When and why should I quit smoking before cosmetic surgery?

Several patients have asked recently about the potential effects of smoking on healing following plastic surgery procedures. Smoking increases one’s risk of delayed wound healing and infection following most surgeries, however it poses even greater risks following face lift, abdominoplasty, and mastopexy (breast lift) given the nature of these procedures. These surgeries involve more extensive dissection through elevation of skin flaps and require revascularization as the body reestablishes its blood supply within the surgical field. Smoking causes vasoconstriction through the effects of nicotine, which narrows small blood vessels and decreases the blood supply to these already compromised skin flaps. In addition to vasoconstriction, carbon monoxide from cigarette smoke decreases the oxygen carrying capacity of blood. So less blood is being delivered to the skin flaps through vasoconstriction and the blood travelling to these regions also carries less oxygen. These effects increase the risk of post-operative infection, delayed wound healing, and for patients following face lift and abdominoplasty,there may be necrosis or skin flap loss. Similar complications may arise following mastopexy in addition to increased risk of partial or complete nipple loss.Smoking also increases one’s risk of undergoing a general anesthetic, in particular respiratory and cardiovascular complications.

Based on these reasons and previous research findings, I recommend for cosmetic surgery patients to complete smoking cessation at least one month pre- and post-operatively to lower risk of surgical and anesthetic complications. Unfortunately nicotine replacement products (e.g. patch or gum) lead to similar effects on blood vessels and should also be stopped.

This timeline poses a great opportunity for patients to consider quitting smoking in the long-term. Smoking cessation may benefit patients from an aesthetic perspective, since smoking has been shown to accelerate the aging process and lead to more prominent wrinkles. Since patients considering elective cosmetic surgery are seeking self-improvement, why not also lower one’s risk of developing many types of cancer, stroke, heart and lung disease as well as accelerated aging by quitting smoking altogether?

Stephanie Power MD, MSc, FRCSC

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