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Facial Changes Caused by Smoking: A Comparison Between Smoking and Non-smoking Identical Twins
Haruko Okada, MD, Brendan Alleyne, BS, Kaveh Varghai, N/A, Kimberly Kinder, MD, Bahman Guyuron, MD.
Case Western Reserve University, Cleveland, OH, USA.

PURPOSE: The purpose 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 five years longer than their 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 to their non-smoking 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, crows 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.
CONCLUSION: This study details the specifics of facial aging brought on by smoking, that it primarily affects the middle and lower thirds of the face. It also demonstrates that a five-year difference in smoking history can cause noticeable differences in facial aging in twins.


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