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Smoking prematurely ages the skin in visible ways, study of twins finds

Courtesy of the American Society of Plastic Surgeons
The twin on the left is a nonsmoker and the twin on the right smoked for 29 years. Note the differences in periorbital aging.

A new study involving identical twins offers some stunning visual evidence of the association between smoking and premature aging.

The study found that even a five-year difference in smoking history between identical twins leads to noticeable difference in facial aging, particularly in the middle and lower thirds of the face.

Previous research on twins has identified several factors that independently contribute to premature aging. These include sun exposure, drinking, weight loss after age 40, weight gain before age 40, and long-term use of anti-depressants, according to background information in the study.

Smoking has also been repeatedly shown to speed up the skin’s normal aging process. Scientists believe it does this by causing collagen and other fibers in the skin — the stuff that gives skin its elasticity and “plumpness” — to break down at a faster-than-usual pace.

Until this current study, however, few researchers had used facial analysis to determine which parts of the face age the most as a result of smoking.

Volunteers recruited at twins festival

For the study, a team of plastic surgeons from Case Western Reserve University recruited 79 pairs of identical twins during the Twins Days Festival in Twinsburg, Ohio, from 2007 to 2010. The twins ranged in age from 18 to 78 years. In 45 of the pairs, only one twin smoked and the other had never smoked. In the other 34 sets of twins, both were smokers, but one had smoked for at least five years longer than the other.

Professional photographs took sized-matched photos of all the twins. A panel of three judges then evaluated and scored the photos, using a standardized assessment tool, for a variety of facial features, including forehead lines, “crow’s feet” wrinkles around the eyes, bags under the eyes, saggy cheeks and jowls, nasolabial creases (those “smile lines” that run from each side of the nose to the mouth) and lip wrinkles. The judges were also asked to select which twin in each set appeared older.

The study was “blinded.” In other words, none of the judges knew which twin was the smoker or the one who had smoked the longest.


An analysis of the assessments led to the following findings:

  • Compared to their nonsmoking siblings, twins who smoked had statistically worse scores for baggy eyes, saggy cheeks and jowls, smile lines, and wrinkles around the lips. The judges also identified the smoking twin as appearing older 57 percent of the time.
  • Among the pairs of twins who both smoked, those who smoked at least five years longer than their sibling scored worse for baggy eyes, saggy cheeks and lower-lip wrinkles. In addition, the longer-smoking twin was identified as appearing older 63.7 percent of the time.

No differences were found in the severity of forehead wrinkles, however. Nor were there any differences in the depth of crow’s feet wrinkles around the eyes.

The findings held up even after the researchers controlled for such factors as weight, sunscreen use, alcohol intake and perceived work stress.

Yet another reason to not smoke

As the study’s authors point out, other research has shown that the negative effects of smoking on the face can be seen even after a facelift.

Of course, prematurely aging skin may be the least of a smoker’s worries. Compared to nonsmokers, smokers are up to 23 times more likely to develop lung cancer, up to 13 times more likely to die from chronic lung disease, four times more likely to develop a heart problem, and two to four times more likely to experience a stroke, according to the Centers for Disease Control and Prevention.

Avoiding premature wrinkles pales against such serious health problems. Still, this study’s findings — particularly its photos — might help deter some young people from taking up smoking and encourage some older people to quit.

You’ll find those photos in the published study, which appears in the November issue of the journal Plastic and Reconstructive Surgery.

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