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Why is smoking so bad for Plastic Surgery?


You should ALWAYS quit smoking before ANY type of Plastic Surgery.  Period.

Most people do not know this, but it is not only the smoke that can create potential complications for Plastic Surgery procedures, such as:

  • wound healing issues
  • delayed healing
  • wound separation
  • superficial skin infections
  • skin loss
  • death of a nipple, facial skin or abdominal skin

… but most do not know that the drug NICOTINE is actually the culprit.  Why?  Nicotine is a “vasoconstrictor”, which means this drug causes significant spasm and narrowing of your blood vessels – the precise blood vessels that are relied upon to deliver adequate blood flow to the tissues that are healing.

If nicotine is in your system in any form up to 6 weeks before a surgical procedure that involves making incisions, rearranging the tissues and healing (such as a facelift, breast reduction, breast lift, abdominoplasty and even a labiaplasty), then not quitting smoking puts you at increased risk of wound healing problems, infections, tissue death and increased scar tissue.

quit smokingTherefore, we recommend to all our patient to stop all forms of nicotine delivery, including smoking cigarettes, nicotine patches, nicotine gum, and even e-cigarettes!  We extensively counsel our preoperative patients about the dangers of smoking and why smoking is so bad for recovery after Plastic Surgery at their preoperative visit, which usually occurs 1-2 weeks before surgery.

However, quitting smoking BEFORE surgery, usually at least 6 weeks before any procedure is VITAL to help avoid complications such as the ones listed above.

How do we confirm that smoking cessation has happened? For patients where we need confirmation that they have in fact truly quit smoking and nicotine exposure, we test for urinary cotinine, a breakdown product of nicotine that is detectable in the blood for several weeks after nicotine exposure.  If a patient in fact has been smoking, then their surgery will be cancelled!

SAFETY is the number one priority for our patients, and avoiding complications is something we value above patient convenience or collecting fees.  If a patient is unable or unwilling to quit smoking, then Plastic Surgery is NOT for them, and we will recommend that they not have surgery at all.  It’s just not worth the risk.

To learn more about Plastic Surgery and to receive further education about preparing for a procedure and avoiding potential Plastic Surgery complications, schedule your consultation with Dr. Horton via our online consultation request form or call 415-923-3067 today!

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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA