventually increase complications.

Take our Plastic Surgery Quiz to find out if you’d be a good candidate and if you are ready for cosmetic surgery.

How to Stop Smoking & Vaping Nicotine

Giving up smoking & vaping can be challenging – nicotine is highly addictive. Here are some options that could help you quit smoking and vaping.

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.

Psychological treatment

Hypnosis, behavioural 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.

Counselling 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 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 sprays, and nicotine patches, also known as transdermal patches. 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 optimal results.

For more help contact the Government’s QUIT line

How Smoking, Nicotine & Vaping affects your surgery

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 some time before and after surgery). Most surgeons will insist 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 wider and more prominent scars or a complete wound breakdown.

Some of the other potential side effects of smoking during surgery, especially in the postoperative 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 – abdominoplasty surgery.
Life-threatening complications like thrombosis or PE (pulmonary embolism) have been associated with increased risk of cardiovascular complications in some individuals.
Increased pain and suffering
Implant rejection which may require re-operation.

Consequences of Smoking When Having Cosmetic or Plastic Surgery

Tissue hypoxia and skin necrosis

In 1966, research conducted and published by Dondero et al showed that smoking decreased cutaneous 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.

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.

Wider and more 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 skin.

Cosmetic & Plastic Surgery and the Consequences of Smoking

Smoking negatively impacys 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 dermal blood flow, it may impair healing and affect the aesthetic outcome of the procedure. Smoking can also cause deep wound breakdown and the death of tissues (necrosis).

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 and longer would be better.

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 caring manner and high patient satisfaction rates. She approaches all surgeries with up-to-date approaches to help her patients achieve an optimal result.

Research on Smoking & Surgery

Research has been conducted with the main purpose of understanding the several consequences of smoking on the surgical and post-surgical, healing processes.

Rees Research

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.