pre-operation period smoking

[sea of possibilities]

hi guys.

I've read in the bernstein site that it's preferable to cut off smoking for one week prior to the operation and two weeks after it. is this really necessary? I'm having a hair transplant in a couple of days and i haven't quit smoking :\

[sea of possibilities]

hi guys.

I've read in the bernstein site that it's preferable to cut off smoking for one week prior to the operation and two weeks after it. is this really necessary? I'm having a hair transplant in a couple of days and i haven't quit smoking :\

[Dr. William Lindsey]

Numerous studies document an increased risk of infection in patients who smoke 10 days PRIOR TO surgery.

 

But, it is very uncommon to have a hair transplant infection.

 

We ask all patients to stop for 10 days preop and a week postop. Most follow these instructions.

 

Dr. Lindsey McLean VA

[FenderPlayer]

Even though it may not be "necessary," when youre paying a bunch of money and undergoing an operation, I'd have to say you should listen to the doctor's suggestions. Since you apparently didn't, you might as well stop NOW. Better safe than sorry. Don't be stupid about this.

[Dr. Timothy Carman]

The reality behind the phenomena of those little grafts surviving, thriving and growing is the re-establishment of their microvascular connections with the surrounding tissues. Nicotine , being a potent vasoconstrictor, certainly wouldn't help this process, in theory at least; so why take a chance on a procedure that is so expensive and ultimately will have it's success judged based on the outcome (survival, growth) of those grafts?

That said, I realize we're talking about quitting smoking here. No easy feat, for sure.

[Dr. William Lindsey]

Right. Dr. Carman, I haven't been able to find any studies showing decreased graft survival in smokers. I completely agree with your thoughts on vasoconstriction altering graft perfusion and what would probably be early on ischemia and decreased growth.

 

I learned way back in the early 90s, from a plug doctor--I hate to admit that. I recall discussing smoking with Dr. Davis, my mentor, in several conversations and he didn't know of any studies showing problems even with plugs. You would think that plugs, kind of like a small full thickness skin graft, would have significantly less perfusion to the central core and would have shown follicle death. But when I see old plug patients now, who say they smoked right through the surgical period, I have not ever seen a "dough nut" of a plug with a hairless center in those folks.

 

Lastly, I don't think anyone has discussed whether follicular units are vascularized by plasmatic imbibition as traditional skin grafts are. I would guess they are.

 

This would be an interesting area of research for someone with alot of time on their hands. Wish I were a fellow again.

 

Dr. Lindsey McLean VA

[john36]

William H. Lindsey, MD, FACS

McLean, VA

wrote this:

"

 

Right. Dr. Carman, I haven't been able to find any studies showing decreased graft survival in smokers. I completely agree with your thoughts on vasoconstriction altering graft perfusion and what would probably be early on ischemia and decreased growth.

 

I learned way back in the early 90s, from a plug doctor--I hate to admit that. I recall discussing smoking with Dr. Davis, my mentor, in several conversations and he didn't know of any studies showing problems even with plugs. You would think that plugs, kind of like a small full thickness skin graft, would have significantly less perfusion to the central core and would have shown follicle death. But when I see old plug patients now, who say they smoked right through the surgical period, I have not ever seen a "dough nut" of a plug with a hairless center in those folks.

 

Lastly, I don't think anyone has discussed whether follicular units are vascularized by plasmatic imbibition as traditional skin grafts are. I would guess they are.

 

This would be an interesting area of research for someone with alot of time on their hands. Wish I were a fellow again.

 

Dr. Lindsey McLean VA

 

William H. Lindsey, MD, FACS

McLean, VA

"

 

I thought I can help Dr.Lindsey

 

here is

what Mark Gorney, M.D., F.A.C.S.,clinical professor emeritus of plastic surgery at

Stanford University, a founding board member

of The Doctors Company,where he is immediate past medical director and held that position for 18 years.says about smoking and plastic surgery:

If a patient is a heavy smoker (one pack a day or more), surgery should be declined or postponed, or the plastic surgeon should

carefully document that the patient was warned of the possible complications of continued smoking.

If a surgery is to take place after a no-smoking

period, the procedure should be postponed for a

minimum of two weeks, preferably one month.

Patients should sign a document stating that they have not smoked for the specified period and will not smoke for the same length of time postoperative.

 

There is tons of articles on the web and also on the

web that you sir advertise about this :

 

You sir are listed on ISHRS

 

This is an Article from ISHRS

"Smoking, Drinking, Medications and Herbal Products Can All Affect the Course of Your Hair Restoration Surgery

August 2007

 

Do you smoke? Do you drink alcoholic beverages? What medications do you take? Do you use herbal "health food" products? These are questions a patient will be asked before undergoing hair restoration surgery-or, for that matter, any type of surgery. What is the connection between smoking, drinking and surgery? What does it matter what medications a patient takes, or what herbal products or vitamin supplements a patient may use to improve his/her health?

 

The connection between all of these and surgery is their potential to contribute to excessive bleeding during the operation, and bleeding or "oozing" after the operation. That is why a patient will be asked:

 

?· Do you smoke-if so, how much and for how long?

?· Do you drink alcoholic beverages-if so, how much and for how long?

?· Do you use so-called recreational drugs such as cocaine?

?· What prescribed medications do you take?

?· What over-the-counter (non-prescribed) medications do you take regularly?

?· What vitamin supplements do you take?

?· What, if any, herbal products do you consume?

 

The patient should be honest and forthcoming in answering these questions, even if he/she is embarrassed to do so. Patients who know that smoking and moderate to heavy drinking are generally regarded as unhealthful "bad habits" may be unwilling to admit to a doctor that they drink or smoke, or to admit how much they drink or smoke.

 

In a pre-surgical examination with medical history, however, the physician hair restoration specialist needs to have honest answers to these questions-not to change how the patient conducts his/her life, but to assess the potential for excessive bleeding or oozing from wounds during and after surgery.

 

Patients should be honestly forthcoming about their use of prescribed and over-the-counter medications, vitamin supplements and herbal products. Sometimes a patient may not remember the name of a prescribed medication-for example, "the pills my doctor prescribed for my leg pains". The patient may be asked to call the office later with the name of the drug and the name of the prescribing physician. If there are further questions about the patient's medical condition, the physician hair restoration specialist may call the physician who prescribed the drug to clarify the condition for which it was prescribed and whether the patient's medical condition increases risk for medical or surgical complications.

 

The presence of a risk factor for excessive surgical or post-surgical bleeding may be an indication to delay surgery until the risk factor has been reduced-for example, a period of "no smoking", "no drinking" and "no recreational drugs such as cocaine" prior to surgery, and discontinuation of smoking, certain prescribed and over-the-counter drugs, vitamin supplements and herbal products for a period of time before surgery.

 

The decision to delay or to proceed with surgery is made by the physician hair restoration specialist on the basis of individual patient characteristics including medical history, current prescribed and over-the-counter medications, vitamin intake and use of herbal products. The assessment of risk varies from patient to patient and must be individualized to the patient-a criterion that stresses the need for the patient to provide full information to the physician. Risk for excessive bleeding is minimal to none for most patients. The bleeding risk for hair transplantation patients is largely for "oozing" that can extend the time needed for implantation of hair grafts, and pose a potential threat for loss of some grafts postoperatively.

 

Some Major Risk Factors for Excessive Surgical and Post-Surgical Bleeding

Tobacco Smoking

 

Tobacco smoking-especially long-term and heavy tobacco smoking-has numerous ill effects on the body including increased risk for lung cancer, chronic obstructive pulmonary disease, heart disease and systemic circulatory disease. The nicotine and other chemicals in smoked tobacco may cause or contribute to disorders of blood circulation that can increase risk for excessive bleeding . They may also reduce elasticity of small blood vessels in the skin, diminishing the blood supply to hair transplants and thus increasing risk for transplant failure. Diminished blood supply to the skin (and thus to hair transplants) can also be an effect of long-term exposure to second-hand tobacco smoke, as discussed in the prestigious American Heart Association journal Circulation.

 

The physician hair restoration specialist may ask the patient to stop smoking for several weeks prior to hair restoration surgery. Heavy smokers may find it difficult to completely stop smoking for weeks prior to surgery. The risk for excessive bleeding, or for transplantation compromise, must be managed with the patient 's understanding of the risk imposed by long-term tobacco smoking.

"

 

Thanks

[Dr. William Lindsey]

John

 

You are right and I use The Doctors Company and have noted that their website and information are right on as well.

 

I still think it would be interesting to microscopically see revascularization of grafts in an animal model. I am still an Assistant Professor at George Washington University School of Medicine and am looking at the logistics of such a project now. It is doable, if we can get funding for microscope analysis and staining.

 

Dr. Lindsey McLean VA