Smoking is well known for its detrimental effects to one’s lungs and health. Lung cancer, heart disease, chronic lung disease, strokes are all sited to have much higher rates in those that smoke. It certainly is no leap of faith to imagine the harm smoking causes to the largest organ of the body, the skin.

There is one study which shows that moderate smokers (30 cigs/day) will show 14 more years of aging when they hit 70 then nonsmokers. They are more likely to have deeper crows feet and “smoker’s lines” above the lips. Telangiectasias, often called broken capillaries, are more common in smokers. The color and glow of the skin is changed. The circulation is decreased because the blood vessels are constricted (vasoconstriction), mainly due to nicotine, so the skin becomes dull, ashen, and loses it redness. Carbon monoxide levels become elevated in the blood stream, reducing the oxygen capacity of the blood. Hydration of the skin is reduced in smokers. Also, the vasoconstriction affects the hair by thinning it and causing premature graying.

Another study shows that smoker had about a 20% collagen reduction in response to a wound. Extracellular matrix turnover was also decrease. Smoking also depletes vital nutrients in the skin such as Vitamin B and Vitamin C (needed for collagen formation), and magnesium. Each cigarette generates million of free radicals, which causes an inflammatory response throughout the body.

Many of our aesthetic procedures rely on the body’s response to get optimal or for that matter, any outcome. A collagen response is needed in our collagen stimulating fillers such as Sculptra, Bellafill, and Radiesse. The longevity and volume afforded by these fillers is solely collagen related. These fillers should be reconsidered if they are planned to be used in a smoker.

A flap during surgery is when an area of skin is elevated from its normal position. This compromises the blood flow because part of the normal vasculature  is cut. This is what occurs when performing a face lift, neck lift, rhinoplasty (nose job), blepharoplasty (eyelid surgery), tummy tuck (abdominoplasty), and breast surgery. A smokers outcome with these procedures is at significantly higher risk because of the vasoconstriction that nicotine causes. The flaps are at risk of necrosis (dying), prolonged edema, prolonged healing, scarring, need for reoperation and infection.

Laser resurfacing or RF (radiofrequency) procedures depend on the heat injury to cause an inflammatory response which ultimately leads to collagen stimulation and skin tightening. In a smoker, the blood supply in compromised to the skin so WOUND HEALING AND COLLAGEN FORMATION IS SIGNIFICANTLY IMPAIRED. Complications such as infection, prolonged healing, scarring, poor results are much higher with smokers. Most physicians will not perform ablative laser procedures on smokers because of these additional risks.

Many smokers say they will quit and use nicotine gum/patches or e-cigarettes. These solutions are just as detrimental as cigarettes to wound healing and collagen formation. There is still vascular constriction with these substitutes. Most surgeons require a window of at least 3 weeks prior to surgery and 4 weeks after to be smoke free. Some require urine testing for nicotine and its by products to document compliance.

Smoking and aesthetic procedures aren’t a good combination. It is counterproductive to smoke while striving to look younger. If one is really concerned about their looks, smoking cessation is absolutely necessary. It will save your appearance and save your life too!

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