Stop Smoking Before and After Cosmetic Surgery

Why you must stop smoking before and after your cosmetic surgery

Smoking has long been known to be the enemy when it comes to cosmetic surgery. It is one of the leading causes of preventable deaths and illnesses worldwide, and plastic surgery has a similar destructive effect.

Symmetry, healing and scars are the main factors in a cosmetic procedure, and these are negatively impacted by smoking. The many toxins found in tobacco smoke interfere with the body’s ability to heal well after any surgery, and when it comes to cosmetics, this may affect your results.

This ‘cause and effect’ relationship is well described in medical research (see below) and that’s why many surgeons refuse to perform cosmetic surgeries on women and men who won’t quit smoking in the weeks before and after their surgery. No nicotine at all for at least 6 weeks before and after surgery would help with surgery recovery.

If you’re having a hard time quitting, there are several methods and numerous sources that can help you take this important step towards better health.

Why should you stop smoking if you’re getting plastic surgery?

Whether you’re planning to get breast, body or face surgery or any major cosmetic procedure, stopping smoking is critical to healing.

Numerous studies have shown that smoking interferes with the outcomes of plastic surgery procedures and leads to poor recovery.

If you’re getting a facelift, a tummy tuck (Abdominoplasty), or breast augmentation, for example, your risk of developing wound complications after surgery is tripled if you’re a smoker.

Since your reason may be cosmetic for having surgery, poor healing and wound complications could deny you the results you are seeking and may lead to unsatisfactory surgery outcomes.

Some of the wound complications that can be catastrophic to your results include:

• Delayed wound healing: Surgical wounds usually take only a few days to heal if you take proper care of them. In smokers, this might take much longer, which interferes with the healing process and puts you at risk of developing complications.
• Wound infection: Smokers have weaker immunity, so if your wound becomes infected, your body might not be able to fight off the offending microbes.
• Wound dehiscence: This is when the sutures that close your wound snap and your wound becomes open. You have basically 4 to 6 weeks to heal internally before the dissolvable stitches start to dissolve. If you haven’t healed adequately by then, your incisions may open up and ruin the surgery result. Dehiscence might sometimes require an expensive vacuum dressing or a re-operation to repair.
• Skin necrosis: When your skin cells don’t receive enough blood and oxygen, they’re likely to die and slough off. This is more likely to happen if you’re a smoker.
• Unpleasant scarring: Smoking increases scarring and makes your scars larger and more noticeable after plastic surgery.

Along with the wound complications, smokers are at a higher risk of developing several peri-operative complications that can make their experience unsatisfactory and may extend their hospital stay.

What are the surgical complications of smoking?

Cigarette smoke contains more than 4000 chemicals and toxins that are harmful to your body, some of which can be lethal in high doses. The most well-known of these are nicotine, carbon monoxide, hydrogen cyanide, and nitric oxide. These toxins have detrimental effects on nearly every body system and their damage is well described. Smokers are at higher risk of developing several medical conditions such as heart disease, lung disease, high blood pressure, strokes, and cancer to name a few.

In addition to these serious conditions, numerous studies have revealed that smokers are more likely to develop surgical complications if they’re undergoing surgery:

• Impaired wound healing: Having decided to get cosmetic surgery, the way your incision scar looks is probably important. Toxins contained in cigarette smoke disturb your body’s ability to properly heal itself (discussed below). This means that if you smoke, your wound will need a much longer time to heal, which in turn increases the risk of infection. Moreover, smoking can put you at risk of wound dehiscence, which is when your stitches rupture and your wound fully or partially becomes open, and necrosis, which is when the skin around your wound dies. These complications can be traumatic to both the patient and the plastic surgeon, and corrective surgery or long-course antibiotic treatment might be needed to control the damage.
• Smoking can interfere with your other medications: As already mentioned, tobacco smoke contains many chemicals that can enter your bloodstream and interact with any medications you might receive during surgery. This can affect the type and dosage of anesthetic and pain medications that will be administered, and will likely make it harder to control the pain after surgery.
• General anesthesia complications: During major surgery, your anesthetist will likely put you in deep sleep (general anesthesia). When your body is under general anesthesia, your breathing will be artificially controlled. Smoking is well-known to damage your lungs, and it does this by destroying the fine hair-like cilia on your lung cells that are responsible for clearing your airways from mucus and debris. This puts you at a higher risk of developing pneumonia (lung infection) or collapsed lungs after surgery.

How does smoking affect wound healing after surgery?

Numerous studies have shown that smoking delays wound healing, increases the risk of wound infection, skin sloughing (necrosis), and interferes with how your scar will appear. Several mechanisms explain how smoking can cause wound complications in patients undergoing surgery:

• Smoking reduces oxygen supply to the wound: Oxygen is essential to proper wound healing, and smoking prevents enough oxygen from reaching your tissue, a condition known as hypoxia or ischemia. Carbon monoxide, one of the known toxins in cigarette smoke, binds to hemoglobin, the oxygen transporter in your blood. This prevents hemoglobin from carrying oxygen to the tissue and deprives your cells of their supply. The nicotine in tobacco smoke causes your blood vessels to shrink and become narrow, so less blood will reach your skin and wound. Moreover, nicotine increases your heart rate and your blood pressure, which can stress your heart and even damage it, causing further oxygen deprivation in your body.
• Smoking impairs cell functions: Several types of cells are involved in the wound healing process, and they usually determine how quickly your wound will heal, and how your scar will look after healing. According to researchers, smoking can impair the function of fibroblasts, which are cells responsible for repairing your wound and forming the final scar. This means that if you smoke, your scar will probably end up more obvious.
• Smoking impairs immunity: Smoking cigarettes weakens your immunity and makes you more prone to developing infections. If you’re having plastic surgery, you will be more likely to develop a wound infection, which can dramatically affect how your wound will heal, and how it will eventually look.
• Smoking increases the risk of Blood clots: The nicotine in tobacco smoke stimulates the release of certain chemicals in the body that make your blood more sticky and thick. This increases the risk of developing small blood clots that obstruct your blood vessels and deprive your wound of blood and oxygen supply.

How long before surgery should you quit smoking?

The longer you’re smoke-free before your surgery, the better your chances are of improving the outcomes. Plastic surgeons usually recommend that you cease smoking at least 4 to 8 weeks before your procedure to get the most benefit.

Cutting down on smoking alone without completely quitting will not reduce the rate of complications. You have to give smoking up completely to reverse the damage done by cigarettes to your lungs, heart, blood, and body’s healing abilities.

If you can’t cease smoking for this long, stopping even as little as 12 hours before your surgery can still have some benefits, albeit rather minimal. After surgery, your plastic surgeon will need at least 4 to 6 smoke-free weeks, however, you might want to take this chance to quit forever and never go back to smoking at all.

Will surgeons still operate on smokers?

Whether a plastic surgeon will operate on you or not if you refuse to stop smoking depends on several factors. Many plastic surgeons now refuse to perform surgery if you choose to continue smoking since the results would be poor and you would be more prone to developing complications.

Whether complications happen or not, your results may still be less than ideal, and this is what makes many experienced surgeons reluctant to perform cosmetic surgeries on smokers who won’t quit. Many plastic surgeons in the USA are now requiring patients to take a nicotine test on the day of surgery and if they fail the test – the surgery is cancelled with NO refund for the patient. It is that serious!

What if I don’t stop smoking before surgery?

If you don’t stop smoking before surgery, there’s a higher chance that you will not develop complications, however, you will still be at a much higher risk of developing complications when compared to a non-smoker. This means that your surgical wound won’t properly heal. Some complications may require hospital admission, re-operation, and extended treatment, and even with all this, serious complications (like wound infection) will likely cause permanent cosmetic damage to the body part where you’ve had surgery.

Is vaping a good alternative to tobacco smoking before surgery?

E-cigarettes are considered just as harmful as smoking cigarettes. They are still bad for your health and can impair wound healing after surgery.

The smoke from vapes and E-cigarettes contains nicotine. Nicotine will raise your blood pressure, heart rate, and constrict your blood vessels, all of which contribute to impaired wound healing.

This also applies to nicotine replacement products, such as nicotine patches, chewing gums, and inhalers.

How can I quit smoking before surgery?

Whether you’re planning on surgery or not, quitting smoking is one of the best decisions that anyone can ever make. We know that it’s much easier said than done and that the cravings and withdrawal symptoms can be excruciating, however, the health impacts are well worth the struggle.

You can start noticing changes in your stamina within days of quitting, and your body can repair almost all its normal functions within just a few weeks. Smoking cessation is the single most important step you could take to prevent smoking-related illnesses and reduce your risk of heart disease, lung disease, strokes, and cancer.

If you’re like all the other smokers and find quitting extremely hard, you’d be glad to know that several methods can help you go through with your decision.

• Quitline: The Australian Department of Health has dedicated a phone line to assist smokers in their journey toward a smoking-free life. Whenever you’re ready, any time of the week, you can call 13 QUIT (13 7848) free of charge, and talk to a trained counsellor to get important information, tips, coaching, and support to successfully quit. You can also visit the Australian Lung Foundation’s website to explore valuable resources that might be of benefit.
• Nicotine replacement therapy: Nicotine is one of the most addicting chemicals found in tobacco smoke. Nicotine withdrawal can cause several symptoms that include increased appetite, weight gain, stress, irritable mood, and sleep disturbances. Several products are available to provide your body with nicotine without having to smoke it along with all the other toxins contained in cigarettes. Nicotine replacement products are available as chewing gum, skin patches, and nasal spray. No specific type was shown to be better than the other, however, they are all known to effectively help smokers successfully quit. You need to know, however, that nicotine-containing drugs can still interfere with normal wound healing.
• Non-nicotinic drug therapy: Bupropion HCL and Varenicline are two drugs that do not contain nicotine, however, they’re been shown to be effective in dealing with nicotine withdrawal and smoking cessation. These drugs are only available on prescription, so you would have to ask your GP before getting them.
• Therapy: Therapy, in its many forms, can help if you’re planning to quit smoking. Hypnosis, psychotherapy, group therapy, and self-help programs have all been successful in helping smokers quit their habit.

If this article hasn’t convinced you to quit, consider all the harmful effects of tobacco smoking on your body. If you’re planning to have cosmetic surgery, take this as an opportunity to quit smoking for good and repair your body.

If you can’t QUIT you will certainly have to STOP Smoking for a prolonged time if you want surgery.

Further Reading and Medical Resources

• Lung Foundation Article on Quitting Smoking
• Management of Medical Morbidities and Risk Factors Before Surgery: Smoking, Diabetes, and Other Complicating Factors
• Smoking and plastic surgery, part I. Pathophysiological aspects: update and proposed recommendations
• The evils of nicotine: an evidence-based guide to smoking and plastic surgery

For more help and advice about smoking and your cosmetic surgery call the clinic or contact us online.