Tobacco smoke contains more than
3,800 identified substances in which both nicotine and carbon monoxide are the
two biggest that are most detrimental to wound healing and of course has
the potential of causing pulmonary complications. Bottom
line.......impaired wound healing can decrease the final cosmetic outcome of a
Tobacco use increases
chronic health risks associated with smoking, and does have a direct correlation
with nicotine causing blood vessels to constrict which result in less blood and
oxygen going to the surgical site to help healing.
Nicotine closed the blood vessels
by constriction. These blood vessels are responsible for bringing
oxygenated blood to the tissues. Blood cells that are oxygenated help to
keep tissue alive as well as being instrumental in delivering important
medications such as antibiotics. Smoking clogs the lungs in which
increases the risk of pulmonary infection such as pneumonia.
For some procedures, smoking has even more risks associated with it and these
include breast reduction, tummy tuck, and facelift. These procedures have
complex and extensive wounds that the body needs to heal and impairing this
healing ability can cause real problems. Compared with nonsmokers, smokers have
a higher incidence of insufficient healing after face-lift surgery, as well as a
greater degree of complications following breast surgery.
Smoking can also prematurely age a person's face by:
Constriction of blood flow increases the free radicals
Decreases the skin's elasticity (leading to earlier sagging and wrinkling of
Repeated "puckering" action involved with having a cigarette in the mouth -
in which causes lines and wrinkles
Because of the risk of complications with smoking, some plastic surgeons will
require their patients to quit smoking prior to surgery. Most will ask to
have the patient quit for a period of two weeks before the procedure and also
for a period of two weeks after the surgery. Some plastic surgeons will
help their patients with smoking cessation medication or will advise the patient
to seek help from their internist on smoking before surgery.
Surgeons or physicians check the patient's background health completely before
committing to perform the surgery. Patients who are suffering from health
problems like hypertension, diabetes or kidney problems are considered high
risk. And of course smokers are also considered a health risk as well.
are studies that show that plastic surgery patients who smoke are 12 times more
likely to develop healing complications than non-smokers.
following complications occur with patients who smoke:
Nicotine is a vasoconstrictor that reduces nutritional blood flow to the skin,
resulting in tissue ischemia and impaired healing of injured tissue. Nicotine
can also contribute to blood cell platelet gumminess, raising the risk of thrombotic micro-vascular obstruction and tissue ischemia (an inadequate supply
of blood to a part of the body, caused by partial or total blockage of an
artery). In addition, production of red blood cells, fibroblasts, and
macrophages are all reduced by nicotine.
Nicotine has also been implicated as a negative factor in pain management - as
it has the tendency to distort one's perception and control of pain.
Monoxide binds to the hemoglobin in red blood cells and prevents it from carrying oxygen.
This causes less blood to be delivered to the metabolically demanding healing
tissue and once the smaller amount of blood arrives, it has greatly decreased
oxygen which is needed to help the healing process progress.
Carbon monoxide is referred to as a potent
inhibits the enzyme systems necessary for oxidative metabolism and oxygen
transport at the cellular level. It is these enzyme systems that are
important for the metabolism of oxygen at the level of the tissue where there is
a need for this oxygen. This is critical for proper tissue repair and
Anesthesia can be
hard on the human body. It is even harder on patients who smoke.
Because of the fact that smokers have a tendency to develop coughs and an
elevated heart rate, makes the odds higher for problems with anesthesia.
Smoking causes the
Lowers the body
immune system with trying to fight off an infection
of blood clots
oxygenation in the red blood cells
Some plastic surgeons have various opinions about the issue of smoking and
having cosmetic surgery, but most will agree that the patient should stop
smoking for a period of time before the surgery and up to three to four weeks
after the procedure.
Lightening Up the Smokes Eases OR Recovery
By Adam Marcus
Bone-joint patients heal faster by cutting
tobacco intake ahead of operation
Smokers facing elective surgery on bone joints
heal better and recover faster if they quit or cut down their tobacco intake
several weeks before the operation, a new study says.
Researchers in Denmark, who studied smokers
undergoing hip and knee replacements, found that those who tried to quit six to
eight weeks before surgery had fewer wound complications and a lower risk of
cardiovascular trouble after the procedures. They also spent fewer days in the
hospital recovering than did full-bore smokers, according to the study, which
appears this week in the journal The Lancet.
"How short-term smoking cessation influences
wound healing has not been shown clinically, but experimental data suggest that
even a few days [off tobacco] could improve tissue blood flow and oxygenation,
so it might very well have a positive effect on wound healing," Dr. Ann Møller,
lead author of the study, said in an e-mail interview.
While other researchers have found that
smoking impedes wound healing, the latest work is the first randomized trial to
look at the impact of smoking cessation programs on post-operative outcomes,
Møller, an anesthesiologist at Bispebjerg
University Hospital in Copenhagen, and her colleagues followed 120 smokers
scheduled for hip and knee replacement surgery.
Half of the smokers were told to stop, or to
cut their cigarette intake by at least 50 percent, starting six to eight weeks
before the operation. They were encouraged to do so with counseling and nicotine
replacement, such as the patch. The rest of the smokers were allowed to continue
smoking. All the smokers, who were typically in their mid-60s, reported puffing
an average of 15 cigarettes a day before entering the study.
Of the men and women in the smoking cessation
group, 36 managed to quit smoking, 14 cut their tobacco intake and six continued
smoking. Only four of the people in the second group quit smoking before
surgery, while the rest did not alter their tobacco intake significantly. Eight
patients whose operations were delayed or canceled were dropped from the study.
Ten patients in the smoking cessation group,
or 18 percent, suffered complications after surgery, compared with 52 percent of
those in the second group, the researchers say. These complications included
infections and bruising at the surgical site, urinary tract infections and
The difference was particularly marked for
wound-related trouble, which occurred in only 5 percent of the stopped smokers,
compared to 31 percent of those who did not stop.
None of the patients in the no-smoking group
suffered a cardiovascular setback, while 5 people, or 10 percent, in the other
"This doesn't mean that quitters cannot have
complications, but that it will happen less often," Møller said.
Patients who received smoking-cessation
therapy were also about 75 percent less likely to require additional surgery to
correct problems with the initial procedure. And they spent less recuperation
time in the hospital -- 11 days vs. 13 days.
Møller said the study shows that the effects
of smoking on recovery are reversible, and that smoking-cessation therapy prior
to surgery is "an intervention that gives us a major reduction in postoperative
complications, patient suffering and, presumably, in health care costs."
Orthopedic surgeons say long lead times for
elective procedures like joint operations offer a good opportunity for doctors
to encourage their patients to quit smoking.
"Even [quitting] for a few weeks, you will see
positive effects, but the longer the better," said Dr. Stuart Hirsch, chairman
of the department of orthopedics at Somerset Medical Center in Somerville, N.J.,
and a member of the board of directors of the American Academy of Orthopaedic
Not only does smoking undermine tissue and
vessel health, it weakens the bone mineral that keeps the skeleton strong,
"It is a worthwhile effort to say to your
patient, 'Stop smoking,' Hirsch said. "What you want to do is partner with
your patients for the very best result. If the patient doesn't do everything
that he or she should do to get the very best result, they're going to be