Monday, December 28, 2009

Smoking in Facial Aesthetic Surgery Patients

Just finished reading a CME article on “Aesthetic  Surgery of the Face and Neck” in the Nov/Dec issue of the Aesthetic Surgery Journal (the first article referenced below).  Nice review article, but I want to just concentrate on the section on smoking.  This is the time of year when many resolutions are made, and often to quit smoking is one of them. 

One of the major things to avoid pre- and post-facial surgery is smoking.  The other major one is platelet inhibitors (ie aspirin, NSAIDs, and certain herbals).

The logic for smoking avoidance is because “tobacco smoke is an aerosol of particulate matter, volatile acids and gases.  The overall cellular effect of these inhaled or absorbed byproducts is to produce an environment of relative tissue hypoxia, and delayed wound healing mediated by vasoconstriction, abnormal cellular function, and thrombogenesis.” [second reference]

The reported incidence of facelift skin flap necrosis is 12.5 times greater in smoker than nonsmokers.  This risk is too high for elective surgery, so no surgeon will knowingly operate on the face of a smoker electively.

Even smoking one cigarette has been shown to cause temporary vascular spasm which can last up to one hours.  This vascular spasm can result in 24-42% decrease in blood flow.  This can lead to skin necrosis, poor wound healing, and increase infection.

The current recommendation for elective facial surgery is smokers is patients remain nicotine-free for four weeks before surgery and for four weeks after surgery.

Patients often underreport their smoking.  To “test” their truthfulness, a salivary rapid test (NicAlert) has been developed which test for cotinine, the metabolic breakdown product of nicotine.

I would encourage all smokers to quit just for general health benefits.  Keep trying.  If one method doesn’t work for you, work with your primary care physician to find one that does.




Aesthetic Surgery of the Face and Neck; Aesthetic Surgery Journal, November 2009, Vol. 29, Issue 6, Pages 449-463; Fritz E. Barton (DOI: 10.1016/j.asj.2009.08.021)

Clearing the Smoke:  the Scientific Rationale for Tobacco Abstention with Plastic Surgery; Plastic and Reconstructive Surgery. 108(4):1063-1073, September 15, 2001; Krueger, Jeffery K.; Rohrich, Rodney J.

The Effect of Cigarette Smoking on Skin-Flap Survival in the Face Lift Patient; Plastic and Reconstructive Surgery. 73(6):911-915, June 1984; Rees, Thomas D.; Liverett, David M.; Guy, Cary L.

Planning Elective Operations on Patients Who Smoke: Survey of North American Plastic Surgeons; Plastic and Reconstructive Surgery. 109(1):350-355, January 2002; Rohrich, Rod J.; Coberly, Dana M.; Krueger, Jeffery K.; Brown, and Spencer A.


Chrysalis said...

Fireguy quit cold turkey years ago. He was a bear, but it was worth it. Now, he can smell someone smoking in the car in front of us on a highway. I kid you not(summer time of course).

Weird, that a fireman would smoke, but almost everyone of them did at one point or another. It's a very strange thing to see them come back from a working structure fire and light up. Glad he quit.

WordDoc said...

You can always tell a smoker by that gray undertone to the skin. Interesting about the rapid test, hadn't heard of that one. Funny when they reek of smoke (can't smoke in the car and still smell fresh) and still deny it. Aroma so powerful I have to abandon the exam room for an hour or two lest my next patients think it's me that's the puffer!