Thank you for your question. You state in your question that eleven days after surgery
you went to a social gathering where you were exposed to secondhand smoke and that you are
concerned that there may have been a change in your rate of healing and you're asking
about the effects of secondhand smoke and what level secondhand smoke is significant
depending on your location relative to the source of the secondhand smoke.
Well, I can certainly assist you with this question. A little bit of background I'm a
Board-certified cosmetic surgeon certified by the American board cosmetic surgery, I'm
also a fellowship trained Oculofacial plastic and reconstructive surgeon I've trained through
fellowship sponsored by the American Society of Ophthalmic plastic and reconstructive surgery
and in practice in Manhattan and Long Island for over twenty years and eyelid surgery is
an area of specialty in particularly Asian eyelid surgery.
So the question about smoking is a very important question to any doctor who performs cosmetic
surgery and it is no secret that smoking has an impact on healing. But, in your situation
we can certainly temper that by understanding exactly what the phases of healing are. You
know there's a lot of concern for patients about potential poor healing or thickened
scars or keloid is often referred to when it comes to healing of eyelids surgery.
So, to understand wound healing let's start by just understanding the phases. There are
basically three phases, there's an inflammatory phase which is a time which is approximately
the first week or so where the body is healing the area and it's marked by a lot of redness
and it is just this activity of inflammation. The second phase is called proliferative phase
and that pretty much goes on for the first month and it overlaps a little bit with inflammatory
phase.
The last phase is called the wound remodeling phase and that's beyond, that also overlaps
with the month of the proliferative phase and that goes on for up to one to two years.
So when you make observations about healing it's very important to understand that there
are distinct phases and that you may still be experiencing a normal healing process.
A lot of times I explain to my patients is like in the first month the eyelid incision
can be a little bit thick and can be a little bit bumpy and very often people fear that
this is a time when they can be developing keloids or hypertrophic scarring and that
they want to go and get something like a topical cream or something to treat that when actually
it's a normal part of the proliferative phase.
So to answer a question about smoking let's just understand what smoking does. Smoking
does mainly two things regardless of whether you're the smoker or whether you are getting
second hand smoke. Smoke causes something, increases the carbon monoxide levels in your
blood carbon monoxide is not usable by your cells, which in effect depletes oxygen needed
for the body to function and to heal.
Now the second part is that smoking causes an incredible amount of inflammatory and something
called free radical type of generation which is destructive to the cells. So if you just
think about if you look at somebody who's a longtime smoker and compare them to somebody
who's not a longtime smoker all things being equal gender, age, environment, general state
of health the smoker very often looks considerably older considerably more weathered and worn
down because of those issues now when it comes to wound healing, when you think about it,
if you are in some way causing inflammation or depriving the tissue of oxygen, it can
potentially have an effect but I would say that in your situation it would've been probably
more significant early on.
But nonetheless, avoiding smoking throughout the healing process is critically important.
I would say that most likely a short-term remote secondhand smoke exposure is not likely
to have a long-term negative impact on your healing process.
I think that most likely it is still better to avoid a second hand smoke very often when
we asked our patients' medical history we ask them if they smoke and we ask is there
somebody in the house who smokes and it's already been well documented in the medical
literature over and over the negative effects of secondhand smoke so it is very important
that you keep doing the right thing to take care of yourself so that your surgery heals
properly and of course you continue to be healthy and enjoy the benefits of your cosmetic
eyelid surgery.
So with that being said, I hope that was helpful. Thank you for your question.