Facial changes caused by smoking: a comparison between smoking and nonsmoking identical twins.
BACKGROUND
The purpose of this study was to identify the specific components of facial aging secondary to smoking, by comparing standardized photographs of identical twins with different smoking histories.


METHODS
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 using the validated Lemperle Assessment Scale, and ranked age-related facial features on a four-point scale.


RESULTS
Smoking twins compared with their nonsmoking counterparts had worse 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. Transverse forehead wrinkles, glabellar wrinkles, crow's feet, and lower lip lines accentuated by puckering did not have a statistically significant differences in scores. Among twins with greater than 5 years' difference in smoking duration, twins who had smoked longer had worse scores for lower lid bags, malar bags, and lower lip vermillion wrinkles.


CONCLUSIONS
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 demonstrates that a 5-year difference in smoking history can cause noticeable differences in facial aging in twins.


METHODS
Risk, II.
Cleveland, Ohio From the Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University, University Hospitals of Cleveland.
Haruko C
HC
Okada
Brendan
B
Alleyne
Kaveh
K
Varghai
Kimberly
K
Kinder
Bahman
B
Guyuron
D000293:Adolescent; D000328:Adult; D000368:Aged; D004200:Diseases in Twins; D005145:Face / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010781:Photography; D015595:Skin Aging / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects*; D014430:Twins, Monozygotic; D055815:Young Adult