Why does smoking increase risks associated with plastic surgery? Smokers seem to know that smoking is “bad” for them but tend to be unaware of the specific risks and generally believe they won’t personally suffer an adverse surgical outcome because of smoking. Tobacco smoke contains some 4,000 different compounds, many of which are toxic, addictive, or can cause cancer. These chemicals include ammonia, arsenic, cyanide and even radioactive substances but the most harmful for healing are nicotine, which restricts blood flow to healing tissue, and carbon monoxide, which decreases the oxygen-carrying capacity of blood.
In some plastic surgical procedures, the blood supply is temporarily compromised in order to reposition skin, fat or other tissue to a more favorable location. During a facelift, for example, skin of the cheeks and neck is separated from the underlying fatty tissue, from which it obtains some of its blood supply, in order to rejuvenate facial appearance. Survival of the skin then depends on the remaining blood supply coming from beyond the boundaries of the lifted skin. Diminished blood supply caused by the nicotine and carbon monoxide in cigarette, cigar or pipe smoke may additionally compromise circulation to the point that the skin does not maintain enough blood supply to survive. Other procedures where circulation is critical to tissue survival include tummy tucks and breast lifts.
Nicotine patches may be helpful to wean a patient from the addictive nature of smoking but nicotine has the same detrimental effect on wound healing regardless of how it is delivered. Secondary smoking, which means being in the vicinity of someone else that is smoking, is detrimental for the same reason.
Some plastic surgeons refuse to perform elective cosmetic surgery on smokers. They feel it is illogical to offer an improvement in appearance to an individual who won’t take the more basic step of quitting smoking to prolong the quality and length of their life. As a practical matter, people have the right to make decisions that aren’t perfectly logical to others and the addictive nature of smoking must be taken into consideration: many people who want to quit simply aren’t able to do so. I don’t believe smokers should be denied access to elective surgery so long as they understand the increased dangers and accept responsibility for smoking related complications.
For more information, please call Edward Pechter, MD at 661-255-2151, e-mail drpechter@aol.com or visit www.drpechter.com .