Most people understand that smoking is detrimental to one's health in a variety of ways. Yet every day, cosmetic physicians face patients who smoke. Because smoking can present specific hazards to successful facial aesthetic surgery, we are forced to turn these patients away in hopes that they will return healthy and smoke-free in the future.
But are we missing an opportunity to provide an even greater service to our patients? By actively engaging them in the smoking cessation process, we not only bring them closer to their cosmetic surgery goals, but we also aid them in achieving a healthier lifestyle.
The majority of prospective cosmetic surgery patients arrive in their doctors' offices having completed an extensive if not exhaustive amount of research into the types of cosmetic surgery procedures available, the estimated costs, and the local options for qualified surgeons. Patients interested in face lifts are often excited and eager to embark on a journey that will produce the reflection they've been longing to see in the mirror.
These patients are primed and ready to achieve a revitalized appearance and are often disappointed to learn that their smoking habit makes them unsuitable for face and neck lift surgery. Rather than send these patients home crestfallen and left on their own to begin  the smoking cessation process, our clinic has developed a novel program to help these patients quit smoking and ultimately undergo their facelift surgery as a healthier surgical candidate.
Earlier this year, I launched the Reveal a Better You program to properly address the needs of patients who need to stop smoking prior to surgery. The program takes a holistic and incentive-based approach to smoking cessation. Patients are encouraged to consider their desire for aesthetic improvement through surgery as just one part of an overall effort to improve their lifestyle, health and appearance.
|
This patient successfully quit smoking and received a facelift, facial fat grafting, upper and lower blepharoplasty, and a brow lift. Photo courtesy/ Dr. Fechner.
|
Included in the program are a series of consultations, the development of an individualized smoking cessation plan, patient education on the dangers of performing facelift surgery on a smoker, a list of local smoking cessation support resources, routine urine testing for nicotine products and collaboration with the patient's primary care physician as needed. Patients who successfully complete the program are eligible for surgery, and as a reward for their success, are eligible for a discounted surgical fee associated with their
facelift procedures.
The Consultation
As is the case with all cosmetic surgery patients, the relationship with the smoking patient begins at the initial surgical consultation. Taking the time at this meeting to get to know the patient and understand their unique history, concerns, and goals is imperative. By encouraging an open and honest dialogue in this meeting, we set the tone for the patient to feel comfortable enough to admit their smoking habit.
Once that hurtle is crossed, patients are better prepared to consider the health and lifestyle changes necessary for them to undergo a safe and successful procedure. Once a patient qualifies for the program, each candidate participates in the development of an individualized plan and timetable for his or her facial rejuvenation goal.
After the consultation, the patient learns the hazards smoking presents to recovery from the face and neck lift, and why the habit initially makes them poor candidates for this procedure. Few patients are aware that, in addition to pathologic changes of the large and small arteries, the nicotine found in cigarettes is a powerful vasoconstrictor and has been shown to significantly impair blood supply to tissues, thereby greatly increasing their likelihood of serious post-surgical complications.
In facelifts, the skin or composite facial flap requires sufficient blood supply for proper healing. In certain cases, insufficient blood supply can have serious consequences causing skin slough, flap necrosis and ultimately unsightly scarring. Aside from pulmonary and cardiovascular problems, all smokers, regardless of the quantity they smoke, are at an increased risk for delayed healing and infections.
With these complications in mind, it is vital to explain to the patient that sufficient tobacco-free time is necessary to improve the body's smoking-associated disadvantage.
There is no time criterion for smoking cessation that is uniformly embraced by facelift surgeons. While opinions on the matter may vary from one week to one year, a reasonable consensus is that a period of at least six weeks without exposure to cigarettes is sufficient to reduce the most severe risks associated with smoking. Ideally, we prefer a three-month smoke-free period prior to face and neck lift procedures.
Counseling the Patient
With the dangers of smoking and surgery clearly outlined, patients then begin a smoking cessation program. In an extension of the typical surgical consultation, a goal-oriented plan is devised to help the patient map out a reasonable timeline for quitting. Once the plan is agreed upon, we provide the patient with a list of local smoking cessation support resources. We also encourage our patients to visit their primary care physicians for additional assistance.
Some patients with a particularly heavy and long addiction to cigarette smoking have successfully used prescription drugs to assist in the process. Patients then visit our clinic at regular intervals for urine testing to assure they are remaining smoke-free in preparation for their surgery.
Encouraging the Patient
As we all know, few things are as difficult as quitting smoking. Most smokers have repeatedly tried to stop only to restart the habit after a short while. While there is no magic bullet that works for everyone, the prospect of being able to safely undergo the desired facial cosmetic procedure can be a powerful motivator for the patient. However, patients in the Reveal a Better You program are encouraged to succeed on several fronts.
Not only does a successful smoking cessation program allow them to undergo their desired aesthetic procedure, but patients who reach their goal of becoming smoke free for a three-month period in advance of surgery are rewarded with a 20 percent reduction in surgical fees.
We found this incentive-based program an extremely powerful motivator for a challenge as great as smoking cessation. While one may question the value of offering financial incentives in the patient care setting, experience has shown us that it not only benefits the patients in a real and meaningful way but also engenders a sense of trust and commitment between the plastic surgeon and patient.
As these patients are challenged to make an investment in themselves, we too are making a tangible investment in them. While the financial benefits enjoyed by these patients through the smoking cessation program obviously outweigh those of the facelift surgeon-with fewer complications and optimized facelift outcomes as a result-everyone comes out a winner. (Click Page 2 for sidebar on Dr. Fechner's approach to enhancing prematurely aged skin caused by smoking.)
Frank P. Fechner, MD, is a double board certified facial plastic surgeon who has a private practice (www.drfechner.com) in Worcester, Mass. With teaching appointments at Harvard Medical School and UMass Medical School, he has been featured on ABC, NBC and other news outlets. Focusing exclusively on cosmetic face and neck surgery, Dr. Fechner performs hundreds of facial rejuvenation procedures each year. Disclosure: Dr. Fechner indicates that he has no affiliations with any commercial entities directly or indirectly referenced in this article.
|