Smoking in Relation to Age in Aesthetic Facial Surgery

Department of Plastic Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
Aesthetic Plastic Surgery (Impact Factor: 0.96). 06/2012; 36(4):853-6. DOI: 10.1007/s00266-012-9913-2
Source: PubMed


Smoking is a major cause of premature facial aging. Skin aging in general, often accompanied by wrinkling and furrowing, plays a significant role in the decision to undergo aesthetic surgery. Smoking may therefore be related to the demand for cosmetic surgery. This study aimed to compare smoking habits with respect to a standard cosmetic procedure (blepharoplasty) in the general population and to evaluate whether the age at surgery differs between smokers and nonsmokers.
A questionnaire was sent to 517 patients with valid reports describing dermatochalasis of the upper eyelid who subsequently underwent an upper-eyelid correction in 2004. Smoking habits, socioeconomic status, and medical history were evaluated. The patients were classified as smokers, ex-smokers with at least 1 year of smoking cessation, and never-smokers.
Of the 353 questionnaires (68.3 %) returned, 345 were eligible for statistical analysis. The smoking habits did not differ between the blepharoplasty group and the general population. However, the smokers underwent surgery an average of 3.7 years earlier than the ex-smokers (p=0.0007) and 3.5 years earlier than the never-smokers (p=0.006). No significant difference was observed between the ex-smokers and the never-smokers.
This is the first study to describe an association between smoking habits and an earlier need for upper-eyelid correction among ex- and never-smokers. The mechanism of skin restoration could result in a regenerative mechanism among ex-smokers, but further research is needed to support this hypothesis. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at

Download full-text


Available from: An E K Deliaert, Oct 05, 2015
26 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is little clear evidence of a strong association between cumulative sun exposure and skin wrinkling. Contradictory findings also exist on the association between facial wrinkling and smoking status. To identify the significant determinants of skin wrinkling in a cohort of older subjects and to assess whether skin wrinkling can be used as an objective measure of cumulative sun exposure. This study was carried out in the South Glamorgan health district, Wales, U.K., between 1988 and 1991. A random sample of 792 older subjects (60 years and over) was obtained from the Health Authority register of patients registered with general practitioners. A range of phenotypic and environmental data was collected during a home visit by interview and examination by an experienced dermatology research fellow. Skin wrinkling/ageing was assessed by examining the face, neck and dorsum of the hand and scored on a 10-point ordinal scale. Cumulative sun exposure was assessed by asking subjects to estimate their average outdoor time during each of three periods of adult life. This measure showed acceptable repeatability (r = 0.64 for estimates obtained 1.4 years apart). The response rate was 71% and the mean age of participants was 71 years. The mean +/- SD skin ageing score was 5.5 +/- 1.5. In multiple logistic regression models only age and daily cigarette consumption were significantly associated with skin ageing. Cumulative sun exposure was significant on univariable analysis but this effect was removed by adjusting for age. Smoking 20 cigarettes per day was equivalent in effect to almost 10 years of chronological ageing. Smoking is an important determinant of macroscopic skin ageing/wrinkling in older subjects. This evidence suggests that skin ageing does not clearly provide an objective measure of cumulative ultraviolet exposure, and caution should be exercised before it is used in this way. The association between smoking and wrinkling provides important information for potential use in education campaigns to reduce smoking prevalence among young people.
    British Journal of Dermatology 01/2003; 147(6):1187-91. DOI:10.1046/j.1365-2133.2002.04991.x · 4.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Smoking is one of the major lifestyle factors influencing the health of human beings. Life-long cigarette smokers have a higher prevalence of common diseases such as atherosclerosis and COPD with significant systemic impact. The present review evaluates current knowledge concerning possible pathways through which cigarette smoking can affect human health, with special focus on extrapulmonary effects. Long-term smoke exposure can result in systemic oxidants-antioxidants imbalance as reflected by increased products of lipid peroxidation and depleted levels of antioxidants like vitamins A and C in plasma of smokers. A low-grade systemic inflammatory response is evident in smokers as confirmed by numerous population-based studies: elevated levels of C-reactive protein (CRP), fibrinogen, and interleukin-6, as well as increased counts of WBC have been reported. Furthermore, rheologic, coagulation and endothelial function markers like hematocrit, blood and/or plasma viscosity, fibrin d-dimer, circulating adhesion molecules (intracellular adhesion molecule-1, selectins), tissue plasminogen activator antigen, and plasminogen activator inhibitor type I are altered in chronic cigarette smokers. Although most of smoking-induced changes are reversible after quitting, some inflammatory mediators like CRP are still significantly raised in ex-smokers up to 10 to 20 years after quitting, suggesting ongoing low-grade inflammatory response persisting in former smokers. New longitudinal epidemiologic and genetic studies are required to evaluate the role of smoking itself and possible gene/environment interplay in initiation and development of smoking-induced common diseases affecting humans.
    Chest 06/2007; 131(5):1557-66. DOI:10.1378/chest.06-2179 · 7.48 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Plastic surgeons are always concerned about integrity of facial vascularization in smokers and elderly candidates for face-lifting. Using Doppler ultrasound, this study aimed to evaluate influence of chronic smoking and aging on facial transverse and infraorbital artery blood flow. For this study, 40 healthy volunteer women were submitted to bilateral Doppler ultrasound of facial transverse and infraorbital arteries. Volunteers were divided into three groups: group 1 (13 nonsmoking women ages 18-33 years), group 2 (13 nonsmoking women ages 55-70 years), and group 3 (14 smoking women ages 55-70 years). Blood flow parameters measured were peak systolic velocity, end-diastolic velocity, resistivity index, and pulsatility index. Chronic smoking did not cause statistically significant alterations in peak systolic velocity in any of the arteries. However, there was a significant augmentation of end-diastolic velocity and a reduction in resistivity and pulsatility index in both arteries. Aging process did not significantly alter any of the parameters evaluated. Findings in both sides of the face were similar for both arteries. Chronic smoking significantly altered end-diastolic velocity, resistivity, and pulsatility index in regional arterial circulation of the face. Aging process, however, did not significantly influence any of blood flow parameters studied.
    Aesthetic Plastic Surgery 10/2007; 31(5):526-31. DOI:10.1007/s00266-006-0171-z · 0.96 Impact Factor
Show more