Smoking is not just dangerous to the heart and lungs and throat. The University of Toronto has performed definitive research showing that the nicotine in cigarette smoke can damage skin flaps used in cosmetic and reconstructive surgery . Face lifts, eyelid and nasal surgery, and many other facial plastic surgery procedures are at risk for poor skin healing in smokers. The nicotine in the smoke halts or decreases the blood flow to the flaps and or skin causing the flap to fail to hold or the skin to break down. That is also why quitting smoking but still using a nicotine patch, gum or candy is just as dangerous.
Some damage that smoking does to the microcirculation of the skin is permanent and may not be reversed by cessation. But smokers who quit at least one month prior to surgery and continue to refrain from smoking for at least one month after surgery will decrease that risk. Smoking patients undergoing face lift surgery are especially susceptible to complications because there is usually some tension placed on the face flaps which make them more vulnerable to nicotine.
Additionally smokers have what we call reactive airways, meaning that their lungs and windpipe are chronically irritated causing frequent coughing which can lead to bleeding or excessive pressure on the flap or skin. By stopping at least one month prior to surgery, the airways have an opportunity to calm down.
Furthermore, smokers tie up their normally oxygen-carrying red blood cells with carbon monoxide, preventing full oxygenation of all the body's cells. Since red blood cells are not replaced for 120 days, the optimum time to quit would be four months in advance of surgery to give the skin the best chance to heal following surgery.
In our practice we have seen the deleterious effects that smoking has had on skin and flaps and we can show you pictures should you so desire. We strongly encourage you to stop smoking and ask that you plan the timing of your surgery appropriately. We cannot be responsible for the effects that your smoking may have on your surgery. Please discuss your smoking with us. We would be happy to provide you with the names of cessation programs that might assist you should you so desire.
Sincerely Yours,
Russell W. H. Kridel, MD, FACS
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