Smoking: adverse effects on outcomes for plastic surgical patients.

Smoking is known to have a potentially adverse effect on the outcomes of plastic surgical procedures and, in particular, on wound healing. Numerous clinical studies have substantiated that cigarette smokers are at increased risk for wound healing problems. Cigarette smoke contains a number of toxic products. Of these toxins, nicotine has been studied in detail and is known to inhibit macrophages and fibroblasts, potentiate vascular thrombosis, and cause vasoconstriction. Carbon monoxide combines with hemoglobin to form carboxyhemoglobin, which reduces oxygen availability to tissues. When operating on cigarette smokers a few options exist that may improve outcomes: less undermining with rhytidectomy; sympathetic blockades; limited use of alternate nicotine sources; and of course smoking cessation, which is ideal.