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“I wanted to talk a little bit today, it’s the questions today that prompted us about Rhinoplasty and some of the pre-and post-operative considerations that are important and in general surgery are quite important. One of them is about smoking.
Smoking with Rhinoplasty or facelifts or any surgery frankly reduces the oxygen carrying capacity in your blood stream and as a result those important healing molecule isn’t getting to the cells that it needs to, to repair the tissues that have been injured in surgery.
So, when we talk about smoking I really encourage patients to stop well in advanced of the surgery. If they can’t stop well in advance, then we’ll help them. There are great programs, medications, even the patch which I don’t mind nicotine if there’s a tobacco or nicotine addiction I’m okay with patches, it causes a little constriction of the blood vessels but doesn’t interfere with wound healing like smoking does where their carbon monoxide and other pollutants that are in smoke bind to hemoglobin irreversibly, that’s the oxygen carrying molecule in our red blood cells and really starves the wound of the needed oxygen that needs to heal.
So, I’ll tell people to stop at least a week in advance. We’d like to get people stop a month or so, it’s very difficult for long term smokers. Like I side there are good medications and combinations of the patch in therapy. For most patients if they get a lollipop or some other thing that they can handle with their mouth it’s a good thing, there’s an alternative to putting a cigarette in and for many, many patients I’ve got them to quit smoking for the long term but smoking around the time of surgery is critically important.
What’s interesting is there’s another molecule that is often described as being a complete, the no-go as it relates to surgery in general and that’s a drug called Accutane, and Accutane has been used for many years it’s an excellent drug although it’s gotten a bad name it’s been used for many years for acne treatment and it’s really the sort of the top of the treatment pyramid. When all things fail, Accutane is the place to go for [Inaudible [00:02:29] transistic acne and historically we have been taught that one shouldn’t do any surgery at all while people are on Accutane.
Now in my experience and we’ve got several Rhinoplasties we’ve done now people who are either just going off for Accutane or taking those Accutane. When making small incisions like those done in Rhinoplasty and not lifting extents of flaps or doing any skins resurfacing then the Accutane doesn’t seem to interfere with wound healing.
Now, I know this is contrary to popular belief, there are even a couple of case reports out in the literature about Accutane but I would say that Accutane itself is really a major contra indication in my hands only in areas what we’re doing laser skin resurfacing where there’s a large area surface of the skin that have been injured or even small and that relies on those adnexal glands, the sweat and oil glands and the epithelial skin cells that line them to repopulate the skin surface. In those cases, there’s a clear difference with Accutane.
So, I would say that Accutane is a relative contour indication in Rhinoplasty, not an absolute one. We’ve had good experience in treating people who really can’t or stop their Accutane suddenly but have been on Accutane and have seen no contoured results as it relates to wound healing.
In the last category is not really a medication or drug but it is one that we should always thing about and that’s people who have diabetes and many diabetics are told they should never have electro-surgery. I’ve had a number of people come with diabetes and that’s really not the case. It’s certainly true that diabetics will have microvascular small blood vessel disease but it doesn’t mean they can’t have surgery. There are certain precautions that we take we certainly want to control blood sugars around the time of surgery and post operatively in the post care scenario we want to closely monitor and control servers but that by no means disqualifies them from having procedures that can help them look better and that’s really what we’re here for is to help people look their best.
If you have any other questions about drugs or molecules or preconditions that might stop you from having Rhinoplasty face lifter. Any of the other aesthetic procedures that we discussed extensively please do not hesitate to write, you can send photos or short video clips to DrMaas.com and we’re very happy to get those answered for you either privately or we can share the questions with others so that they can learn. This is Corey S. Maas MDTM on looking your best.”
