Plastic Surgery Safety: How Do Lifestyle Factors Affect Outcome?

Many consumer articles focus on the importance of researching board-certified plastic surgeons with experience in the particular procedure a patient is seeking. While this is one of the most important predictors of outcome, any good plastic surgeon will explain that lifestyle factors play a huge role in mitigating short-term complications and ensuring long-term satisfaction. Before meeting with a qualified surgeon, Tampa Bay’s Dr. David Halpern recommends considering the following factors that make or break a candidate for plastic surgery procedures.

Smoking

About 45% of board-certified plastic surgeons limit the types of procedures they perform on smokers, according to a 2002 survey conducted by the University of Texas Southwestern Medical Center. Nicotine and carbon dioxide decrease blood and oxygen supply to the tissues, which impairs healing. Smoking also impairs the pulmonary system, increasing the risk of serious surgical complications. Most surgeons require patients to stop smoking for a period — usually at least a month — before and after surgery.

Weight

The poor circulation, nutrient deficiencies and impaired immune system functioning often associated with obese patients impairs healing. The ideal plastic surgery candidate is within 30 percent of his or her ideal Body Mass Index.

Patient satisfaction is another consideration for obese patients. For instance, surgeons find a high level of success with patients looking to correct an isolated oversized body part (such as the panniculus abdominal flab or disproportionately large breasts).

However, patients looking to completely re-contour the body through excisional surgery and liposuction are often disappointed if they do not lose some weight on their own prior to surgery. They are also more apt to re-gain fat if healthy eating and exercise habits are not demonstrated.

Alcohol Consumption

Alcohol consumption affects plastic surgery results in several ways:

• By increasing swelling – Alcohol dilates blood vessels and dehydrates / boosts water retention.
• By increasing bleeding risk – Alcohol thins the blood, causing more bleeding.
• By interfering with healing – Heavy alcohol use disrupts cell migration and collagen deposition.
• By decreasing effectiveness of pain medications – Alcohol interferes with many pain drugs.
• By interfering with anesthesia – Alcohol increases risks of internal bleeding and breathing failure.
• By drying out the skin – Each shot increases urine production by four ounces, which leads to dehydration. Patients with dehydrated skin take longer to heal and also look much older.

Alcohol also affects the long-term success of plastic surgery. A 2009 study of twins by Dr. Bahman Guyuron found that “the twin who avoided alcohol looked significantly younger.” Most surgeons recommend abstaining from alcohol for at least two weeks prior to surgery and limiting alcohol intake afterward to maintain results.

Sun Exposure

Limiting or avoiding sun exposure is particularly important for facelifts, rhinoplasty, forehead lifts, scar removal surgery, breast lifts, chemical peels and skin resurfacing procedures. The sun can increase the amount of swelling, inflammation and bleeding after surgery. Changes to skin pigmentation caused by the sun can also increase the risk of scarring, not to mention contribute to premature aging. Dr. Guyuron’s study of twins also found that the twin who spent less time in the sun looked significantly younger. Some doctors recommend keeping the scars out of the sun for as long as a year after a procedure.

Sleep Habits

Sleep deprivation can affect plastic surgery patients in countless ways. For instance, a patient coming in for blepharoplasty (eyelid surgery) may not get the results they hope for if they continue to get insufficient sleep. Lack of sleep causes the blood vessels to dilate, disrupts new collagen and skin cell formation, decreases skin elasticity, and accelerates the tear trough crease under the eye along the bony rim by accelerating loss of fat in the face.

Furthermore, how you sleep may affect anti-aging results. The American Society for Aesthetic Plastic Surgery recommends that patients sleep on their backs following facelift surgery or wrinkle-reducing treatment. Experts believe that sleeping on your stomach or one side contributes to wrinkle formation. Ideally, patients will use soft bedding materials with soft pillowcases that have a high thread count. Dr. David Halpern includes sleep solutions in his consultations to provide you with the best action plan for plastic surgery recovery.

Diet

Certain foods and drinks have been found to interfere with anesthesia, bleeding time, immune function and healing times and should be avoided for at least one week prior to surgery, including:

• Omega 3 and fish oil supplements
• Green tea
• Cayenne Pepper
• Gingko biloba
• Garlic
• Ginger
• Flaxseed
• Tomatoes
• Potatoes
• Eggplant
• Alcohol
• Caffeine
• Aspartame
• MSG
• NSAID drugs like Aspirin
• Multivitamins

Ingesting the proper nutrients can aid in healing. Post-operative patients need sufficient: Vitamin A for immune functioning, epithelial and bone formation and cellular differentiation; Vitamin C for collagen formation and antioxidant power; Vitamin E for cell differentiation and inflammatory response; as well as protein, glutamine and arginine for wound repair.

Patients are often advised to consume:

• 5-6 small meals per day packed with protein from milk, eggs, meat, soy, yogurt or beans
• At least 8 glasses of water per day to maintain hydration
• Citrus fruits, potatoes and tomatoes for adequate vitamin C
• Leafy greens, carrots and chicken liver for Vitamin A
• Cabbage and beets for glutamine and arginine
• Liberal intake of seasonal fruits for an assortment of micronutrients
• A supplement of B vitamins, Vitamin E and/or Vitamin C

Exercise

For many body contouring procedures, it’s important to continue a regular exercise program to avoid undoing your plastic surgery results. For instance, a study of 36 Brazilian women who underwent abdominal liposuction found that women who did not exercise saw a 10% increase in visceral fat six months later, compared to women who exercised three times a week.

While exercise is important, it’s equally important that patients follow their surgeon’s specific instructions for when to resume physical activity. For instance, tummy tuck patients are usually advised to wait at least six weeks before resuming aerobic exercise and weight lifting. When they do get going again, they’re told to do less repetitions, less weight and a shorter duration of exercise to ease back into it.

Stress

A number of physiological processes are affected by stress that delay wound healing. Stressed individuals have:

• Greater cortisol secretions
• Increased catecholamine production
• Lower circulating oxytocin levels
• Diminished expression of proinflammatory cytokines at the wound site
• Reduced cell and leukocyte infiltration at the wound sites
• Damaged blood vessels, which decreases oxygen availability
• Reduced immune system functioning to prevent infection.

All of these factors makes wounds slower to heal, which is a problem for plastic surgery patients. People who suffer from depression and anxiety are also more likely to engage in unhealthy behaviors like drinking, smoking, staying up all night, eating poorly and reducing physical activity.

A review of research in 2011 published in the Journal of Immunology and Allergy Clinics of North America found that psychological stress significantly delays healing more than medical status and sociodemographic variables. For instance:

• Gallstone surgery patients with more stress on the third postoperative day stayed in the hospital longer.
• Coronary artery surgery patients with more depressive symptoms were more likely to require rehospitalization.
• Coronary artery bypass patients with more depressive symptoms suffered more infections and poor healing.
• Patients with the highest depression and anxiety were four times more likely to have non-healing leg wounds.

Likewise, a survey of more than 700 plastic surgery practices found that psychological issues following surgery were more common and problematic than physical complications. Consequences included “delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety.”

While some stress is to be expected after any kind of medical procedure, an honest discussion with your plastic surgeon will help you develop realistic expectations for recovery and best prepare for the road ahead. A good plastic surgeon will keep tabs on your psychological health as you recover and suggest appropriate medical or therapeutic interventions if you are experiencing significant anxiety or depression.

Schedule Your Plastic Surgery Consultation

Dr. David Halpern is happy to work with you to discuss how to safely achieve your plastic surgery goals, given your lifestyle. Call (813) 871-5000 to schedule a consultation at his office or contact us here.