IntroductionWe are all aware of the adverse effects of smoking not only on our health, the beauty of the skin, but even the health of people around us that are affected by second-hand smoking. Moreover, it is important for people looking to undergo plastic surgery to know that smoking can also have a negative effect on wound healing after the procedure.Avoiding smoking is one of the most commonly known rules to follow before and after a plastic surgery intervention. Because cosmetic surgeries are performed on an elective basis and on healthy patients, the patient has enough time to quit smoking a few weeks before the procedure to ensure a faster and uneventful recovery period. Smoking and wound healingThere are several studies that demonstrate the incidence rate of post-surgical complications occurring much higher in patients who smoke compared to patients who don’t smoke. Delayed wound healing and infections of the surgical site, as well as developing hypertrophic scars, are some of the complications that have been observed to affect smokers more.To get a better understand of what smoking does, a study performed in 2003 made the assessment on 228 surgical wounds and showed that the rate of infection was 12% in smokers and 2% in non-smokers and that the rate of wound dehiscence was 12% in smokers while there were no cases in non-smokers. Other studies have demonstrated that people who smoke a lot (one pack of cigarettes per day or more) have a significantly increased risk of developing tissue necrosis.The effects smoking has on healing after surgery is not news. We have been aware of them for a long period of time. However, when it comes to plastic surgery, we can really reduce the effects by quitting smoking for as long as possible before and after the surgery. I always tell my patients that it is not worth jeopardizing the results of their intervention with smoking.Delayed wound healing, wound dehiscence, and surgical wound infection can trigger even more severe complications and lead to scarring that can significantly reduce the aesthetic appeal of the results after the intervention. Why does smoking affect the recovery process after surgery?Before anything else, we should mention that more than 4,000 substances have been identified as present in tobacco smoke, and some of them are known to impact the healing process. Among them, we can mention nicotine and carbon monoxide, which are the most well-known components of cigarettes. It is the carbon monoxide that doesn’t allow the tissue to get proper oxygenation and also causes poor blood circulation. Nicotine is also known for its vaso-constrictive effect that causes a decrease in blood flow and an unsatisfactory supply of nutrients that are required and mandatory for the healing of the tissues.Many people are not aware of the fact that having a single cigarette will have a vasoconstrictor effect on your body for at least one and a half hours, and smoking a pack of cigarettes will lead to a full day hypoxia.Other studies have shown that the production of collagen is decreased in people who smoke. Apparently, the fibroblasts that create collagen are disrupted by tobacco. Even the mere exposure to tobacco smoke during the healing process can have negative impacts on wound healing as it reduces the capacity to contract which is essential for creating aesthetic looking scars. Should I quit smoking before plastic surgery?Many people wonder if there is any point in quitting smoking before the surgery as they have been heavy smokers for years. They tend to believe that after years of tobacco exposure, there is no benefit that can come from quitting smoking for a few weeks. To prove them wrong, there have been several studies performed that show that the pre-operative cessation of smoking has a considerable positive effect on the healing process and also reduces the rate of complications that can occur, mainly infections.Numerous studies claim that avoiding surgery at least 21 days before an intervention is optimal. However, if the patient can stop smoking 6 to 8 eight weeks prior to surgery, he can avoid the unpleasant scarring and have a faster recovery process.Some of my patients complain about the fact that it is impossible for them to quit smoking prior to surgery. My advice for them is to seek help from their doctor. Moreover, even a reduction in a number of the cigarettes smoked per day can have a beneficial effect on the overall result. When it comes to undergoing a complex surgical intervention (with significant incisions and skin excision such as the tummy tuck, for example), I advise the patient to avoid quitting smoking right after the procedure as cough fits can be triggered and this is something to be avoided until the surgical wound has healed.Smoking is to be avoided at all costs, both before and after a plastic surgery intervention. The pre-operative period is the best time to start a withdrawal program. It is also important to know that the use of nicotine patches or gums during the abstinence period hasn’t been proven to cause damaging effects on wound healing.I also had patients who will just quit smoking after their intervention. This is not a good idea. Before anything else, the recovery period after plastic surgery can be a stressful time for the patient. It can take a few days until the patient can resume his day-to-day activities, and after some interventions the patient will be required to avoid sitting in certain positions or performing certain movements. A certain level of discomfort and pain can also be experienced during this time as normal side effects of the surgical intervention. Trying to quit smoking with all of these happening at the same time might seem like a terribly difficult task. You might find smoking good for stress release as studies have shown that post-surgery actually increases the level of stress in the body, hence having a tendency to smoke even more.The recommendation is to quit smoking at least three weeks before and after, preferably six weeks, if possible. The sooner you start with the withdrawal period, the better it will be for the results of the intervention.Quitting smoking can be a very difficult thing to do, but keep in mind that you are undergoing surgery to improve the aspect of your body. You will look better, feel better, and benefit from a boost of self-esteem. Maybe this is a good time to drop bad habits and celebrate your new, beautiful body.Plenty of studies have shown that the skin tends to wrinkle and show signs of aging sooner in smokers that people who do not smoke. There is not much point seeking help from plastic surgery to maintain your youth for longer when you are actively working against it by smoking. ConclusionThe effects of smoking on the healing and recovery process after surgery have been documented in multiple studies that have been performed in the last two decades. There is irrefutable proof that smoking leads to complications that could otherwise be avoided. Among the most common complications that can be experienced by smokers are wound dehiscence, infections, and delayed wound healing. All of them lead to unsightly scarring, which is something we all try to avoid, especially after cosmetic surgery.Even the exposure to tobacco smoke can trigger complications, so it is better to avoid it altogether. Research has shown that using nicotine patches has no damaging effect on wound healing, so these are safe to use when going through the withdrawal period.It is recommended to quit smoking at least three weeks before the surgery, but preferably six weeks or up to three months in advance. The components in tobacco smoke, mainly carbon monoxide and nicotine, have negative effects on blood circulation and oxygenation of the tissues. The sooner you quit, the better your chances to avoid complications after the procedure.