Presurgical intervention reduced patients' smoking.(Aesthetic Dermatology)

WASHINGTON -- Cosmetic surgeons are in a unique position to help their patients quit smoking, Dr. Howard Krein said at the annual fall meeting of the American Academy of Facial Plastic and Reconstructive Surgery.

"Our results suggest that patients desiring facial plastic surgery are more likely to reduce or quit smoking, compared with the general population," said Dr. Krein, who is an otolaryngologist at Thomas Jefferson University in Philadelphia. "We need to realize that we are in a ... position not only to affect them on a cosmetic level but also to effect a change in their health."

Many studies have demonstrated that cigarette smoking hampers wound healing and increases perioperative morbidity, said Dr. Krein. "This is the biological basis for why we ask our patients to quit smoking before we do things like face-lifts or other surgery."

Despite decades of warnings about the dangers of smoking, prospective plastic surgery patients may continue to smoke, and they won't necessarily tell the physician unless he or she asks. But the promise of an enhanced surgical outcome may be the extra motivation that some patients need to quit or at least cut back on smoking, Dr. Krein explained.

Be sure to screen patients for tobacco use, discuss the benefits of smoking cessation, and help them design a plan to quit if they are willing.

"As a specialty, we can and should help our patients quit smoking, and we need to understand how to better tailor interventions to our select patient population," he said.

Previous research shows that smoking cessation interventions tailored to specific populations may be more effective than generic interventions.

To assess the effect of a surgeon's requirement that smoking cease before surgery on patients' quit rates, Dr. Krein and colleagues conducted a prospective analysis that is ongoing.

Dr. Krein shared data from 262 patients, average age 54 years, who were candidates for facial plastic surgery. The study population had a lower baseline smoking rate than did the general U.S. population (16% vs. 30%), but the reported rate of previous attempts to quit mimicked reports from the general population (83% vs. 85%).

During the 8-month study period, 68% of patients who were asked by their facial plastic surgeon to quit smoking said that they actually tried. Of these, 72% were able to reduce their smoking for up to a month.

Reduction was defined as a greater than 25% decrease of their daily smoking habit, said Dr. Krein. For example, many patients went from smoking one pack of cigarettes daily to only five cigarettes daily. Overall, 48% of the smokers did quit smoking for at least a month, compared with a reported quit rate of 25% after a month among smokers in the general population who tried to quit.

The benefits of quitting smoking are numerous. "If you quit, you are going to be healthier from head to toe, we all know and understand that," Dr. Krein said.

Quitting smoking is tough--studies have shown that with no assistance, only 5% of smokers who try to quit will succeed. But the data also show that with some advice and counseling in the office, doctors can double the quit rate to 10%. Add smoking cessation medication and the quit rate may increase to 30%. But the relapse rate remains high and smokers who try to quit make an average of four attempts before they are successful, according to data from the American Lung Association.

The investigators are reviewing which patients have maintained their reduction or abstention from cigarettes for the long term. Future research plans include a retrospective analysis to see whether the ability of facial plastic surgeons to influence smoking cessation is consistent across the United States.

BY HEIDI SPLETE

Senior Writer