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How Bad Is Smoking Before and After Elective Surgery?

The link between smoking and postoperative complications is well documented across surgical specialities. Dr Rozina Ali is a highly qualified aesthetic and reconstructive plastic surgeon. Her expertise lies in all aspects of breast reconstruction &  aesthetics as well as surgical and non-surgical facial aesthetics. In this article, she will share with us 3 of the main reasons why smoking is contra-indicated in the weeks and months before and after surgery. 

Smoking increases the risk of blood clots

Smoking damages your entire cardiovascular system. Nicotine causes blood vessels to tighten, which restricts the flow of blood. Over time, the ongoing narrowing, along with damage to the blood vessels, can cause peripheral artery disease. Because the blood also gets thicker if you are a smoker, it raises your risk of developing a blood clot in your legs. If a blood clot travels from your legs to another part of your body, it could cause a heart attack, stroke, or pulmonary embolism (a blood clot in your lungs).

Smoking affects every aspect of your outer layer – skin, hair and nails

The more obvious signs of smoking involve skin changes. Substances in tobacco smoke actually change the structure of your skin. Your fingernails and toenails aren’t immune from the effects of smoking. Smoking increases the likelihood of fungal nail infections. Hair is also affected by nicotine. An older study found it increases hair loss, balding and greying.

Smoking affects the appearance of your result

Sadly, smokers stand a higher risk of complications including poor wound healing, adverse scarring, infection and wound breakdown. Aesthetic procedures which are done to improve appearance are therefore contra-indicated in smokers- Facelifts, breast reduction, fat transfer and tummy tucks all fall into this category. 

For example, in tummy tucks and other procedures affecting the abdominal wall, surgeons sometimes do not tighten the abdominal muscles as much as they would for a non-smoker: Smokers tend to cough, and this can disrupt abdominal healing. Studies showed that 40 per cent of patients who smoked before and after breast reduction surgery displayed impaired healing of the surgical wounds. This is why smoking is a key eligibility criterion for breast reduction procedures; and why surgeons may refuse to operate on patients who do not stop smoking beforehand and abstain until after all wounds have fully healed.

Smoking can complicate the anaesthesia

It’s no secret that smoking causes serious health problems, including heart disease, asthma, and lung cancer. If you are having surgery, you also may experience complications related to smoking and anaesthesia. This is especially true if you are having a general anaesthetic. Anesthesiologists have to work harder to keep smokers breathing while under anaesthesia, fighting against lungs compromised by cigarette smoke. 

When To Quit Smoking Before Plastic Surgery

The sooner you quit smoking before your surgery, the better. With each smoke-free day, your overall risk of complications decreases. Quitting even 12 hours before surgery can make a difference, but quitting at least two months prior to your treatment can have a dramatic positive impact on your surgery and recovery.

  • 12 hours before surgery: Improved oxygenation, blood pressure, and heart rate.
  • 2 weeks before surgery: Less breathing problems during surgery.
  • 3 weeks before surgery: Wound healing will be greatly improved.
  • 8 weeks before surgery: Lower risk of clot-related problems, such as a heart attack, a lower risk of infection and improved immunity and response to anaesthesia.

The good news is that there is nothing like a long-desired elective or ‘chosen and wanted’ surgery to get most smokers to quit the habit.  If your doctor or plastic surgeon has been strongly encouraging you to quit smoking before surgery, it’s only because the benefits are high and not just in the short-term run-up to the surgery.

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