Posted on 01 Mar 2016
There are lots of reasons not to smoke that we all know about. Cancer. Disease. Lung problems. A little known problem resides in people who smoke and wish to undergo a plastic surgery procedure. Why is this? Plastic surgery procedures rely on a healthy blood supply and smoking limits the circulation to the skin and other tissues which impacts the surgery and your ability to recover along with a few other significant complications.
A few thoughts to consider:
What we are doing with plastic surgery is changing the shape of different areas of the body. The word “plastic” comes from the Greek word “plastikos” which means to mold, or change shape. In order to accomplish these changes in shapes, we need to move skin or other tissues around, sometimes over significant distances. When we do this, we change the blood supply to these tissues. Actually, we are decreasing the normal blood supply to varying degrees, but not enough to interfere with healing (hopefully).
For instance, when we are doing a tummy tuck, some of the blood vessels that normally carry blood to the skin of the abdomen are divided in order so that that the skin can be moved around to give a flatter, better shape to the abdomen. However, we leave enough other blood vessels intact so that the skin will heal. If there isn’t an adequate amount of blood flowing to the skin, the tissues will not get enough oxygen, and some of the tissue will die or not heal properly. That’s not a good situation. But the same thing is going on with many other procedures like facelifts, breast lifts, breast reductions and many of the complex reconstructive cases. So, we have to make sure that what we have left is adequate blood supply to the tissues that we are moving to ensure healing.
When we are doing these procedures, we are really operating at the limit of what the circulation to the skin and other tissues will allow; living on the edge so to speak. But, in order to have adequate circulation, we must not only leave enough blood vessels intact, but must also make sure that the blood flow through these blood vessels is sufficient. Certain things can affect this blood flow and the biggest and baddest of these is, cigarette smoke. Although nicotine in the cigarette smoke is the most dangerous element, the carbon monoxide and the hydrogen cyanide don’t help much either.
A recent study (June 2015) presented at the European Society of Anesthesiology confirms what we have long suspected in the operating room. Compared with people who don’t smoke, smokers needed 33% more anesthesia throughout the operation and an additional 23% more pain medication after their procedure to achieve the same results. But the study went further. Those who didn’t smoke themselves but were exposed to secondhand smoke required 20% more anesthesia and 18% more pain medication than non-smokers who weren’t exposed to second hand smoke. Ouch.
Nicotine causes the blood vessels to constrict, which means they decrease in their size (diameter) and blood flow through them drops off. The nicotine can also make the blood clot more easily, which can further clog small blood vessels and capillaries. All in all, these effects are extremely serious because they decrease the blood supply to the tissues, can result in wounds not healing, and can result in some devastating complications.
Many people who smoke tell us that they have never had healing problems before, so why should it be a problem now? Let’s go back to living on the edge. What we are doing when we are moving tissue around in plastic surgery procedures, is much different, than — say — in a hysterectomy. Because in this operation, the tissue is not moved around in the same way, and the blood supply to the skin is not altered. (Now, we’re not saying that you won’t have a complication with a hysterectomy if you smoke, but you are at greater risk with some of the procedures that we perform.)
The take-home for all this is rather straight forward: stop smoking. It’s no more complicated than that. If you are a smoker and you do not stop, this may very well push us over the edge when you have surgery. Contact Neaman Plastic Surgery for a consultation if you are considering plastic surgery.
Dr. Keith Neaman
Dr. Neaman is a board-certified plastic surgeon that specializes in surgical body contouring. He prides himself on being on the cutting edge of plastic surgery. He takes an informative approach to each consultation, and through open dialogue and communication, he helps his patients decide on a treatment plan that meets their needs.