NEW YORK (Reuters Health) - Smokers seeking plastic surgery should kick the habit before going under the knife, plastic surgeons advise.

Smoking increases the risk of post-surgical complications, particularly with major procedures such as breast reconstruction and facelifts. It also lowers the odds that patients undergoing elective surgery will be happy with the cosmetic results, researchers report in the September issue of Plastic and Reconstructive Surgery. Smoking, with its ill effects on the circulatory system and wound healing, has long been known to hinder patients' recovery from an array of surgical procedures. ``Nicotine, carbon monoxide, and many other toxic tobacco by-products clearly interfere with the dynamics of normal wound repair,'' write Drs. Jeffrey K. Krueger and Rod J. Rohrich of the University of Texas Southwestern Medical Center at Dallas. In the field of plastic surgery, the researchers note, operations with the highest risk of smoking-related complications include breast procedures, facelifts and abdominoplasty (''tummy tucks''). Such procedures, they explain, involve injury to large flaps of skin, and smoking may interfere with healing. One recent study of women undergoing breast reconstruction after mastectomy showed that smokers had higher rates of necrosis, or tissue death, in skin flaps at the surgical site. Krueger and Rohrich advise plastic surgeons to encourage patients to quit smoking and to help them find the means to quit whenever possible. One strategy, they note, would be to refuse to do an elective procedure until the patient quits. At the very least, the surgeons advise, patients should agree to quit smoking for 4 weeks before and 4 weeks after any cosmetic or reconstructive surgery. Anything that could interfere with successful procedures on ''aesthetically important regions'' of the body ``must be identified and eliminated,'' according to Krueger and Rohrich. ``We have the power to improve the quality of surgical results, reduce the incidence of postoperative complications, and watch our patients enjoy longer, healthier lives,'' the authors add.

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