The Effects of Smoking and Nicotine on Your Plastic Surgery

The Effects of Smoking and Nicotine on Your Plastic Surgery

Not only smoking been known to increase one's risk of developing lung cancer, chronic lung disease and coronary artery disease, but it also been found to hasten aging.  The risk of development of wrinkles at an earlier age is two to three times greater in smokers than non-smokers.  So does plastic surgery reverse the effects of aging among smokers?   Does smoking has any effects on your plastic surgical procedure?
 
Fast Facts on Smoking and Plastic Surgery

• Smoking one cigarette may cause the small vessels in your skin to constrict (vasoconstriction) for up to 90 minutes.  Thus, patients who undergo facelifts and other plastic surgery procedures, such as a breast lift, are at risk for necrosis of the skin.
• Smoking a pack of cigarettes per day will remain tissue hypoxic (oxygen deprived) for most of the day.  Thus, it is critical to stop smoking before and after your plastic surgery procedure.
• The nicotine in cigarettes causes constriction of the small blood vessels of your skin.  This leads to decreased delivery of oxygen to your skin.  
• Thus, taking nicotine for smoking cessation would still have an adverse effect on tissue oxygenation after your plastic surgery procedure.
• Nicotine impairs wound healing.

Jessica Biel states that she does not smoke.  She'll likely maintain her youthfulness.

Scientific Evidence of the Effects of Smoking on Wound Healing

• Nicotine is associated with thrombosis of small vessels by interfering with prostacyclin activity.
• Nicotine also retards the rate of wound epithelialization.
• Nicotine decreases the proliferation of fibroblasts, which is an important part of wound healing.

Smoking and Plastic Surgery

• 40% of patients who smoke before and after breast reduction surgery had impaired wound healing in one study.
• After breast reduction surgery, the risk of developing complications, such as inverted T-incision site necrosis, among smokers is doubled (odds ratio 3.1).
• After breast reduction surgery, the infection rate (OR 3.3) was significantly elevated among active smokers.
• In patients who undergo a facelift procedure, smokers present a 13-fold risk of skin necrosis.  
• Smoking is also associated with an increased risk for the development of hematoma (bleeding) after a facelift surgery.
• In patients who undergo transverse rectus abdominis myocutaneous flaps (TRAM flaps) for breast reconstruction, smoking is associated with significantly higher flap necrosis rates for smokers than nonsmokers (19% vs 9%, P=0.005). 

As a physician and surgeon, I do not advocate smoking and highly recommend smoking cessation, especially if one is to undergo a surgical procedure.  One should avoid nicotine and smoking at least one month prior to undergoing plastic surgery in order to minimize potential complications that can occur after your surgical procedure. 

Emmanuel De La Cruz MD

The Woodlands Plastic Surgeon

References:
Bartsch et al.  Crucial aspects of smoking in wound healing after breast reduction surgery. Journal of Plastic  Reconstructive Aesthetic Surgery. 2007;60(9):1045-9. Epub 2007 Mar 9.

Grover, et al.  The prevention of haematoma following rhytidectomy: a review of 1078 consecutive facelifts.  British Journal of Plastic Surgery.  2001 Sep;54(6):481-6.

Knobloch, et al.  Nicotine in Plastic Surgery: A Review.  Chirurg.  2008 Oct;79(10):956-62.
Koh JS, et al. Cigarette smoking associated with premature facial wrinkling: Image analysis of facial skin replicas. International Journal of Dermatology. 2002;41:21.
Krueger J, Rohrich RJ. Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery. Plastic  Reconstructive  Surgery. 2001 Sep 15;108(4):1063-1073. 
Mosely, et al. Nicotine and its Effect on Wound Healing. Plastic  Reconstructive  Surgery. 1978 Apr;61(4):570-5.

Siana JE, Rex S, Gottrup F. The effect of cigarette smoking on wound healing. Scandinavian Journal of Plastic Reconstructive Surgery & Hand Surgery. 1989;23(3):207-209

Date Updated:  April 1, 2011