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Can I Smoke if I’m Having Plastic Surgery?
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Can I Smoke if I’m Having Plastic Surgery?

Episode 46: Can I Smoke if I'm Having Plastic Surgery?

Can I smoke if I'm having plastic surgery? Well, the short answer is you really shouldn't, and we're going to go through a few reasons why it's not a great idea to smoke if you're planning on having a plastic surgery procedure and why your plastic surgery procedure can be a great reason to quit smoking. There are three categories of reasons that should prevent you from smoking when you're planning on having a plastic surgery procedure. The first is that smoking can cause issues with wound healing. The second is that smoking can actually cause soft tissue loss. And the third is that smoking can cause systemic health issues related to anesthesia and recovery from your surgical procedure.

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How does smoking affect healing after plastic surgery?

The first two problems with smoking and plastic surgery come down to the same basic issue, which is that smoking and the products contained in cigarettes and related items, cause issues with the microvasculature. That is they prevent blood from flowing freely through the tiny blood vessels that ultimately supply vital oxygen and nutrients to your skin.

This is a problem for wound healing because the wound healing process depends on critical factors that are delivered to the edges and base of a wound that allow it to heal. And these are things like different kinds of blood cells and also the soft tissue and connective tissue cells that come together in a wound to allow it to properly close.

If you want to think of a healing wound or surgical incision as a construction site, the circulation is essentially the supply line for all of the materials necessary for the construction at that work site to happen. And smoking really effectively cuts off these supply lines. Examples of when this is a particularly problematic occurrence is after a procedure like an abdominoplasty or a breast reduction that has very long incisions that also might be relatively far away from their blood supply. Because when we perform an abdominoplasty or a breast reduction, we are elevating tissue off of its normal blood supply and requiring it to live off a more limited blood supply. So if we then introduce smoking into the mix, we're further limiting the blood supply to those wound edges and making healing a very difficult proposition.

Taking this problem one step further, we get to actual soft tissue loss. So every part of your body needs blood to live. And as I just mentioned, when we are performing procedures like an abdominoplasty or a breast reduction, or even a facelift, and there are many others where we are essentially altering the body's blood supply and asking your tissues to live off a new modified blood supply, any insult or damage to that new blood supply could be catastrophic.

Examples of this would be things like in a breast reduction or a breast lift smoking can contribute to really potentially devastating complications like the loss of the nipple or the nipple-areolar complex, or in the case of an abdominoplasty, the loss of a belly button. And in the case of a facelift, things like loss of the facelift flap, which can lead to major cosmetic and sometimes even functional concerns.

How else is smoking dangerous with respect to plastic surgery?

The last category of problems related to smoking and plastic surgery are those related to anesthesia and systemic health concerns. And this comes back to the fact that for all the reasons that smoking is unhealthy in general, these risks are all magnified in the context of surgery and anesthesia, because this is a strenuous or stressful state for your system to be in. So when we're asking your body to heal a large wound or to recover from surgery or to undergo anesthesia, the risk of problems with your heart and lungs and other systems is increased by smoking.

One very real way that smoking can be extremely dangerous in the context of surgery is in increasing the risk of a blood clot. And a blood clot that forms in your legs, which is called a DVT or a deep venous thrombosis can travel to the lungs, which turns it into a PE or pulmonary embolism. And that can block off blood supply from transferring oxygen in your lungs. And that can be a very, very dangerous event.

So we recommend for really all plastic surgery procedures not smoking for a good month before or after that procedure. So if you're a smoker, a plastic surgery procedure can be a great excuse to stop. And I'd encourage you to speak with your board certified plastic surgeons about strategies to help you to achieve that goal.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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