Often I am asked by patients considering cosmetic surgery if they really need to quit smoking prior to their surgery. In order to answer that question, one needs to understand the effects of smoking. Now I am not going to lecture anyone on how bad smoking is, how it causes lung cancer and emphysema or how more that 400,000 people die each year from smoking-related illnesses and diseases. In today's society, you would have to be a hermit living in the mountains of Timbuktu not to have heard these reasons for quitting. I simply want to explain why we, as plastic surgeons, ask patients to quit smoking before their procedure.

Smoking and Plastic Surgery
There are several issues that arise with smoking and plastic surgery. First, there is the obvious dichotomy of improving one's appearance through plastic surgery while remaining a smoker and disregarding the health effects. However, there are more subtle consequences to smoking and those consequences may result from exposure to secondhand smoke, "social smoking," or the traditional 2-pack-a-day smoking. Any amount of smoke inhalation results in a permanent tightening of the blood vessels known as vasoconstriction. This is primarily caused by the nicotine component. Therefore even patients with a history of smoking who quit long ago still have slightly greater risks associated with surgery. In addition, active smokers have the additional problems associated with the carbon monoxide in smoke. Carbon monoxide reduces the blood's ability to carry oxygen to the tissues resulting in more significant risks. Overall the risks of smoking include:

• Poor or delayed wound healing
• Poor scarring including hypertrophic or keloid scarring
• Increased risk of infection
• Respiratory issues related to anesthesia
• Skin and soft tissue breakdown or complete loss
• Increased bruising

Though many of these sound negligible, it can be devastating to the patient that experiences even the most minor complication. For that reason, I frequently ask patients to quit smoking 1 month before and 1 month after surgery for certain procedures. In addition, I remind patients that many of the self help products available over-the-counter like gum or patches still contain the offending chemical, nicotine, that causes the vasoconstriction. This inability to use traditional self help tools makes it even harder to quit something that has become a part of one's everyday routine. For that reason, I offer patients as much help as possible in the form of referrals or anti-smoking medications because I know that it is difficult to quit. It certainly is not that I relish the idea of making patients go through an extra step (a very difficult step at that) before surgery. My priority above all else is to keep my patients safe from harm. I only ask because I care about my patients and their outcome.