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Cigarettes, Nicotine and Vaping – Impact On Plastic Surgery Procedures

Posted by Laurence Weider on October 5, 2021

While it may not be surprising that your surgeon has asked if you smoke cigarettes during your consultation, you may not be aware of how smoking, as well as vaping and other forms of nicotine, are especially detrimental for patients undergoing many cosmetic surgery procedures. Of course, everyone is aware that smoking increases your risk of heart disease as well as lung cancer and COPD (emphysema). However, smoking cigarettes as well as using other forms of nicotine can turn an otherwise successful plastic surgery procedure into one with serious complications. Let me explain why that is the case.

Let’s talk for a minute about other common types of surgery. If you are having a general surgery procedure, the surgeon cuts straight down until he or she reaches your abdominal cavity and then removes the diseased organ whether that is the appendix, the gallbladder or part of the intestine. The surgeon then closes the layers of tissues including the skin. The blood flow to the skin and the fat below it is hardly affected. Many cosmetic surgery procedures are quite different. In procedures such as face lifts, breast reductions, breast lifts and tummy tucks, the skin and the subcutaneous fat below it are raised up and separated from the deeper tissues below. This allows the surgeon to tighten and reshape loose skin. However, it also means that many of the small blood vessels that nourish the skin are severed, and the skin and other tissues that are tightened must rely on far fewer blood vessels to survive. This is usually fine, but if the remaining blood vessels have shrunken down because of the effects of smoking, vaping or other forms of nicotine, it could have disastrous consequences. Specifically, skin and fat can die. This is called tissue necrosis, and it is more than ten times more common in smokers and other nicotine users having plastic surgery than in non-smokers. Additional risks of nicotine use around the time of plastic surgery include:

  • Increased risk of infection
  • Death of fat cells resulting in overly firm lumps (fat necrosis)
  • Thickened, darkly pigmented scarring
  • Blood clots (which can be fatal)
  • Breast implant complications
  • Increased risk of stroke, heart attack or pneumonia during or after surgery
  • Increased pain or discomfort after surgery

So, if smoking and nicotine are so bad for cosmetic surgery, what can we do? The good news is that if a person completely abstains from all cigarettes and other nicotine products for four to six weeks before surgery, their risk of wound healing complications approaches that of a non-smoker. Yes, I know it isn’t easy to quit, and as mentioned, nicotine gums and patches are not suitable alternatives, but for most people who are really motivated, it can be done. However, once you have had your procedure, you are not out of the woods. The tissues are still healing, so you must continue to avoid cigarettes and other forms of nicotine for at least three more weeks. Of course, for the sake of your overall health, it would be best not to resume smoking if possible.

What about e-cigarettes (vaping)? E-cigarettes were promoted as a healthier alternative to cigarettes and a good way to stop smoking when they were first introduced in 2004. Unfortunately, that isn’t turning out to be the case. First of all, most vaping liquids contain nicotine. Nicotine constricts (shrinks) blood vessels as we discussed above. In addition, recent studies have shown that there are high levels of toxic metals including lead, chromium, nickel and manganese in the inhaled e-cigarette vapors.

With the changing perception of marijuana due to its use medically as well as loosening of restrictions regarding its possession in some parts of the country, we are also seeing more people who use marijuana medically or recreationally. Unfortunately, use of marijuana, especially if it is smoked, also greatly increases one’s risk of complications during and immediately after surgery. Smoking marijuana has been shown to increase your risk of strokes, heart attacks, and pneumonia as well as wound healing complications during and after surgery. Orally ingested forms of marijuana probably pose less of a risk. However, their composition is not well regulated, and they may contain substances that impair wound healing as well.

In order to ensure the best possible outcomes for our patients, we have instituted stricter policies regarding the use of tobacco and nicotine products as well as e-cigarettes and marijuana. Our policy, which is included in our patient packet, states that patients must completely quit use of all tobacco, nicotine, e-cigarettes and marijuana for six weeks prior to surgery and for three weeks after surgery. Compliance with this policy will be confirmed with a nicotine test at the time of surgery. Some exceptions will be made at Dr. Weider’s discretion for procedures that don’t require rearranging skin (breast augmentation, for example).

Quitting smoking before surgery can be a first step on a road to a healthier life after surgery. Please contact Weider Plastic Surgery at (972) 566-8444 to schedule a consultation. We will be happy to discuss any concerns you have about quitting smoking or any other topic related to your desired procedure.

All the best,

Dr. Weider

Dr weider

Dr. Weider, a native of Southern California, is a Board-Certified Plastic Surgeon who has maintained a private practice in Dallas, TX since 1999. After attending Stanford University, he obtained his medical degree (M.D.) from Baylor College of Medicine in Houston. He then completed a one year surgical internship in Los Angeles at Harbor-UCLA Medical Center, followed by a four year general surgery residency in Dallas at Methodist Medical Center, and a two year plastic surgery fellowship in Cleveland at Case Western Reserve University.

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  • Dallas Society of plasctic surgeons