Smoking and Plastic Surgery

Serving Chattanooga, Tennessee

he negative health effects of tobacco use have been widely studied and are well documented. Just look at the surgeon general’s warning on the package of every tobacco containing product. Despite this deluge of worrisome information, smoking remains a popular habit in the United States. The allure of smoking tobacco, in particular, remains so great that intelligent people will risk cancer, cardiac disease, peripheral vascular disease, and premature death to continue the practice.

All organ systems including the unborn are negatively affected by exposure to tobacco. However, particularly in the surgical specialties, smoking presents obstacles which are insurmountable. Surgery that is performed, even in the areas of the head where there is robust blood supply, experience an eight to thirteen-fold increase in wound healing complications over non-smoking controls.  Smoking even impairs bone healing.

Smoking not only delivers an active drug called nicotine to the body, but also saps away oxygen by replacing it with carbon monoxide. Nicotine is a very potent chemical that produces collapse of blood vessels limiting nutrition to injured areas. It has also been implicated as a negative factor in pain management worsening one’s perception and control of pain. Other chemicals in the cigarette plume, like tars, are directly injurious by creating free radicals which initiate the changes necessary for cancer growth. All these factors negatively impact the surgeon’s goal of uncomplicated healing.

In plastic surgery, this cannot be over stressed. It is the nature of our specialty to technically push the healing model as far as we can without complication. Major and minor cosmetic and reconstructive procedures are significantly complicated by smoking. Keep in mind that, particularly in aesthetic surgery, skin and soft tissues are often closed tightly as this is part of the intervention. Plastic surgeons have long been trained to make critical judgments regarding skin tension. However, so much as smoking one cigarette after surgery can start a cascade of events that cannot be stopped. This can lead to poor healing, added procedures to repair the damage, and disastrous scarring. Even though many people have great confidence in the ability of modern medicine to intervene to correct any problem, there is no way to stop the deterioration created by continued tobacco abuse coupled with surgery.   

Patients need to be fully aware of the risks smoking presents in the short and long term. Tobacco use needs to be considered with other known factors which delay healing like poor nutrition, diabetes, radiation exposure and chronic steroid use. Elective cosmetic procedures should not be carried out on active smokers.

We routinely recommend that smoking stop one month before surgery and not resume after. Nicotine patches or substitutes are also discouraged, but drugs such as Wellbutrin or Zyban are permitted. Our patients are given an informed consent which discusses the surgical risks they will encounter if they continue to smoke despite assuring their doctor to the contrary.

We in medicine all know that smoking is a very difficult habit to break. It is, however, most important that our smoking population understand the risks they assume before planning elective surgery. November 18th is the Great American Smokeout. Kick the habit!

The Plastic Surgery Group, P.C., in Chattanooga, Tennessee offers the latest skin care procedures, including JUVADERM. For more information on Smoking and Plastic Surgery, call our plastic surgery staff at (423) 756-7134 or (800) 634-3334. You can also e-mail us your questions and we will be in touch with you shortly.