Plastic 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,
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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