Smoking and Wound Healing

Smoking and Wound Healing | Aesthetic Surgical Images
When cigarette smoking is discussed as far as health risks, most people think in terms of the lungs. They think, "Well, if I smoke, I might get lung cancer, or I might get chronic obstructive pulmonary disease or emphysema." But not many people understand how it affects wound healing. Not only does it affect the lining of the lungs, but it also constricts the small blood vessels in different parts of the body, particularly the skin and the fat.
Certain operations that we perform devascularize, meaning that they take away blood supply from edges of skin more than others. In those cases, when you add cigarette smoking to it, those edges could actually die. Die means that skin turns blue; it turns black; it has to be removed, leaving a hole, could be small, could be big.
The operations that are particularly sensitive to cigarette smoking are those where we're raising what's called a flap. Now, a flap is a component of tissue, or a composite of tissue, where, for example, the tummy tuck, we make a long incision along the bottom of the abdominal wall. As soon as we make that incision, the top skin doesn't get any more blood supply from the bottom. When we lift that skin and fat off the abdominal wall, we no longer get any blood supply from the muscle into that. So all the blood flow to that edge is coming down from the rib cage down to the edge. If you add cigarette smoking to that vascular compromise, we can lose skin in the lower part. You can lose enough skin to leave a hole that would be very difficult to fix ... And so in the tummy tucks, we'll tell patients, "You should stop smoking for six weeks before and four weeks after."
Breast lift surgery is similar. We have edges that have been disconnected from the surrounding tissue. There's less blood supply in those edges. If you add cigarette smoking to that, you can lose blood supply to the edges, having wound breakdown and having a very unsightly scar.
Face lifts are another area where we lift off the skin off of the underlying tissue. We cut down the blood supply to that skin. Once again, if you add cigarette smoking to it, they can lose skin and leave a scar that we can't fix, so it's very important in these particular operations to not smoke for six weeks before and four weeks after.
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