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Smoking's Effect on Plastic Surgery Complications Including Flap Death, Fat Necrosis, Wound Healing
By: Dr. Kenneth Benjamin Hughes, MD
Smoking contains several chemicals that are harmful to healing. Nicotine is a potent vasoconstrictor, which will decrease the blood supply to the healing tissue and result in greater complications including poor wound healing and poor scarring. In some cases, the vasoconstriction can lead to the death of tissue or death of a flap of tissue, known as tissue necrosis or flap necrosis. This dead tissue develops due to lack of blood supply to the tissue that is surgically manipulated. In fat transfer procedures such as the Brazilian buttlift or the BBL, the fat can be killed in this manner and lead to dead fat referred to as fat necrosis. This dead fat then may require future procedures to remove or excise, which can lead to further deformity. Smoking can have disastrous consequences that cannot be overstated in the surgical setting.
Some of the chemical compounds in the tobacco smoke can be removed from the body in a few hours. Thus, smoking cessation just a few hours or days before surgery can result in significant reduction of complications. However, for the patient to return to more normal respiratory and immune system function, smoking cessation should occur at least a month prior to surgery. The cigarette smoke definitely reduces the ability of the immune cells to recognize and remove bacteria and other microbes that can lead to infection. The inability of the cells to perform the normal surveillance functions can obviously have grave repercussions. Cigarette smoke is also known to significantly reduce lung function, increasing the risk for lung-related complications including asthmatic attacks. We also know that smoking increases the rate of platelet aggregation and clot formation leading to the increased risk of heart attack and stroke.
In addition, there are some very specific complications related to plastic surgery. In addition to the wound healing complications that have already been delineated, these compounds can lead to poor scarring and higher scar revision rates. In addition, smokers have a 50% higher rate of fluid collections (seromas), which can distort and totally destroy a very nice cosmetic result after liposuction or similar body contouring procedures. The most serious complication of cigarette smoke to the plastic surgery itself is the death of tissues, known as tissue necrosis or flap necrosis. A piece of skin dissected can literally die, yielding an open wound that can create a very long healing period and a poor result.
To learn more about the Negative Repercussions of Tobacco Use on Plastic Surgery, please visit Dr. Kenneth Hughes's websites at
Dr. Kenneth Hughes
Los Angeles Plastic Surgeon