David B. Reath, MD
Knoxville, TN (865) 450-9253
HKB Knoxville Staff

Why Smoking Makes Plastic Surgery Recovery Difficult

Smoking and 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.

Smoking Makes You Need More Anesthesia and Pain Medication
A recent study (June 2015) presented at the European Society of Anesthesiology confirms what we have long suspected in the operating room. Compared with people who don’t smoke, smokers needed 33% more anesthesia throughout the operation and an additional 23% more pain medication after their procedure to achieve the same results. But the study went further. Those who didn’t smoke themselves but were exposed to secondhand smoke required 20% more anesthesia and 18% more pain medication than non-smokers who weren’t exposed to second hand smoke. Ouch.

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.

Many patients ask about “vaping”, thinking that it’s heathier before surgery. Vaping with nicotine is as bad or worse than smoking.

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,

Dr. David B. Reath

David B. Reath, MD

Editor’s note: This blog was originally published in March 2011. It has been updated to reflect the new European study on smoking and anesthesia.
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10 Responses to Why Smoking Makes Plastic Surgery Recovery Difficult

  • Rebecca G says:

    I am planning on having plastic surgery later in 2015 and am a smoker. The doctor did explain why I needed to quit before but I wanted to let you know that I appreciate your explanation.

    I have cut down a great deal (only had 3 yesterday and 1 today) and will completely quit WELL before the surgery. BUT I wonder if there are exercises or supplements that I can do to increase the oxygen levels in my skin and increase my body’s healing abilities?


  • David B. Reath, MD says:

    I am glad that you found the explanation helpful. The best thing that you can do is what you are doing: giving up cigarettes. That is really the key thing. Other than that, leading a healthy life style is the best thing you can do. Manage your weight appropriately and keep up with aerobic exercise.
    Good luck on your surgery.
    David B. Reath, MD

  • Tracy Thomas says:

    This is the best explanation as to why nicotine is bad for plastic surgery. Thanks! I have stopped smoking nicotine ready for my consultantat next week. I have suffered with Myalgic Encephamyeletis and Fibromyalgia since 2002 – will this stop me having a breast augmentation? I have wanted the procedure done since I was 18 in 1998 but I have only just been able to afford it now at the age of 36!

  • David B. Reath, MD says:

    Thanks for your kind comments. You may be a candidate for breast augmentation. It really depends upon the opinion of the doctors taking care of your Fibromyalgia and ME. If he/she clears you for surgery, then you can could proceed.
    All the best,
    David B.

  • Anna Levis says:

    It is necessary to stop smoking and using any nicotine containing products at least 3-4 weeks before a breast augmentation procedure. Smoking causes vasoconstriction so it decreases the amount of oxygen in the blood and decreases the amount of blood traveling to the body tissues. Smoking and use of nicotine can cause wound formation, high rates of capsular contracture, aging of skin and the collagen break down.

  • Jennifer says:

    I had breast reduction surgery on 3/28/18. I also have MS. I am a smoker, stopped 2 weeks prior to surgery ( smoked between 6-10 cigarettes day since 2010 when I got divorced.)
    After surgery, no smoking for 1st 2 weeks after surgery and just past few days probably have been smoking 2-4 a day. Will this change the shape of my breasts adversely? I already know slow healing due to MS. I’m scared enough, I won’t be smoking anymore!!! See my surgeon in 4 days for my 2 week follow up.
    Thank you for your explanation ????

  • David B Reath says:

    Dear Jennifer,
    The main problem with smoking is its effect on the blood supply to the skin and the tissue of your breasts. The shape of your breasts may be affected if there is a healing problem. But your best bet is to stay off cigarettes for at least another couple of weeks and preferably forever.
    Sincerely yours,
    David B. Reath, MD

  • Cyndi says:

    I picked up smoking about a year ago and plan on having a mommy make over in December. I have recently stopped is this still enough time to detox my body before surgery or should I schedule my surgery later.

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