This month’s issue of Plastic and Reconstructive Surgery Journal February 2013 had an article out of Hopkins on “Plastic Surgery and Smoking; A Prospective Analysis of Incidence, Compliance, and Complications.” Yes, all of you smokers out there have likely tuned out immediately. You know smoking is bad for you. We as doctors talk about how bad it is. We plastic surgeons won’t do certain surgeries which rely heavily on blood supply like facelifts, tummy tucks, and breast lifts and reductions on active smokers. The question is: how honest are you being with your plastic surgeon?
This was a study of 415 patients. Preoperatively they were asked if they were past or current smokers. They were then assessed using urine samples to look for nicotine metabilites. They were followed for 3 months after surgery to determine complications.
Findings?
- 33 % had quit smoking
- 9% admitted to active smoking
- They had samples of 362 patients. They found 54 were actively smoking. Of those 4% had denied current tobacco use.
- Complications were statistically significantly higher for smokers
- tissue necrosis (death of tissue)
- general complications
- complications requiring reoperation
- **They did not do high risk procedures on patients who were self reported to be smokers. Even then they still had higher complications.
- Patients who stated they had quit smoking were more likely to be deceitful than those who had never smoked.
This study may seem like an obvious thing. Everyone knows smoking is bad. We as plastic surgeons are not your parent. If you want to smoke, you can. But don’t deceive your doctor. We ask and we care because we want you to have a complication free safe surgery with a good outcome. I was surprised at the number of patients who had denied current use. Smoking any amount (one or two on a weekend when out at a party to chain smoking) or anything (cigarettes, cloves, pot) is not okay around the time of surgery. If you live with a heavy smoker, it can also affect your healing.
Risks cited in this study of smoking: pneumonia, cardiac arrhythmiias, different drug responses while under anesthesia, wound breakdown, poor healing, infections, and scarring. Some studies indicate you need to stop smoking for at least 4 weeks ahead of surgery.