Most plastic surgeons avoid procedures on patients who smoke

NEW YORK (Reuters Health) – Smokers who elect to undergo cosmetic facial surgery or another type of invasive cosmetic procedure may have a harder time finding a surgeon willing to perform the procedure compared with their nonsmoking peers, recent study results suggest.

Nicotine and carbon monoxide, plus more than 3800 other detrimental substances found in tobacco smoke, are known to have an adverse effect on the heart, lungs and immune system, putting smokers at an increased risk of wound-healing problems.

"This impaired wound healing may dramatically decrease the final cosmetic outcome," lead study author Dr. Rod J. Rohrich, of the University of Texas Southwestern Medical Center in Dallas, said in a statement.

Dr. Rohrich and his colleagues investigated surgeons' willingness to perform elective operations on smokers in a survey of 955 members of the American Society for Aesthetic Plastic Surgery.

Nearly all of the surgeons performed elective plastic surgery on patients who smoked, the researchers found, but roughly half said they only performed operations that did not involve skin undermining, according to the report in the January issue of the journal Plastic and Reconstructive Surgery.

For example, 88% or more of the respondents said they would be willing to perform rhinoplasty, liposuction or breast augmentation on smokers, while 54% or less said they would perform breast reduction operations or abdominoplasty. Only about 4 in 10 said they would perform a facelift on a smoker, the report indicates.

Roughly two thirds of the physicians said they had set a maximum level of patient smoking that would be acceptable prior to surgery. Of this group, 62% said that the maximum acceptable level was less than a half pack of cigarettes per day, while 36% said a half pack or even one pack per day was acceptable.

Slightly more than 7 in 10 surgeons said they would cancel a scheduled surgery if they suspected that the patient had not stopped smoking, the authors report. Less than 20%, however, said they would give the patient a nicotine test to confirm their suspicions.

Of the surgeons who required that their patients quit smoking before their operation, nearly three-quarters requested that the patients remain abstinent for at least 2 to 4 weeks prior, according to Dr. Rohrich and his team.

In other findings, roughly 30% of the surgeons were current or former smokers. Current smokers were less likely to say they had a maximum acceptable level of patient smoking before operation. In addition, although half of the respondents overall said they would operate on a diabetic smoker, previous smokers were less likely than their peers to say they would do so.

Plast Reconstr Surg 2002;109:350-355.

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