In a recent Plastic & Reconstructive Surgery journal article titled "Facial Changes Caused by Smoking: A Comparison between Smoking & Nonsmoking Identical Twins" specific components of facial aging secondary to smoking were identified. This was performed by comparing standardized photographs of identical twins with different smoking histories. The following is a summary of the study.

During the Twins Days Festival in Twinsburg, Ohio, from 2007 to 2010, 79 pairs of twins were identified, in which only one twin smokes or where one twin smoked at least 5 years longer than his or her counterpart. Questionnaires were obtained and standardized photographs were taken by professional photographers. A panel of three blinded judges analyzed the twins' facial features and graded wrinkles and ranked age-related facial features.

The results showed that smoking twins compared with their nonsmoking counterparts had aged more causing upper eyelids sagging, lower lid bags, malar bags, heavy cheek folds, upper and lower lip wrinkles, and jowls. Other less significant features found in smokers included lower lid hyper-pigmentation, transverse and vertical forehead wrinkles and crows feet.

In conclusion, this study details the specifics of facial aging brought on by smoking, which primarily affects the middle and lower thirds of the face. It also demonstrated that a 5-year difference in smoking history can cause noticeable differences in facial aging between twins.

My personal philosophy is to ask smoking patients to quit 3 weeks prior to surgery, for both surgical and anaesthetic reasons. It has already been well documented that smokers have up to a 4-5 times greater complication rate after surgery in regard to wound healing, scarring, infections as well as slower recovery in regard to breathing and return to normal functioning. This study adds the bonus that if you stop smoking you will will also look younger than if you keep smoking. Now is a good time to quit! If you have any specific requests regarding cosmetic surgery topics that you would like discussed on this blog, please feel free to email me: