Considering Cosmetic Surgery? Don't Bother If You Smoke!

Many patients are disappointed when they have a consultation and are told that, despite their wishes and the probability that the surgeon is capable of delivering a satisfactory result, surgery is not advisable. The number one reason for patients being "turned down" for cosmetic surgery is that their cigarette smoking is of such a magnitude that chances of complications - both from the surgery and anesthesia - are unacceptably high.Smoking carries significant risk for both the surgery and anesthesia. One should not willingly increase the risk by smoking.Typically in cosmetic surgery, one does not require a deep anesthetic because the surgeons are able to anesthetize the tissues using local anesthetics producing a pain-free zone. The tissues are numb, just like during dental procedures. Usually, with a minimal amount of drugs, the anesthesiologist or nurse anesthetist creates a state of unawareness for the patient to reduce the chance of the patient moving or acting otherwise inappropriately during the operation. Naturally, the less medication the better, plus a quicker wake-up and less chance of nausea and vomiting after surgery.Anesthesiologists and nurse anesthetists are unhappy with smokers because the smoke creates a state of chronic irritation and inflammation of the bronchial passages in the lungs. During the surgery, the lungs will be unduly sensitive to the gas anesthetics which are frequently used. Because of that, to avoid coughing, wheezing and the production of abnormal thick mucus, the anesthesiologist will have to "deepen" the anesthesia.If a patient is capable of stopping their smoking for weeks before surgery, that is ideal. Luckily, the body's phenomenal regenerative powers will allow the irritated tissues of the lining of the lungs to settle down and repair themselves. The longer one has smoked and the greater the number of cigarettes smoked per day, the longer it takes for such healing to take place.Regarding the operation itself, the risks are dependent upon the procedure. In rhinoplasty or cosmetic nasal surgery, the nose has been subject to the same type of irritation as the lining of the lungs. As a matter of fact, the lining of the nose structurally and microscopically is identical to that of the lungs, hence the similar response. The nose does not take to smoking very well because the smoking dries out the normal nasal mucus which is necessary to cleanse the incoming air. The smoke paralyzes the tiny hair-like fibers which help filter the incoming air. The smoke's heat dries and thickens the existing mucus causing immobility of the mucus and what we call the "post-nasal drip": the thick, rubbery mucus eventually gets to the back of the throat, causing the reflex to cough it out. Not what you want when recovering from surgery. In addition, there is a greater chance of bleeding excessively during surgery and after surgery because the smoking has generated a proliferation of blood vessels inside the nose.For the nose, the cigarette is an enemy. Whether they are filtered or unfiltered, light or whatever. Smoke is smoke.Other cosmetic operations carry different risks for the cigarette smoker. Facelifts which rely on the elevation and movement of large territories of skin on the face and neck are subject to a very negative effect of cigarette smoke which can be disastrous for the tissue. The noxious elements in smoke, such as carbon monoxide, carbon dioxide and nicotine, inhibit the flow of oxygen-carrying blood to those tissues and may threaten the very survival of the tissues. This could lead to wound breakdown, infection and then scarring. Obviously, this is an unacceptable risk for an elective operation. Therefore, surgeons respectfully decline to perform face and neck lifting on patients who smoke. Period. No appeals accepted.The same risks exist for other operations performed on the body such as tummy tuck and breast surgery, particularly breast reduction where akin to the facial operation, large amounts of skin are elevated from their bed and moved to a new location.Frankly, for everyone, there is not a single good thing that could be said for cigarette smoking. Medically, smoking takes its toll on the heart, lungs and all internal organs.Smoking is a friend of aging, however. It prematurely ages the skin. The skin is the last stop along the circulation railway and is chronically deprived of oxygen because of the blood-vessel narrowing by the carbon dioxide, carbon monoxide and nicotine mentioned above.The biggest mistake a patient can make is to lie to the doctor or anesthesiologist about smoking, past or present. After all, the surgeon and anesthesiologist are responsible for your surgical outcome, your comfort, your safety - and even your life. Unlike cigarettes, they are on your side.Don't stub your toe. A better solution than denying you are a cigarette smoker is to seek professional help which is available everywhere to stop smoking. There are even medications that help the cause. Then, when your body has recovered from smoking's damage, you can schedule the proecedure(s) you want and feel comfortable that your body is in better shape for surgery.- Robert Kotler, MD, FACSGet the free WebMD Skin & Beauty Newsletter - tips to look good and feel great.

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