Guess which of these identical twins is the smoker

Smoking: It'll wreck your face.

Recently, researchers at Case Western University's Departments of Plastic Surgery and Otolaryngology set out to identify the effects of cigarette smoking on facial aging. To do so, they compared standardized photos of identical twins with different smoking histories. Their results reveal subtle but noticeable differences in the faces of smoking and nonsmoking twins.


From 2007 to 2010, researchers led by plastic surgeon Bahman Guyuron recruited a total of 79 pairs of twins, all of them attendees of the annual Twins Days Festival in Twinsburg, Ohio. Importantly, Guyuron and his team only recruited pairs in which one twin either smoked, or had smoked a minimum of five years longer than his or her sibling. Twins were photographed by professional photographers, and their photos were later analyzed by a panel of blinded judges, who graded wrinkles and ranked age-related facial features according to standardized scales.

Their results, which appear in the latest issue of Plastic and Reconstructive Surgery, were as follows:

Smoking twins compared with their nonsmoking counterparts had worse scores for upper eyelid skin redundancy [i.e. lax eyelid tissue, the result of gravity, loss of tissue elasticity, and weakening of the connective], lower lid bags, malar bags [aka "cheek bags"], nasolabial folds [the "smile-lines" that run from your nose to your mouth], upper lip wrinkles, lower lip vermillion wrinkles, and jowls. Lower lid hyperpigmentation [thought to contribute to dark under-eye circles] in the smoking group fell just short of statistical significance. Transverse forehead wrinkles, glabellar wrinkles [the vertical lines that form between the eyebrows, where the nose meets the forehead], 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.

In other words: Smokers, unsurprisingly, tend to look worse for wear than their non-smoking counterparts. What makes the study interesting, of course, is that it provides the closest thing to a control group that researchers can get when conducting an investigation of this nature, allowing them to get a rough gauge for how much worse for wear the smokers appear. "This study details the specifics of facial aging brought on by smoking, which primarily affects the middle and lower thirds of the face," conclude the researchers. "It also demonstrates that a 5-year difference in smoking history can cause noticeable differences in facial aging in twins."

Which brings us to the photographs. Below are photos of four representative twin pairs who participated in the study. Can you guess which of these twins is the smoker, or has the longer smoking history?


All captions via Guyuron et al.


The twin on the left has smoked 17 years longer than the twin on the right. Note the differences in lower lid bags and upper and lower lip wrinkles.


Both twins are smokers. The twin on the right smoked 14 years longer than his brother.


The twin on the left is a nonsmoker and the twin on the right smoked for 29 years. Note the differences in periorbital [i.e. the eyelid or skin around the eye] aging.


The twin on the right is a smoker; the twin on the left is a nonsmoker. Notice differences in nasolabial creases [i.e. the lines running from the sides of the nose to the sides of the lips].

How'd you fare? I was four for four, but I'll be the first to admit that the differences were not as striking as I thought they'd be. It occurs to me that Guyuron and his colleagues would do well to continue the study, for completeness' sake; imagine, for example, a similar photo series comparing the twins' hearts and lungs, postmortem.


Check out the full study in Plastic and Reconstructive Surgery.

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