You know that there is absolutely nothing except a wide variety of some very nasty “bad things” that will inevitably come along to those who continue to smoke, right? Smoking is at the root of a multitude of diseases and cancers affecting the lungs but also pretty much everything the cigarette smoke passes on its way into the lungs is affected, too. The mouth and lips, the teeth, the gums, the tongue, in fact the entire oral cavity often succumbs to disease and many forms of dangerous cancers at an alarming rate in smokers. Cancer of the throat, vocal cords, and windpipe are also significantly more common in smokers. But the lungs are what everybody talks about. And everyone knows that over the long haul, smoking will take exact its toll on the lungs in every horrible way imaginable – chronic cough, bronchitis, recurrent pneumonia, diminished breathing capacity, COPD, emphysema, and the big one – and highly deadly – lung cancer. Even those of us who are around smokers are exposed to the risks of “second-hand smoke” as the toxin-laden smoke does things to non-smokers like aggravating asthmatic attacks or causing respiratory illnesses.
The lungs act like a giant pair of filters. As the years go by, they desperately try to filter out all the harmful chemicals in the tobacco smoke from getting into your body. As a result, the lungs become the central depository for all those toxins which ultimately end up making the lungs themselves “sick”, dysfunctional or even cancerous. We’ve all seen those classic photos of the nice, healthy, pink, non-smoker’s lung as compared to the somewhat gross, black and beleaguered lung of a long-term smoker. Clogged filters don’t allow much of anything, including oxygen and blood, to pass through very easily. The lungs start to lose their ability to simply do all the things they are supposed to do – like breathing and warding off bacteria. This is also one of the ways that smoking forces your heart to work harder and harder, generating problems like hypertension and heart disease. There are other ways – including the direct damage to blood vessels – which occurs over time in smokers.
The insidious dangers waiting for the smoker abound because smoking damages nearly every blood vessel in the body. Blood vessels carry in all the oxygen and nutrients which nurture and support all your body’s tissues. Blood vessels also carry away any waste products, toxins, or chemical “debris” from the tissues so that your body can safely eliminate it all. Smoking chronically slows this whole system down, at almost every level, from the largest vessels to the smallest. The damaged blood vessels become more and more narrow, and the circulation drops. Some of the smaller vessels shut down completely. Less good stuff can make its way in; more of the bad stuff lingers around. The tissue begins to suffer and struggle – whether that tissue is your brain, your heart, your liver, or even your skin – aging is accelerated, disease and malfunction are promoted. The longer it goes on, the worse and more irreversible it gets. Lose a few too many or critical vessels in one place and the tissue can no longer survive. This is the same mechanism at work in situations like gangrene, frost bite or advanced peripheral vascular disease. When the circulation reaches below a critical level you can end up losing a toe, or a finger or you have a heart attack, renal failure, or a stroke. And guess what? Your lungs are a living tissue too! So the diminishing blood vessel flow also has negative impact on lung function too, on top of the direct effects of the smoke itself – a double hit! In patients with medical conditions that also have similar long- term detrimental effects on blood vessels – such as Diabetes, high cholesterol, and hypertension – the impact of smoking becomes even more severe.Smoking also regularly introduces many toxic chemicals into the bloodstream which directly and acutely only serves to further limit proper blood vessel function.
These principles of dysfunction as caused by smoking are at work whether there is obvious “evidence” it is happening or not. Then one day, a surgical procedure becomes necessary. Perhaps it is a procedure needed to treat a serious medical problem. But it could also be for something elective and cosmetic, like a face lift; not too unlikely because of the accelerated aging of the face seen in smokers. The lungs are about to be exposed to anesthesia. Anesthesia which is characteristically harder to properly administer and carries more risks in the smoker. Harder and often longer to wake up too, and typically with a whole lot of coughing and hacking. Just what we don’t want for the delicate wounds and tissues at the very infancy of their healing process. And a procedure which involved the abdomen or chest – what a beating those wounds and stitches take in the smoker, coughing away while emerging from the operating room. All that coughing also makes for some pretty big swings in the blood pressure, leading to immediate potentiation of things like swelling, bruising, drainage, and bleeding. What a contrast to the non-smoker, quietly getting oxygen in, taking deep breaths and giving the freshly operated upon tissues an actual chance to recuperate! And we can also assume, depending on just how disadvantaged the lungs in the smoker have become with time, that the amount of oxygen getting in per breath is not to likely to be that wonderful either.
In the smoker having surgery, the dangers abound. All that blood vessel narrowing and diminished flow now become a critical problem to the post-operative surgical wound. Wounds need extra blood flow, oxygen, and nutrients – and the active smoker’s blood vessels often have very limited, if any, reserve ability with which to comply with that need. In fact, the tissues themselves have actually gotten used to “getting by with less”; they are lacking in many of the compensatory responses that the challenges imposed by surgery and the demands of healing which normal (non-smoker) tissues can call upon. That is a recipe for poor, delayed or even absent healing, higher infection rates, loss of tissue (tissue necrosis), bad scars, or much, much worse. The greater the number of “pack-years” you’ve smoked, the greater the degree of blood vessel damage and dysfunction. But just like it is for the lungs, it is never too late to stop smoking and get some benefit. And even short-term discontinuing of smoking is extremely helpful when it comes to preparing for a surgical procedure.
That’s the one ray of light – the degree of blood flow restriction and reserve capacity are also directly linked to how “current” the smoking is – significant improvements are demonstrable after about 2 weeks in those stopping smoking. So, if someone has a surgical procedure at hand and wants to play a key role in the success of their procedure (rather than contributing to their increased risk!), there’s no better time to stop than in the 2 – 4 weeks beforehand. Staying off cigarettes through the early phases of the healing process – the 2 – 4 weeks following the procedure – is just as important. This two-pronged, “no smoking” for 2- 4 weeks both before and after a procedure strategy is the best way to thwart the smoking history impact on a successful procedure. Here’s the bottom line: stopping all smoking for 2 weeks or more before and for 2 weeks or more after a surgical procedure, will significantly lessen tissue healing risks and recovery dangers. Moreover, the lungs get a “breather” as well and will be better capable of responding to and dealing with the demands of anesthesia. And if you can prove to yourself that you can quit for what overall amounts to about a month to lower your peri-operative risks and complication rate, why not just quit altogether?
Do you hope that your doctors and other health care providers will use every bit of knowledge and skill that they have to make your surgical procedure as safe and risk free as possible? Do you expect that if they knew of anything that would make your risks lower, potential complications less likely, and chances for success higher they would recommend it or do it for you? All patients have some of those same abilities and powers as they chose to follow their doctors’ guidelines for before and after a procedure. If you are a smoker, you have the power in your very own hands which can “make or break” the success of your own procedure. If you can’t stop smoking altogether, at least stop long enough to lessen the dangers.
Dr. Lyle Back is originally from New York City, receiving his medical and surgical training at Rutgers Medical School, Cooper Hospital – University Medical Center, and Ohio State. He is Board Certified in General Surgery (ABS) and Plastic Surgery (ABPS). He is a Fellow of the American College of Surgeons (ACS), the American Academy of Cosmetic Surgery (AACS), and a longstanding member of the premier American Society of Plastic Surgeons (ASPS). He served as a Professor of Plastic Surgery at Temple University and St. Christopher’s Hospital for Children and performed reconstructive surgery with “Operation Smile” in Vietnam. He specializes in the full range of the most modern and state of the art cosmetic surgery procedures for the body and non-surgical cosmetic enhancement techniques available today.