Below are some of the most frequently asked questions patients have about plastic surgury issues.  If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

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All surgical procedures are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons.  Our expert team is dedicated to making your operation go smoothly.  We careful review your medical history and current health condition before deciding if it is safe for you to proceed with surgery.  It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved.  We will take every precaution necessary to reduce the possibility of any complications. For all procedures, it is important to follow the instructions of your plastic surgeon regarding medications, eating, drinking and stopping smoking.
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There several important factors that come into play when deciding whether plastic surgery is the right option for you.  One of the most important factors is your health.  Being in good health greatly reduces the risk of complications occurring during surgery and leads to a speedy recovery.  Next, you need to ask yourself what your motivations are.  People who have plastic surgery generally find that the surgery enhances their overall appearance and self-esteem.  Thirdly, you should have realistic expectations.  Plastic surgery is both a science and an art, neither of which are perfect.  Set reasonable goals as to the result you wish to achieve and be prepared to thoroughly discuss these goals during your initial consultation.
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It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation.  This allows the surgeon to better “sculpt” your final appearance.  In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once.  However, having too much done at one time can lead to complications.  The decision to have multiple procedures done depends on which procedures are being done, the extent of surgery, the operating time, and your age/health.  Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.
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Due to the variety of procedures available in plastic surgery, there can be no blanket rule on age although age will be taken into consideration when planning your operation.  People of all ages have taken advantage of the image-enhancement offered by plastic surgery.  There are even procedures appropriate for young children!  It is important to realize the limitations of plastic surgery.  Plastic surgery cannot “fix” every situation or reverse the aging process.  What is a good procedure for one person may not be an appropriate procedure for another.  We are committed to making your plastic surgery experience a successful one.
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During your consultation we will discuss your desired changes and expectations, review your medical history and current health, and make an assessment on whether the procedure(s) in question are right for you.  This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery.  We will discuss the results that can be achieved, with the aid of photos and/or computer imaging.  When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.
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Generally, post-operative instructions call for rest and limited movement in order to speed up the healing process and recovery time.  The length of recovery varies with each procedure and is different for each individual.  Bruises usually disappear within a few days, and most swelling is gone in a matter of weeks.  If you follow our post-operative instructions carefully, you will be able to enjoy your normal activities within no time.  Your scars will fade over time but are permanent.  We take care to conceal any scars so that they are barely visible, if at all.  The image-enhancing effects of plastic surgery become more evident over time with certain procedures taking up to a year for your body to fully adjust and settle into its new look.  When you come in for your consultation we can discuss your expected recovery period and any post-operative instructions in detail.
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Insurance providers generally cover costs for reconstructive surgery but not for cosmetic surgery.  For example, insurance providers will often pay for breast augmentation to reconstruct a breast following a mastectomy; breast reduction to remedy back pain caused by heavy breasts; eyelid surgery to remove sagging skin that blocks vision; nose surgery to allow for a patient to breathe better; or tummy tucks to remedy the vertical separation of abdomen muscles known as diastasis.  Insurance providers are required by law to cover breast reconstruction surgery and any cosmetic operations necessary to create symmetry in either breast. If your surgery is covered by insurance, pre-certification is required.  We will be happy to assist you with the process.  In general, insurance will cover the costs of making an abnormal appearing body part or area normal.  Cosmetic surgery is the art of taking "normal" and enhancing its appearance, beauty and appeal.  
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The issue of breast implant safety has been a hot topic throughout the last few decades.  As a result, more stringent standards have emerged in order to protect patients.  Current breast implant procedures primarily use silicone shell implants filled with either a saline solution or silicone-gel.  Rarely, an implant will rupture or leak.  With saline implants, the saline is safely absorbed into the body.  The effect of silicone-gel leaking is still being researched.  If rupture or leaking is detected early, the implant can be easily replaced.  Other possible complications from breast implant surgery may include blood clotting or pooling, overly sensitive breasts or loss of sensation in the breasts, and capsular contracture (a hardening of the tissues surrounding the implant).  Our expert team is dedicated to making your operation a smooth one.  We take every precaution necessary to reduce the possibility of any complications.
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Some of the Possible Risks of Plastic Surgery

Plastic surgery ranks among the top surgical procedures in the medical field. With continual innovative technologies and surgical techniques, plastic surgery is consistently reliable and generally considered safe.  Although complications from plastic surgery are rare, risks and posssible complications still exist.

The degree of plastic surgery complications and risks is highly dependent on the specific surgical procedure(s) performed, and the patient's own health condition and physiology.  For example, smokers, the elderly, people with diabetes, heart conditions and certain allergies are more likely to experience complications than healthier patients.

Before you undergo plastic surgery it is important to have blood tests and a physical examination perofrmed to ensure that you are a good candidate and in optimal condition for surgery. Additionally, you should make sure to look into the procedure you are considering and learn about the risks involved so that you can be as prepared as possible for your transformation.

The following lists some "general" risks and complications associated with plastic surgery.

Bleeding and Associated Risks

Bleeding is quite common within the first 24 hours following surgery and can lead to complications. Blood can pool and collect under the skin to form a hematoma which will be firm in feel, and may turn the overlaying skin blue or purple. The area can cause pain but usually becomes reduced when your body's' own clotting mechanism takes over and reabsorbs the collected blood. However, if the hematoma continual to grows, it will compress the tissue and prevent oxygen from circulating around that area. This may result in skin death, and a return to the operating room is required to drain out the excess blood. Further, a large hematoma can increase your risks of other complications such as infection, wound separation, and necrosis.

During surgery and within 72 hours, you become more susceptible to secondary infections since bacterial and viral pathogens have easier access via open wounds, sutures, or drain sites. That is why antibiotics are usually taken during and following the procedure. Typical signs of infection are fever, redness in a local area, foul odor, and/or thick yellow or white discharge.

Seromas are similar to hematomas, except it is a collection of tissue fluid, rather than blood. Seromas can occur usually in operations where tissue is removed (i.e. tummy tucks) since the body will attempt to fill the empty space created between separated tissues. Seromas can be recognized by enlargement, heaviness, weight gain, and even sloshing of fluid. They also increase the risk of secondary infections. Seroma are treated with compression or with drainage with a needle and syringe.

Suture Reaction and Wound Separation

Since sutures are foreign substances, it is not unusual to have an immune reaction against it. If the body rejects the suture, it may try to get rid of it by pushing it to the surface of the skin. This can be manifested as a spitting suture, which can occur within weeks to a months following surgery. The body may produce scar tissue surrounding the suture to separate it from the body. This may result in a suture granuloma, which is seen as a bump under the skin. If bacteria enters the area around the suture and causes infection, a suture abscess may result. This is discernible as redness, tenderness, and pus around the suture. This may cause further infection of the skin if left untreated.

If you have experienced these problems with previous surgeries, it is important to inform your surgeon prior to the operation. This way, they may be able to make the necessary changes (suture material, surgical technique) to minimize the risk of problems.

Anytime an incision is made, there is a probability that it will not seal properly, leading to wound separation. Many factors such as bleeding, nicotine use, excessive movement, steroid medication, uncontrolled blood sugar, hematoma, and infection can contribute to poor wound healing. The surgical technique, the amount of tension placed on the wound, and premature suture removal are also contributing factors. If your wound separates, it may be possible to re-suture the incision immediately (especially within 24 hours of surgery), otherwise your surgeon may prefer to let it heal on its own without tension and then revise the scar once it's healed.

Necrosis

Necrosis is the death of tissues and is generally caused by insufficient oxygen reaching the affected areas. In most cases the risk of necrosis is barely there but with higher risks plastic surgery procedures such as face lifts, tummy tucks, and breast reductions, during which flaps are created separating the skin and its blood supply from underlying structures, the possibility of necrosis is at hand. The risk of necrosis increases with dramatically noticeable swelling. Unsurprisingly, smokers have a higher incidence of necrosis due to blood vessel constriction and a decreased oxygen supply. Signs of necrosis are a blue, purple, or gray cast to the skin, and pain will be all too obvious. In its later stages, the tissue will turn gray or black, and may smell or become infected. Necrosis is generally treated at its earliest stages with therapy including relieving compression by releasing sutures and hyperbaric oxygen therapy.


Nerve Damage

In extreme cases, nerve damage can occur from the surgery or simply from the injection of anesthesia. If nerve damage occurs, you may notice numbness, tingling, or changes in sensation. Weakness or paralysis to the affected muscles may be noticeable after damage to nerves controlling muscle. Usually, any nerve damage is temporary and sensation will return to normal within 6 months to a year, although sometimes it can take 2 to 3 years for complete regeneration. As the nerve regenerates, itching, shooting pains, or electrical shock sensations may be experienced. If the nerve is severed completely then numbness and inability to move the affected muscle is permanent. Reconstructive surgery to give support to the affected muscle may be required.

Adverse Reactions to Anesthesia

Although some plastic surgery procedures do not require the use of anesthesia, some of the more extensive procedures do require the use of general anesthetics. Adverse reactions to anesthesia are generally rare but nevertheless complications are still there. Risks differ depending on the individual with factors varying from your health beforehand and the seriousness of your operation. Nausea is relatively common and is treated with appropriate medication. Sore throat associated with breathing tube placement is also quite common, but usually only lasts a day or so. Of course, there are a number of infrequent, less serious complications, such as pain and bruising at the site of injections, headaches, and dental damage. These are usually easily treatable, get better quickly, and are also quite rare. In very rare cases, adverse reactions could become serious with documented cases of seizures and heart attacks and high temperatures leading to death. But overall, most people do not suffer any complications.

Scarring

Scarring is one of the most common risks that people considering plastic surgery should be aware of and is closely related to wound healing ability and suture reactions. During the process of healing, visible thickening of the skin edges and new red, bumps called granulation tissue form in and around the shrinking wound resulting in a scar. For the following weeks and months following surgery, healing around the scar tissue will usually diminish. However, if that is not the case, scar remodeling can be performed to cha change a thick, red, raised scar to a thin, flat, white scar over a period of months to years.

Most surgeons will try to hide incision lines in places where they aren't noticeable, like under the crease of the breast in breast augmentation plastic surgery or beneath the swimwear line in tummy tuck operations.

Nerve damage is a serious complication that people considering plastic surgery must be aware of. Some people who undergo plastic surgery will lose feeling in the area that was operated on while others may experience problems moving muscles in the area where the surgery was performed.

Inherent Surgical Risk of Breast Implant Surgery:

Bleeding- It is possible, though unusual, to experience a bleeding episode during or after surgery. Should post-operative bleeding occur, it may require emergency treatment to drain accumulated blood or blood transfusion. Intra-operative blood transfusion may also be required. Hematoma may contribute to capsular contracture, infection or other problems. Do not take any aspirin or anti-inflammatory medications for ten days before or after surgery, as this may increase the risk of bleeding. Non-prescription "herbs" and dietary supplements can increase the risk of surgical bleeding. Hematoma can occur at any time following injury to the breast. If blood transfusions are necessary to treat blood loss, there is the risk of blood-related infections such as hepatitis and HIV (AIDS).

 

Seroma- Fluid may accumulate around the implant following surgery, trauma or vigorous exercise. Additional treatment may be necessary to drain fluid accumulation around breast implants. This may contribute to infection, capsular contracture, or other problems.

 

Infection- Infection is unusual after this type of surgery. It may appear in the immediate post-operative period or at any time following the insertion of a breast implant. Sub acute or chronic infections may be difficult to diagnose. Should an infection occur, treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a breast implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the breast implant may have to be removed. After the infection is treated, a new breast implant can usually be reinserted. It is extremely rare that an infection would occur around an implant from a bacterial infection elsewhere in the body, however, prophylactic antibiotics may be considered for subsequent dental or other surgical procedures. In extremely rare instances, life-threatening infections, including toxic shock syndrome have been noted after breast implant surgery. Individuals with an active infection in their body or weakened immune system should not undergo breast augmentation.

 

Scarring- All surgery leaves scars, some more visible than others. Excessive scarring is uncommon. Although good wound healing after a surgical procedure is expected, abnormal scars may occur within the skin and deeper tissues. Scars may be unattractive and of different color than the surrounding skin tone. Scar appearance may also vary within the same scar. Scars may be asymmetrical (appear different on the right and left side of the body. There is the possibility of visible marks in the skin from sutures. In some cases scars may require surgical revision or treatment.

 

Surgical Anesthesia- Both local and general anesthesia involves risk. There is the possibility of complications, injury, and even death from all forms of surgical anesthesia or sedation.

 

Allergic Reactions- In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.

 

Change in Nipple and Skin Sensation- You may experience a diminished (or loss) of sensitivity of the nipples and the skin of your breast. Partial or permanent loss of nipple and skin sensation may occur. Changes in sensation may affect sexual response or the ability to breast feed a baby.

 

Thrombosed Veins- Thrombosed veins, which resemble cords, occasionally develop in the area of the breast and resolve without medical or surgical treatment.

 

Pain- You will experience pain after your surgery. Pain of varying intensity and duration may occur and persist after breast implant surgery. Pain may be the result of improper implant size, placement, surgical technique, capsular contracture, or sensory nerve entrapment or injury.

Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue or due to tissue stretching.

 

Skin Discoloration / Swelling- Some bruising and swelling normally occurs after breast augmentation. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discoloration may persist for long periods of time and, in rare situations, may be permanent.

 

Sutures- Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.

 

Damage to Deeper Structures- There is the potential for injury to deeper structures including nerves, blood vessels and muscles and lungs (pneumothorax) during this surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.

 

Delayed Healing- Wound disruption or delayed wound healing is possible. Some areas of the breast skin or nipple region may not heal normally and may take a long time to heal. Areas of skin or nipple tissue may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to breast tissue from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.

Cardiac and Pulmonary Complications- Pulmonary complications may occur secondarily to both blood clots (pulmonary emboli), fat deposits (fat emboli) or partial collapse of the lungs after general anesthesia. Pulmonary emboli can be life-threatening or fatal in some circumstances. Inactivity and other conditions may increase the incidence of blood clots traveling to the lungs causing a major blood clot that may result in death. It is important to discuss with your physician any past history of swelling in your legs or blood clots that may contribute to this condition. Cardiac complications are a risk with any surgery and anesthesia, even in patients without symptoms. Should any of these complications occur, you may require hospitalization and additional treatment. If you experience after surgery shortness of breath, chest pain, or unusual heart beats, you should have this evaluated immediately

 

Shock- In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalization and additional treatment would be necessary.

 

Additional Breast Implant Advisory Information:

Breast Disease- Current medical information does not demonstrate an increased risk of breast cancer in women who have breast implant surgery for either cosmetic or reconstructive purposes. Individuals with a personal history or family history of breast cancer may be at higher risk of developing breast cancer than a woman with no family history of this disease. It is recommended that all women perform periodic self-examination of their breasts, have mammography according to American Cancer Society guidelines, and to seek professional care should a breast lump be detected. Care must be exercised during breast biopsy procedures to avoid damaging the breast implant.

 

Mammography- Breast implants may make mammography more difficult and may obscure the detection of breast cancer. Any breast implant can impair the detection of breast cancer, regardless of the type of implant or where it is placed in relation to the breast. Implant rupture can occur from breast compression during mammography. Inform your mammography technologist of

the presence of breast implants so that appropriate mammogram studies may be obtained. Patients with capsular contracture may find mammogram techniques painful and the difficulty of breast imaging will increase with the extent of contracture. Ultrasound, specialized mammography and MRI studies may be of benefit to evaluate breast lumps and the condition of the implant(s). Because more x-ray views are necessary with specialized mammography techniques, women with breast implants will receive more radiation than women without implants who receive a normal exam. However, the benefit of the mammogram in finding cancer outweighs the risk of additional x-rays. Patients may wish to undergo a preoperative mammogram and another one after implantation to establish a baseline view of their breast tissue. You may be advised to undergo a MRI study in the future to verify the condition of your breast implants inside your body.

 

Second-Generation Effects- A review of the published medical literature regarding potential damaging effect on children born of mothers with breast implants is insufficient to draw definitive conclusions that this represents a problem.

 

Long Term Results- Subsequent alterations in breast shape may occur as the result of aging, weight loss, weight gain, pregnancy, menopause, or other circumstances not related to your augmentation mammaplasty. Breast sagginess may normally occur.

 

Unsatisfactory Result- Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of surgery. Asymmetry in implant placement, displacement, nipple location, unanticipated breast shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Breast size may be incorrect. Unsatisfactory surgical scar location may occur. In some situations, it may not be possible to achieve optimal results with a single surgical procedure. It may be necessary to perform additional surgery to improve your results, change implant size or remove and not replace implants.

 

Removal / Replacement of Breast Implants- Future revision, removal, or replacement of breast implants and the surrounding scar tissue envelope involves surgical procedures with risks and potential complications. There may be an unacceptable appearance of the breasts following removal of the implant.

 

Capsule Squeeze Procedures- Closed capsulotomy, the process of forcefully squeezing the fibrous capsule around a breast implant to break up scarring is not recommended. This may result in rupture of the breast implant, gel migration, bleeding, or other complications.

 

Immune System Diseases and Unknown Risks- A small number of women with breast implants have reported symptoms similar to those of known diseases of the immune system, such as systemic lupus erythematosis, rheumatoid arthritis, scleroderma, and other arthritis-like conditions. To date, after several large epidemiological studies of women with and without implants, there is no scientific evidence that women with either saline-filled or silicone gel-filled-filled breast implants have an increased risk of these diseases. These diseases appear no more common in women with implants than those women without implants. The effect of breast implants in individuals with pre-existing immune system and connective-tissue disorders is unknown. There is the possibility of unknown risks associated with silicone breast implants and tissue expanders.

 

Breast and Nipple Piercing Procedures- Individuals with breast implants seeking to undergo body piercing procedures to the breast region must consider the possibility that an infection could develop anytime following this procedure. Should an infection occur, it is possible that it could spread to the breast implant space. Treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a breast implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the breast implant may have to be removed. Individuals who currently

wear body piercing jewelry in the breast region are advised that a breast infection could also develop from this activity

 

Interference with Sentinel Lymph Node Mapping Procedures- Breast augmentation procedures (periareolar- transmammary) that involve cutting through breast tissue, similar to a breast biopsy in order to place breast implants, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer. If this is a concern, individuals considering breast augmentation by these approaches may elect to consider another surgical approach (inframammary or standard periareolar).

 

Large Volume Breast Augmentation- Patients who request an outcome of augmentation mammaplasty that produces disproportionately large breast size must consider that such a choice can place them at risk for a less than optimal long term outcome and the need for re-operation and additional expenses. The placement of excessively-sized breast implants exceeds the normal dimensions of the breast, produce irreversible tissue thinning, implant drop out, and visible/palpable rippling.

 

Mental Health Disorders and Elective Surgery- It is important that all patients seeking to undergo elective surgery have realistic expectations that focus on improvement rather than perfection. Complications or less than satisfactory results are sometimes unavoidable, may require additional surgery and often are stressful. Please openly discuss with your surgeon, prior to surgery, any history that you may have of significant emotional depression or mental health disorders. Although many individuals may benefit psychologically from the results of elective surgery, effects on mental health cannot be accurately predicted.

 

Female Patient Information-It is important to inform your plastic surgeon if you use of birth control pills, estrogen replacement, or if you suspect that you are pregnant. Many medications including antibiotics may neutralize the preventive effect of birth control pills, allowing for conception and pregnancy.

 

Medications- There are potential adverse reactions that occur as the result of taking over the counter, herbal, and/or prescription medications. Be sure to check with your physician about any drug interactions that may exist with medications which you are already taking. If you have an adverse reaction, stop the drugs immediately and call your plastic surgeon for further instructions. If the reaction is severe, go immediately to the nearest emergency room. When taking the prescribed pain medications after surgery, realize that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.

 

Breast Implant Technology / Technologic Improvements in Breast Implants- The technology of breast implant design, development and manufacture will continue to progress and improve. Newer generations of implants which may be better in some way from currently available ones may be developed in the future.

 

Smoking, Second-Hand Smoke Exposure, Nicotine Products (Patch, Gum, Nasal Spray)-

Patients who are currently smoking, use tobacco products, or nicotine products (patch, gum, or nasal spray) are at a greater risk for significant surgical complications of skin dying and delayed healing. Individuals exposed to second-hand smoke are also at potential risk for similar complications attributable to nicotine exposure. Additionally, smokers may have a significant negative effect on anesthesia and recovery from anesthesia, with coughing and possibly increased bleeding. Individuals who are not exposed to tobacco smoke or nicotine-containing products have a significantly lower risk of this type of complication.

 

ADDITIONAL SURGERY NECESSARY (Re-operations)-

There are many variable conditions that may influence the long term result of breast augmentation surgery. It is unknown how your breast tissue may respond to implants or how wound healing will occur after surgery. Secondary surgery may be necessary at some unknown time in the future to replace your breast implants or to improve the outcome of breast augmentation surgery. You may elect to or be advised to have your breast implants removed and not replaced in the future. Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, the risks cited are particularly associated with breast augmentation surgery. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. In some situations, it may not be possible to achieve optimal results with a single surgical procedure.

 

Patient Compliance- Follow all physician instructions carefully; this is essential for the success of your outcome. It is important that the surgical incisions are not subjected to excessive force, swelling, abrasion, or motion during the time of healing. Personal and vocational activity needs to be restricted. Protective dressings and drains should not be removed unless instructed by your plastic surgeon. Successful post-operative function depends on both surgery and subsequent care. Physical activity that increases your pulse or heart rate may cause bruising, swelling, fluid accumulation around implants and the need for return to surgery. It is wise to refrain from intimate physical activities after surgery until your physician states it is safe. It is important that you participate in follow-up care, return for aftercare, and promote your recovery after surgery.

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The effects of smoking are well known and documented in literature worldwide. Many plastic surgery patients begin to quit smoking prior to surgery and then resume their daily habit post surgery without think of the harmful effects it may have on the body, the procedure and the long term effects. There is an underlying effect smoking has on people who have undergone plastic cosmetic surgery.

The weathering of one's skin, the lines and wrinkles in the face, and the aging are a direct effect of smoking. Cigarettes have very harmful toxins that combine to create a bad environment for the body to live in. Nicotine causes vasospasms in the vessels of the body. Vasospasms, in simple terms are a contraction of vessels, which cause the narrowing and restriction of blood flow. Carbon monoxide may bind to oxygen and not allow oxygen to be released into the areas that it needs, to areas such as the skin. The effect is the wrinkled and weathered look that so many smokers have. This is very rare in non-smokers, because there is no deprivation of oxygen to the skin. This weathered skin tends to look aged more so than their chronological age. With plastic surgery you can erase those lines and wrinkles, but if one continues to engage in behavior that is detrimental to the outcome, you might ask, why bother?

There is an even more dangerous effect of smoking with surgery. When surgery is involved, when skin is incised and elevated, and its blood supply is decreased temporarily, this may cause a very harrowing situation. In virtually all cases, healthy skin when temporarily disconnected, the decrease in blood supply will be well tolerated. The skin can be elevated, tightened but it must be kept alive- although obvious, it is really the main purpose of plastic surgery. One can see that the effects of nicotine and carbon monoxide described that may take an otherwise healthy skin flap and cause such a decrease in blood supply that may actually kill the skin. If this was to occur, one can get loss of full thickness tissue requiring an increased time in healing or even the use of reconstructive surgery with skin grafting and flaps to correct the deformity. This is not the desired outcome of the cosmetic surgery. Many surgeons will not do an abdominoplasty or a face lift on smokers. Smokers will always have a less satisfactory outcome than non smokers, although they will see some change. Some surgeons may perform procedures that will not require a lot of skin surface elevation, because it will not cause undue trauma, and potential for increased damage. Although there are surgeons who will perform these procedures on smokers, it is important that smokers be aware of the potential risks and side effects that smoking has on the surgery and post surgery healing. It may actually change their attitude towards smoking and its effects on the body.