Evaluating the Safety of Rhinoplasty in Smokers

Overview

Smoking impairs blood supply and wound healing, which matters in rhinoplasty where precise healing determines the result. The nose has a rich blood supply that may offset that, but concern persists. The authors examined whether smoking should rule out rhinoplasty, reviewing 1884 open rhinoplasties performed under general anesthesia from 2014 to 2022, all with at least 12 months of follow up.

Sections of note

• Design: retrospective review, 1884 patients: 80 active smokers, 39 former smokers and 1765 nonsmokers.
• Average follow up: 23.8 months.
• Overall revision rate: 3.3 percent, comprising 3.8 percent in smokers and 3.3 percent in nonsmokers.
• 3.8 percent of smokers required additional antibiotics for skin infection compared with 1.6 percent of nonsmokers.
• All infection cases resolved without long term complications.
• No significant differences were found between smokers and nonsmokers in revision, infection or wound complication rates.
• Stated conclusion: active smoking does not appear to be a strict contraindication, though cessation should still be recommended.

What it means for a patient

• Smoking is often treated as a bar to elective facial surgery, and this series found no significant difference in outcomes.
• Skin infection requiring antibiotics was more than twice as common in smokers in absolute terms, though not statistically significant with 80 smokers.
• The nose's blood supply comes from several directions, which is the anatomical reason it tolerates reduced perfusion better than some other sites.
• Limits: retrospective, one practice, only 80 active smokers, and no measurement of how much or how recently they smoked.

Why this paper matters

Smoking status routinely determines whether patients are offered elective surgery, often on evidence from other operations where blood supply is more marginal. A series of 1884 rhinoplasties tests that assumption in this specific setting. Eighty smokers is too few to exclude a modest difference in infection.

Terms

• Tissue perfusion: the delivery of blood, and therefore oxygen, to tissue.
• Contraindication: a reason a treatment should not be given.
• Revision rate: the proportion of patients needing a further operation.
• Cellulitis: a spreading infection of the skin and tissue beneath it.
• Perioperative optimization: measures taken before and around surgery to reduce risk.
• Open rhinoplasty: surgery through an external incision on the strip between the nostrils.