Oral Niacin and Topical Nitroglycerin to Prevent Nicotine-Related Complications Following Facelift Surgery

Objective To prove through our experience that the prophylactic use of oral niacin and topical nitroglycerin results in a reduction in nicotine-related skin flap complications following facelift surgery.  Methods This is a retrospective, observational study. The study population consisted of 40 surgical patients (27 patients who used nicotine products and 13 non-nicotine users with signs of flap ischemia) seen over 18 months. Follow-up ranged from six months to 1.5 years. The main outcome measure was the incidence of flap ischemia in nicotine users who were placed on oral niacin and topical nitroglycerin. In addition, the time needed to improve flap ischemia was measured with the use of this therapy.  Results  There was no incidence of flap ischemia in 22 nicotine users placed on oral niacin and topical nitroglycerin. Four smokers who did have early signs of flap ischemia readily improved with the above therapy within 3-5 days. One smoker had skin slough but the wound re-epithelialized in 18 days. All 13 non-nicotine users with signs of flap ischemia, who were started on niacin and topical nitroglycerin, had an improvement in the appearance of their flap in 3-7 days (mean = 5 days). No long-term complications were recorded with the use of this therapy.  Conclusion  In patients undergoing facelift surgery, the use of oral niacin and topical nitroglycerin is a safe and effective therapy to both prevent skin flap ischemia in nicotine users and to prevent skin slough in those with an ischemic facelift flap.