Smoking and Plastic Surgery

Smoking while having plastic surgery is a disaster waiting to happen. Most plastic surgeons tell their patients not to smoke before, during, and while healing from surgery. Why?

Simply stated, smoking causes wound healing complications.
– Perhaps the entire incision doesn’t heal.
– Perhaps the tissue that has been stitched dies and turns gangrenous.
– Perhaps the incision does heal but with a poorer scar.
– Perhaps the scarring around a device such as an implant is hardened leaving to a permanently hard breast.

I recently had a tummy tuck patient who was having one small area of her incision have difficulty healing. I ended up treating this area of her incision for several extra weeks to get it healed. She had stopped smoking at my request prior to surgery. When she came in upset that she was not healing properly and asked why, I asked her if she was still smoking. She told the truth, and I once explained that smoking causes healing issues. It really does. It is difficult to understand the concept and believe that smoking has such a tremendous impact on healing however time and time again smokers prove to have more complicated postoperative courses.

This week a strikingly beautiful young lady and her mother came in for breast enhancement surgery consultation in my New Jersey plastic surgery office. I was reviewing her medical history and it said she smoked one half a pack of cigarettes a day. I explained to her the need to stop smoking prior to surgery and the risks involved and both she and her mother looked at me like I was crazy. Her mother stated “I didn’t know smoking causes healing problems.” I don’t think that many people realize this.

I tell patients this all of the time. I am writing about it again because it is a very important issue. If you need to have an emergency operation (appendix, etc) and you are a smoker you do not have much choice other than to have the procedure. For an elective operation, you do have the choice. Optimizing outcomes for my patients is not only about surgical skill and techniques but also about patient education.

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