How nicotine sabotages plastic surgery

Having plastic surgery? Then your plastic surgeon probably told you not to smoke. That’s good advice. But that doesn’t mean you can reach for a substitute. Nicotine wears several masks that may seem seductively harmless, but don’t let them fool you! Nicotine gum, patches, snuff, chewing tobacco, cigarettes, pipes, cigars, and even trendy e-cigarettes have one thing in common: Nicotine.

If you’re a smoker, you might have healed great after an appendectomy, so you may feel you don’t need to worry about quitting before a facelift. But plastic surgery is different. Let me explain with a layer cake. How do you cut a piece? You take a knife, and you go straight down, all the way to the plate. That’s how a general surgeon cuts to get to your appendix. Straight down.

Now, imagine cutting through just the top layer, then turning your knife sidewise, and cutting through the yummy frosting layer so you can lift off the top layer. That’s what a plastic surgeon does when performing a facelift, a tummy tuck, a breast reduction, a breast lift, and hundreds of other procedures. Once the skin has been lifted, it can be pulled, stretched, moved around, and removed.

Of course, cake and flesh have many differences, like a blood supply. A cake doesn’t need it, but flesh does because blood carries oxygen, which flesh needs to survive. Without oxygen, skin, fat, and muscle die.

If a cake needed oxygen, it would have blood vessels traveling from the bottom layer all the way to the top. What do you think would happen to those blood vessels if you lifted off the top layer of cake? You’d sever them, and the top layer of cake would die.

But if we lifted only half the cake, we would leave some blood vessels untouched, and those vessels could serve the entire top layer. That’s what happens in plastic surgery. Some of the blood vessels are cut, but some are left intact. The vessels that are intact supply oxygen to the skin that has been elevated after a facelift or a tummy tuck.

So what does nicotine have to do with cutting cake? OK, let’s say those blood vessels were the size of giant drinking straws, large enough to suck up mini-marshmallows. But if we add a little nicotine to the blood, those giant straws would shrink down to the size of little red stirring straws. Small blood vessels mean less blood flow, and less blood flow means less oxygen, and less oxygen can mean tissues die.

Mixing nicotine with plastic surgery can result in other problems, too:

• Loss of cheek skin, nipples or tummy skin after a facelift, breast lift, breast reduction, or tummy tuck surgery
• Infections
• Death of fat cells (fat necrosis), causing hard lumps
• Delayed wound healing
• Thick, wide scars
• Blood clots, which can be fatal
• Increased pain
• Permanent small vessel damage adding risk even if you quit
• Loss of breast implants
• Life-threatening complications like stroke, heart attack, blood clots, and pneumonia.

If you smoke and you’re planning to have plastic surgery, quit. Follow your plastic surgeon’s recommendation, which may be to quit three to six weeks before surgery through three to six weeks after (though forever is best).

Even if you don’t smoke cigarettes, you’re not off the hook if you smoke e-cigarettes or chew nicotine gum! Quit any form of nicotine, including secondary smoke (yes, send your smoking friends and family outside). Even one puff will cause your blood vessels to shrink. If you’ve scheduled surgery in the near future, and you have a weak moment, confess to your surgeon. It’s better to delay surgery than to risk having your tissue die.

After surgery, you still can’t smoke, so develop nerves of steel and think about how much you might regret that one little puff.

After all, you want to have your cake and eat it, too!

This blog was contributed to ASPS by Dr. Heather Furnas.