If you’re a smoker undergoing surgery you’re at much greater risk of complication.
That’s why we advise all patients to stop smoking at least three weeks ahead of surgery and three weeks after, but it’s not just traditional cigarettes that should be avoided – all nicotine products can sabotage your results.
“Vaping” still risky
E-cigarettes have become increasingly popular and because they don’t involve burning tobacco many people believe them to be the “safe” way to smoke.
Patients tell us they have stopped smoking when in fact they have simply switched to e-cigs. Others will have turned to nicotine gum or patches to cope with the cravings and believe this also constitutes having “given up”. Unfortunately this is not the case.
While there is still nicotine in your body you are at an increased risk of blood clots, small vessel damage, infection and complications with wound healing. That’s because nicotine increases the level of a pituitary hormone called vasopressin, which causes tightened blood vessels and inhibits blood flow.
Good blood flow is essential for carrying oxygen and haemoglobin to injured tissues, so this results in poorer and more prolonged healing.
What’s more, sluggish white blood cells become less effective at fighting pathogens, increasing the risk of the wound becoming infected.
Nicotine poses even greater risk in plastic surgery
Patients undergoing any type of surgery are advised to quit nicotine, but it’s especially important for those having a cosmetic procedure such as a facelift, tummy tuck or breast lift.
The way the incisions are made for this type of surgery differ to, say an appendectomy or disc operation. In the latter, the surgeon will cut straight down through multiple layers of skin, tissue and muscle. On the other hand, for a procedure where the aim is to lift and tighten the skin, the incisions made are more similar to filleting a fish.
The surgeon will dissect down to a layer without blood vessels and detach the skin from the underlying muscles. Once the skin has been lifted, it can be pulled, stretched, moved around, and removed.
During this process normal blood flow is restricted so it’s important the remaining blood flow is sufficiently oxygenated. Skin, fat and muscle all need oxygen to survive – that’s why smokers are at greater risk of skin and fat necrosis.
How nicotine constricts blood flow
If you’ve ever tried sucking a thick milkshake through a thin straw you’ll understand the effect constricted blood vessels have on blood flow. Nicotine causes the blood vessels to shrink down and tighten making it harder for blood cells to pass through.
In turn, this means less oxygen circulating the body and that can lead to tissue death. Wound healing can be delayed, scarring can be worse and even pain levels during recovery can be higher.
More serious complications can include stroke, heart attack, blood clots, and pneumonia. One study found smokers have a 77% higher risk of heart attack after surgery than non-smokers.
Smoke brings extra complications
The blood flow issues presented by nicotine are further compounded by the carbon monoxide present in cigarette smoke. Smoking cigarettes also makes anesthesia more complicated.
Smoke paralyses cilia, the little hair-like structures in the lungs that help move out debris. Consequently, debris stays in the lungs, meaning smokers’ lungs don’t work as well as non-smokers.
Anesthesiologists have to work harder to keep smokers breathing while under anesthesia and it is more likely that breathing apparatus will have to be used post-surgery.
Even secondary smoke can have a significant impact, so anyone undergoing or recovering from surgery should avoid enclosed spaces where people are smoking.
Stop now and reap the benefits
The sooner you stop any nicotine intake the better. Even if you only have a few weeks to go before your surgery it can make a big difference.
In one study of general surgery patients, quitting smoking for three or four weeks before surgery reduced the complication rate from about 40% to 20%.
And we know you’ll be nervous before going into the operating theatre, but resist the urge for a quick cigarette and chew some gum instead!