title: Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas.
abstract: BACKGROUND
  Despite the obvious relation between smoking and facial wrinkling, grossly undetectable wrinkling and the consequences of smoking on the face have been poorly studied.
  
  
  OBJECTIVE
  To assess the risk factor of cigarette smoking on the development of premature facial wrinkling.
  
  
  METHODS
  One hundred and twenty-three nonsmokers, 160 current smokers, and 67 past smokers, aged 20-69 years, were studied. Cigarette smoking status, weight changes, average sun exposure time (recreational and occupational) in 1 month, and past medical and facial cosmetic surgery were quantified by self-questionnaire. Computerized image analysis of silicone skin replicas was used in addition to clinical visual measurement, and a severity score based on predetermined criteria was assigned to each patient.
  
  
  RESULTS
  Current smokers have a higher degree of facial wrinkling than nonsmokers and past smokers. Past smokers who smoked heavily at a younger age show less facial wrinkling than current smokers. In the analysis, which was adjusted for age group, the relative risk of moderate to severe wrinkling for current smokers compared with nonsmokers was 2.72 (confidence interval, CI: 1.32-3.21, P < 0.05). In current smokers, the relative risks associated with more than 19 pack-years and 11-19 pack-years of smoking compared with nonsmokers were 2.93 (CI: 1.14-4.1, P < 0.05) and 1.75 (CI: 1.54-3.67, P < 0.05), respectively. On image analysis of facial skin replicas, the mean values of Ra (arithmetic average roughness), Rz (average roughness), and Rt (distance between the highest and lowest values) of current smokers were higher than those of nonsmokers and past smokers in all age groups. This indicates a strong correlation between cigarette smoking and skin wrinkling. In addition, microscopic superficial wrinkling (Ra and Rt) was noted in current smokers in the younger age group (20-39 years).
  
  
  CONCLUSIONS
  This study suggests that attention should be paid to smoking-associated facial wrinkling (not evident from a visual assessment) in young people and added to the list of disorders seemingly caused by smoking.
authors.affiliation: Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Jae Sook
authors.initials: JS
authors.lastname: Koh
authors.forename: Hoon
authors.initials: H
authors.lastname: Kang
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Choi
authors.forename: Hyung Ok
authors.initials: HO
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006801:Humans; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D015595:Skin Aging / Q000473:pathology; D012907:Smoking / Q000009:adverse effects*