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Smoking: A Facial Plastic Surgeon’s Perspective

Scott A. Asher, MD

“Why would a facial plastic surgeon care if I smoke?

I mean, he told me he wants to help me look as good as I can! Yeah, yeah, of course, everyone knows smoking is bad for your lungs… but he is probably ok with me smoking since it doesn’t affect my face, AND it makes me look cool, right!?!”

WRONG.

Smoking unfortunately does nothing good for the way you look. In addition to all the bad things you have likely heard about smoking hurting your health, it is can also be devastating to your appearance. The nicotine in cigarettes causes constriction of the tiny blood vessels that feed the skin and soft tissue of the face. This leads to premature aging, more wrinkles, and tissue sagging. It also dehydrates the skin and will lead to a rougher, more crinkly appearance.

“Oh, well, I’m just going to keep smoking, and when I look old, I’ll just have a facelift then to fix that.”

Unfortunately research studies have shown that smokers have a greater than tenfold rate of complications from these and other surgeries to rejuvenate the appearance of the face. Often, plastic surgeons will even refuse to offer elective operations to smokers to prevent such complications.

“What if it’s not elective and I need an operation on my face for reconstructive purposes?”

Your surgeon understands that smoking is very tough to quit, and no one plans on acute events such as car wrecks or other traumas. No one plans on developing a cancer on their face, or elsewhere in the head and neck. The stress from such events in your life can make it that much tougher to quit smoking. Of course, your surgeon will work with you to do everything in his/her power to restore your form and function to as close to the way things were before. But, it definitely limits the options he or she has to offer you in the form of certain reconstructive techniques such as flaps and grafts as these can be compromised by smoking.

“Can I still get Botox® if I smoke?”

Yes, nicotine is not a contraindication for treatment of wrinkles with Botox®. Unfortunately, smokers are more likely to need it much sooner than if they didn’t smoke. Studies in identical twins have shown statistically significant differences in the age of appearance between twins when one was a smoker and the other did not smoke.

“I want to have the hump on my nose and my deviated septum fixed. I’m a smoker, but that shouldn’t matter, should it?”

That scenario is tough, because smoking inhibits wound healing and can put the patient at risk for postoperative nasal congestion. Of course your surgeon will want to make you look better and breathe better out of your nose, but the smoke itself from cigarettes can be quite inflammatory to the lining of the nose. This can cause prolonged swelling to the outside of the nose or stuffiness on the inside of the nose. Cigarette smoke can lead to nasal congestion in the smoker, in fact, even in the perfectly shaped nasal cavity. This is why mothers are encouraged not to smoke around their children, as the stuffiness in the kids can lead to lower oxygen levels, asthma, and even infections of the sinuses and ears. These conditions sometimes require surgery to fix, such as ear tubes or opening of the sinuses to clear infection. Nasal congestion can also lead to puffiness or bags of the lower eyelids, which is never a good look.

“If I quit smoking I should get my normal voice back and get rid of this cough, right?”

When you go to shake hands for the first time with a new friend and make that unforgettable first impression, can you remember a time you didn’t speak? No matter how good you look in that new dress or tailored suit, it’s difficult to make your best impression with a smoker’s cough and a raspy voice. Although sometimes the care of a surgeon can correct the voice and over time the cough can go away, often smokers are left with permanent scars from irreversible damage done to their tissue. Luckily other cosmetic issues can be slightly more treatable without surgery such as yellowing of teeth and fingernails, or thinning hair.

“I saw someone with a plastic tube in their neck the other day to help them breath, and I definitely don’t want one of those.”

Smoking increases the chance you may develop cancer of the skin of the face, the voice box, throat, and tongue. Unlike cancer of the breast, colon or prostate, these head and neck cancers are almost impossible to hide from others. It is difficult and can affect every person-to-person interaction you have for the rest of your life. Sometimes it might require tissue to be borrowed from other parts of your body to reconstruct the defect left behind after the cancer is removed. Sometimes it might be necessary to have a plastic tube inserted into the neck to help you breath. And, sometimes your ability to speak and swallow are permanently damaged, leading to feeding tubes and the interruption of speech requiring use of sign or written language for communication.

“Sure, I know smoking will shorten my life, but I’d rather enjoy the time I am living.”

I would argue the points above could significantly impact the ability of the smoker to enjoy everyday life. No matter how self confident one is, I don’t know a single person who doesn’t look in the mirror when they get ready in the morning….is the pleasure of smoking worth wrecking that?

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