by Dr. Darshan Shah, MD, FACS

The number-one reason for undergoing cosmetic surgery is to enhance appearance and boost self-esteem. That being said, one would think patients would follow their doctor’s orders…especially if non-compliance could negatively impact their post-surgery results.

However, when it comes to smoking and surgery, this is often not the case: Every year a number of patients ignore their surgeon’s warnings and continue to smoke both prior to and following cosmetic procedures. The result is that too many have cautionary tales to tell.

What’s the Danger?

To convince you of the necessity of quitting smoking, it is helpful that you understand how exactly smoking interferes with surgery and surgical results. In general, smoking is dangerous, in terms of plastic surgery, in two ways: First of all, nicotine causes the tiny blood vessels in the skin to clamp down or constrict (termed “vasoconstriction”), which reduces blood supply to the skin. Secondly, the carbon monoxide replaces nutrient-rich oxygen in the blood; these two impediments work together to limit the amount of oxygen that makes its way to the site of the incision…it is oxygen that serves to nourish a wound, causing it to heal properly.

Smoking in the weeks before or after surgery increases the probability of skin and/or organ complications including (but not limited to) the following:

– Impaired and/or delayed wound healing

– Greater risk of infection

– Greater risk of pulmonary (lung) problems

– More extensive and longer-lasting bruising

– Hypertrophic or keloid (thick, fibrous tissue) scarring

– Death or breakdown of skin or other tissue

Another negative is that, while smoking would affect any surgical procedure, it is even more of a detriment to cosmetic surgeries. The reason for this is that, even though the skin is the largest organ in the body, it has the tiniest blood vessels. After cosmetic procedures, it is the skin that needs to heal, and this is impacted by how much oxygen can reach it through these already miniscule vessels. Obviously, if the incision can’t heal properly, the ultimate aesthetic result of the surgery will be less than favorable. In other words, you’re willingly sacrificing the enhanced appearance that was the goal of the surgery in the first place.

Finally, the repercussions of smoking are not limited to an unsightly appearance…and you don’t even have to be a smoker yourself to be at risk. The actual surgery is more dangerous if you have been exposed, even secondhand, to nicotine and carbon monoxide, because you are then coming into the procedure with constricted blood vessels and lower oxygen levels. This sets you up for an increased chance of complications from the anesthesia, in addition to decreased blood supply to the vital organs. Because of this, I recommend that patients should not only quit smoking prior to undergoing plastic surgery, but they should limit exposure to secondhand smoke whenever possible.

Playing It Safe for Superior Results

So how far in advance do you need to ban the butts? While some less prudent plastic surgeons advise quitting for only two weeks before and after procedures, I am among the most cautious, insisting that patients quit smoking for at least one month prior and at least three months following all procedures.

I’m extremely empathetic to the difficulty involved in giving up cigarettes; however, I’m simply not willing to jeopardize a patient’s safety by performing a surgery under anything but optimal conditions. The most important thing is that you do quit prior to and following your cosmetic procedure(s).

For smoking and plastic surgery, the long and short of the situation is this: If you are undergoing cosmetic surgery in an effort to enhance your appearance, be aware that smoking is in direct opposition to achieving this goal. Not only are you sacrificing the best possible aesthetic result, but you could actually end up looking worse than before your procedure due to the excessive bruising and scarring that may result from improper healing. Furthermore, in successfully quitting for good, you will not only look your best post surgery, but you will have made a priceless move toward protecting your health and improving your overall quality of life.