Smoking, Secondary Smoke and Healing

All procedures in plastic surgery are performed to improve form and in some cases, function. Our goal as plastic surgeons is to achieve improvement with minimal scarring. Unfortunately, smoking and secondary smoke affect wound healing in a potentially devastating way. Please be honest with us about your exposure to smoke so we can take good care of you and prevent problems and complications with your procedure.

Here are some online resources about the health risks of smoking and information about how to quit smoking:

• American Cancer Society
• American Heart Association
• National Institutes of Health

Any exposure to smoke either directly or indirectly can result in poor wound healing, delayed wound healing, skin loss necessitating skin grafting, increased risk of wound infection, and loss of skin and deeper tissues, all resulting from decreased blood supply to those areas. The diminished blood flow to skin wound edges can cause the breakdown of skin and scabbing, which will adversely affect the quality and character of the scarring (there is an increased risk of hypertrophic or keloid scarring). This is true for any surgical procedures requiring incisions (even skin lesion removal and liposuction).

The following is a partial list of cosmetic procedures and the impact that smoking or inhaling second hand smoke may have on would healing. It is not intended to be a complete list of procedures or list of all possible complications.

• Facelift: There can be actual skin loss of the face in front and behind the ear.
• Breast Implants (Reconstruction, Tissue Expanders, and Augmentation): There is an increased risk of delayed wound healing, capsular contracture, and implant infection with the possibility of extrusion.
• Breast Reduction and Breast Lift (Mastopexy): There can be delayed wound healing resulting in unsightly scarring and skin loss and potential nipple loss necessitating skin graft. In all cases of patients exposed to smoke or directly smoking, wounds do not heal in the normal length of time. Wound healing can be prolonged, as long as 3-4 months.
• Forehead Lift: There can be hair loss, poor wound healing and scarring.
• Abdominoplasty: Smoking or exposure to smoke will decrease the ability of the skin to heal properly resulting in unsightly scarring, higher risk for infection, and skin loss sometimes requiring a skin graft.
• Muscle Flap Surgery (Tram Flap, Latissimus Flap): There is an increased risk of partial, total loss or failure and increased risk of fat necrosis or hard lumps and scar tissue within the flaps. There is an increased risk of donor site (areas where flap is taken from) would healing complications and seromas. Any of these complications may require additional surgery to treat.

Slow wound healing (months instead of weeks), skin loss resulting in scabbing and prolonged need for dressing changes and infection usually involving the need for antibiotics (but sometimes another surgery to drain the infection) are all complications that can occur if you smoke or are exposed to second-hand smoke. If you have either stopped smoking very recently or have been unable to stop completely, you must accept these risks if you wish to proceed with surgery.