Why Smoking Makes Plastic Surgery Recovery Difficult

Posted by David Reath, MD

March 11, 2011

quit smoking before plastic surgeryPlastic surgery, or more correctly, plastic surgical operations, live on the edge of your blood supply. This is important to understand for a good recovery after a plastic surgery procedure. Let me explain:


What we are doing with plastic surgery is changing the shape of different areas of the body. The word "plastic" come from the Greek word "plastikos" which means to mold, or change shape. In order to accomplish these changes in shapes, we need to move skin or other tissues around, sometimes over significant distances.  When we do this we change the blood supply to these tissues.  Actually, we are decreasing the normal blood supply to varying degrees, but not enough to interfere with healing (hopefully).

For instance, when I am doing a tummy tuck, some of the blood vessels that normally carry blood to the skin of the abdomen are divided in order that that the skin can be moved around to give a flatter, better shape to the abdomen. However, we leave enough other blood vessels intact so that the skin will heal.  If there isn't an adequate amount of blood flowing to the skin, the tissues will not get enough oxygen (a condition known as ischemia), and some of the tissue will die or not heal.  That's not a good situation.  But the same thing is going on with many other operations like facelifts, breast lifts, breast reductions and many complex reconstructive cases.  So, we have to make sure that we have left adequate blood supply to the tissues that we are moving to insure healing.

Why Cigarette Smoke Hinders Good Plastic Surgery
When we are doing these operations, we are really operating at the limit of what the circulation to the skin and other tissues will allow; living on the edge so to speak. But, in order to have adequate circulation, we must not only leave enough blood vessels intact, but must also make sure that the blood flows through these blood vessels is sufficient. Certain things can affect this blood flow and the biggest and baddest of these is cigarette smoke. Although nicotine in the cigarette smoke is the most dangerous element, the carbon monoxide and the hydrogen cyanide don't help much either.

Nicotine Prevents Healing Well
Nicotine causes the blood vessels to constrict which means they decrease in their size (diameter) and blood flow thorough them drops off.  The nicotine can also make the blood clot more easily which can further clog small blood vessels and capillaries. All in all, these effects are extremely serious because they decrease the blood supply to the tissues, can result in wounds not healing, and can result in some devastating complications.

Smoking's Particular Impact On Plastic Surgery Recovery
Many people who smoke tell me that they have never had healing problems before, so why should it be a problem now. Let's go back to living on the edge.  What we are doing when we are moving tissue around in plastic surgery operations, is much different than -- say -- in a hysterectomy.  Because in this operation, the tissues are not moved around in the same way, and the blood supply to the skin is not altered.  (Now, I'm not saying that you won't have a complication with a hysterectomy if you smoke, but you are at greater risk with some of the operations that I do.)

The take-home for all this is rather straight forward: stop smoking. It's no more complicated than that. If you are a smoker and you do not stop, this may very well push us over the edge when you have surgery.

Wishing you all the best,

David B. Google+

Topics: Board Certification, Plastic Surgery Safety, Tummy Tuck, Mommy Makeover, Plastic Surgery Recovery, Health, Fitness, Weight Loss, Facial Plastic Surgery

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