The precautions dermatologists urge patients to take prior to minor skin surgery are based on reasonable assumptions. Smoking has long been known to have several effects on the circulatory system that have the potential to impact wound healing. Lower oxygen levels in the blood, reduced blood flow to the skin, and other factors make advice to patients to stop smoking before dermatological surgery seem like the safest course of action.
However, a 5 year long Australian study has called the necessity of this common preoperative instruction into question. The information released by the Bond University in Queensland is based on a review of outcomes for 7,244 lesion excision procedures. The difference between infection, bleeding and other complication rates for smokers and non-smokers was so small as to be statistically insignificant. Researchers did note that some patients may not have accurately disclosed their smoking status to their physician. However, the percentage and type of complications were virtually the same for both groups. In all, the actual number of complications was very low.
What Does This Mean for Dermatologists and Patients?
Whether this finding will cause a substantial number of dermatologists to stop telling patients to cease smoking prior to skin surgery is unknown. It is important to note that the type of surgery featured in this study is much less invasive then other dermatological or cosmetic procedures such as skin grafting or facelifts. When deeper tissue layers and extensive cutting is involved, the effects of nicotine in the system can have a more noticeable effect on wound healing.
As healthcare professionals, dermatologists will still have many other valid reasons to urge their patients to make long term smoking cessation a priority. From the standpoint of skin health and appearance, smoking is still a significant problem. It can cause the following signs of aging in the skin:
• Wrinkles around the mouth from persistent muscle contraction
• Yellowish or grayish complexion
• Substantially increased risk of squamous cell carcinoma (a common type of skin cancer)
• Decreased collagen production causing skin to droop and wrinkle earlier in life
• Dehydration leading to dry, flaky skin and lips
Having any type of skin surgery (even if it is minor) can serve as a wakeup call for patients to begin practicing better self care. This makes pre-op consultation a good time for dermatologists to speak with patients about long term ways to improve their health.