The Dangers of Smoking in Cosmetic Surgery.

The dangers of smoking will not be discussed in full detail in the paragraphs below; however, the purpose is to detail how smoking specifically interferes with cosmetic surgery. Most people are well aware of the risks of smoking with regard to lung cancer, oral cancer, and bladder cancer, to mention a few. However, I would like to address its devastating impact in the skin itself and the health of the skin after cosmetic surgery. 

In very simplistic terms, cigarettes contain harmful ingredients, which include nicotine and carbon monoxide. Nicotine causes vasospasm of the vessels. Vasospasm in simple terms is a contraction of the vessel, which causes narrowing and restriction of blood flow. Carbon monoxide binds oxygen and does not allow the oxygen that we breathe to be released into the areas that need it so desperately, such as the skin. That is why smoker's skin is much more wrinkled and weathered than non-smokers, and their skin ages much faster because they simply deprive their skin of oxygen through the vasospastic effect of nicotine and the binding effect of carbon monoxide described above. On one hand this weathered skin looks more aged than the patient's chronological age. Therefore, after successful cosmetic surgery, which can be highly successful in eliminating the gravitational and dynamic forces of age, the skin would detract from an otherwise good cosmetic outcome, due to the fact that the skin is in such poor shape, primarily exacerbated in many patients by smoking. 

If this is not enough, there is even a more dangerous effect of smoking with surgery. In any type of surgery the skin is incised and elevated, and its blood supply is decreased temporarily. In almost every instance, in healthy skin this temporary decrease in blood supply during healing is well tolerated. In fact, plastic surgery is said to be a constant battle of beauty versus blood supply. We can take skin, elevate it, and tighten it; however, we must keep it alive! This seems obvious, but it is really the art of plastic surgery. One can see that the effects of nicotine and carbon monoxide described above can take an otherwise healthy skin flap and cause such a decrease in blood supply that the skin will actually die. If this occurs, one can get full thickness tissue loss requiring prolonged healing, delayed healing, or even the use of reconstructive surgery with skin grafting and flaps to correct the deformity. This is certainly not the desired end point in cosmetic surgery. Therefore, it is my policy not to do Abdominoplasty or face lifts on smokers. I tell all smokers that in every single case they will have a less satisfactory outcome than non-smokers; however, they will see improvement. I will do blepharoplasty procedures, full face resurfacing, breast augmentation, and other such surgeries that do not require large areas of skin elevation or undue tension. Therefore, face lifts, abdominoplasty, and breast reductions are much more risky in smokers. There are certainly some plastic surgeons that will perform these procedures on smokers, but my personal policy is that it is too risky, and even one full thickness tissue loss in a face lift or abdominoplasty patient is not worth the risk. This can occur in non-smokers, but it is extremely rare.