Twin study shows smoking prematurely ages face

A new study of twins demonstrates how smoking causes premature aging of the face, causing more wrinkles around the lips and sagging under the eyes.

Researchers led by Bahman Guyuron, M.D., of the department of plastic surgery at Case Western Reserve University and University Hospitals, Cleveland, set out to identify specific components of facial aging secondary to smoking. They did so by identifying 79 pairs of twins in which only one twin smoked or where one smoked at least five years longer than the other.

Participants completed questionnaires, and professional photographers took standardized photographs of the twins. A panel of three blinded judges analyzed the twins’ facial features and graded wrinkles using the Lemperle Assessment Scale, then ranked age-related facial features on a four-point scale.

According to the study, which was published in the November issue of Plastic and Reconstructive Surgery, twins who smoked compared significantly less favorably to their non-smoking siblings in scores for upper-eyelid skin redundancy, lower-lid bags, malar bags, nasolabial folds, upper lip wrinkles, lower lip vermillion wrinkles and jowls. Lower-lid hyperpigmentation in the smoking group fell just short of statistical significance. There was no statistical difference in transverse forehead wrinkles, glabellar wrinkles, crow’s feet and lower lip lines accentuated by puckering.

Among twins with greater than five years’ difference in smoking duration, twins who had smoked longer had worse scores for lower lid bags, malar bags and lower lip vermillion wrinkles.

“The most important finding is confirmation of what was assumed to be the aging changes as the consequence of smoking in a scientific manner,” Dr. Guyuron tells Dermatology Times. “The malar bags and hyperpigmentation of the lower lids seem to be the most common features of the ‘smoker face.’”