Cosmetic Surgery & Beauty Magazine #70

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feature

on surgical waiting lists, and admits his point of view may

be ‘overtly discriminatory and controversial, but it is also

evidence-based’.

Rather than basing his argument on the well-recognised

cardiac and respiratory risks caused by smoking, Dr Peters’

recommendations centred on the increased risk of wound

infection and high incidence of adverse complications

suffered by smokers.

Dr Peters found wound infection rates to be higher

in smokers than in non-smokers who have had breast

reconstruction, facelifts, and a variety of other plastic surgery

procedures. He believes the risk of adverse outcomes from

wound infections alone is clear enough evidence to suggest

aesthetic plastic surgery should not be offered to current

smokers, and that surgery should be delayed for six weeks

after cessation.

Although the mechanism for the high wound infection

rates seen in smokers is not clear, Dr Peters reinforced that

the same rates were not seen in those adhering to nicotine

replacement therapy.

Anaesthetist and assistant professor of anaesthesiology

at the University of Virginia Health Centre, Dr Paul H Ting

has also collated evidence suggesting continued smoking

increases the incidence of pulmonary complications after

anaesthetic by as much as six times.

According to Dr Ting, the reasoning is two-fold. Firstly,

smoking increases the amount of carbon monoxide

attached to haemoglobin in the blood, which decreases

the amount of oxygen available to tissues, including the

heart. At the same time, the nicotine in cigarettes increases

the amount of oxygen the body needs, meaning that the

oxygen supply to the body is compromised at the very time

more is needed.

Smoking also affects the lungs and increases the

amount of mucous secreted while at the same time

decreasing the ability of the lungs to clear these secretions.

The small airways in the lungs are more prone to collapse

in people who smoke, therefore increasing the susceptibility

to infection, chronic cough and pulmonary complications.

Dr Ting says that people who quit smoking for more

than four weeks prior to an operation have a decreased

risk of complications, and that smoking cessation should

be actively encouraged in patients who have surgery and

anaesthesia scheduled for more than a month in advance.

Despite the decreasing number of smokers in Australia,

tobacco smoking remains the country’s leading preventable

cause of death and disease, according to the Cancer

Council Australia. With links to a wide range of diseases

including many types of cancer, heart disease and stroke,

smoking claims the lives of about 15,500 Australians every

year. For those considering cosmetic surgery, the added

risk of complications surrounding anaesthesia and surgery

adds up to a compelling argument to kick the habit for

good. csbm

How

smoking

ages you

When it comes to giving up tobacco smoking, the

health benefits are both obvious and plentiful. As well

as enjoying improved health and wellbeing, quitting

smoking can lead to a younger looking appearance.

Professor of Medicine at the University of Nebraska,

Dr Denham Harman first prophesied the free-radical

theory of ageing in 1956, claiming people age as a

result of changes caused by reactions in the body

initiated by highly reactive molecules located inside

cells, known as free radicals. The changes induced

by free radicals are believed to be a major cause of

ageing, disease development and even death. Free

radicals may be produced endogenously (within

the body) through normal metabolic processes, or

exogenously (outside the body) from sources such

as sunlight, pollution, certain foods and smoking.

Free radicals cause damage to the cellular DNA,

proteins and other structures. They are neutralised by

antioxidants, and in normal circumstances within the

body there is a natural balance between antioxidants

and free radicals. However, smoking greatly increases

the number of free radicals invading the body, to the

extent that the body’s antioxidant defence system is

completely overwhelmed.

Because of the increased number of free radicals

in the bodies of people who smoke, they are

predisposed to the development of a number of

degenerative and ageing diseases. Free radicals are

thought to contribute to a range of other diseases

including stroke, heart disease, arthritis, vision

problems, Parkinson’s and Alzheimer’s diseases and

many types of cancer.

Smoking is also one of the biggest causes of

premature wrinkles. In 1985, Dr Douglas Model added

the term ‘smoker’s face’ to the medical dictionary after

conducting a study published in the British Medical

Journal in which he identified long-term smokers by

their facial features alone. The characteristics of a

smoker’s face, which tend to make people look older

than they are, include many lines and wrinkles – deep

lines on the cheeks, numerous shallow lines on the

lower jaw – and a subtle gauntness of features.

Smokers also often have a dull or grey complexion

because nicotine constricts blood vessels, impeding

oxygen and nutrient delivery to the skin, plus the

carbon monoxide produced by smoking robs the

skin of oxygen.

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