Smoker's Face

Certain sultry scenes from the great Hollywood classics have come to define our notion of glamor and elegance. Think of drop-dead gorgeous Lauren Bacall locking eyes with Humphrey Bogart as she takes a deep drag on her cigarette and exhales seductively, encircling him with smoke. Bacall may have been every man's ideal beauty in To Have and Have Not, but if she'd kept on smoking like that, she may have looked more like Bette Davis in Whatever Happened to Baby Jane.

Among the many devastating things that smoking can do to you, there is one consequence that chiefly affects your vanity: It can increase the wrinkling of your skin -- sometimes enough to produce an unappealing condition known as "smoker's face."

The term was first coined in 1985 by Douglas Model, a British doctor. Model saw a pattern between smoking and wrinkling, so he began surveying patients at an outpatient clinic to see if he could guess, by their faces alone, whether or not they smoked. He correctly identified half the smokers who had been at it for 10 years or more. All had one or more of the telltale signs: paper-dry skin that looks purplish, orange, or red and blotchy; deeply etched prune-like wrinkles radiating at right angles from the lips or eyes; a haggard, sickly-looking face.

If you smoke, by the time you're 40, you could look distinctly older than friends the same age who have never touched tobacco, according to a 1995 study of 911 smokers and nonsmokers. The researchers determined that smokers were more wrinkled, appearing at least a year and a half older than the nonsmoking group. An earlier study of 132 smokers and nonsmokers found that those who smoked 50 packs a year or more were nearly five times as likely to be wrinkled as nonsmokers of the same age and sex.

What causes the massive wrinkling called smoker's face?

Nicotine and carbon monoxide are among the 4,000 known chemicals you draw into your lungs and bloodstream when you puff on a cigarette. As you inhale, these two toxins reduce circulation by constricting vessels that carry nutrient-rich blood and oxygen to the body, including to the tiny blood vessels in the top layer of the skin.

The lack of nutrients to the skin apparently impairs the skin's ability to produce collagen, the fibrous protein responsible for producing new, healthy skin. Smokers have a higher concentration of an enzyme called matrix metalloproteinase 1 (MMP-1). This enzyme's main job is breaking down collagen. One study in the medical journal Lancet comparing the skin of smokers and nonsmokers found that smokers have "significantly more MMP-1 in the skin than nonsmokers." The result is sagging, dry, wrinkly skin.

Can I reverse the damage if I quit smoking?

It's possible that you can reverse some of the damage, but there are no significant studies on this question, according to Dr. Victor Newcomer, a clinical professor of dermatology at the University of California, Los Angeles Medical Center. But by quitting you can certainly prevent any further breakdown in your skin's healthy glow. If you don't smoke now but are lured by the sexy connotations associated with it in popular culture, think again -- and resist the temptation.

In a different context, but applicable here as well, Bacall herself once said, "I think your whole life shows in your face, and you should be proud of that."

Further Resources

Tobacco Information Prevention Source

Centers for Disease Control and Prevention http://www.cdc.gov/tobacco

References

Victor Newcomer, professor of dermatology at UCLA Medical Center, phone interview.

Ernster, V.L., D. Grady, et al. "Facial wrinkling in men and women by smoking status," American Journal of Public Health, 85 (1):78-82.

Kadunce, D.P., R. Burr, et al. "Cigarette smoking: risk factor for premature wrinkling," Annals of Internal Medicine, 114 (10):908-9; and Annals of Internal Medicine, 115 (8):659-60.

Model, D. Smoker's face: An underrated clinical sign? British Medical Journal, 291:1760-1762.

Vander Straten, Melody, Daniel Carrasco, et al. "Tobacco Use and Skin Disease," Southern Medicine, J 94 (6):621-634.

Hart, B.P. "Vascular consequences of smoking and benefits of smoking cessation," Journal of Vascular Nursing, 11 (2):48-51.

Lahmann, C., J. Bergemann et al., "Matrix Metalloproteinase-1 and Skin Aging in Smokers," The Lancet, 24:935-936

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