Cigarette smoking and the ageing skin

Why does an individual start smoking? There are no physical reasons to start smoking. The body does not need tobacco the way we need water, food, sleep and exercise. In fact, many of the chemicals in the cigarettes do a lot of harm.

Many teenagers start smoking because their friends are doing so or someone in the family is doing so. Some teenaged girls smoke because they think it helps in reducing weight (as nicotine is an appetite suppressant) without understanding the consequences of smoking. Some smoke because the advertisements show smokers to appear smart, bold, confident and glamorous which is misinterpreted by the teenagers.

Smoking cigarettes causes not only internal diseases like lung infections, lung cancers, bronchitis, emphysema and heart disease but also adversely affects the skin, although not as dangerous as the internal effects. Some of the effects on skin are as follows:

Prominent facial wrinkling

Aging of the skin can be due to either extrinsic or intrinsic factors. Of the extrinsic factors - sun-exposure, smoking and drinking are common causes. Chronic smokers manifest greater facial aging and skin wrinkling than non-smokers. Heavy smokers are almost 5 times as likely to have wrinkled facial skin than non smokers. Not only did smokers have the most prominent wrinkling, but the wrinkling was found to increase with the no. of packs smoked x no. of years smoked. The risk of wrinkling is more for women than men. This threat to a woman’s beauty and looks should be a powerful incentive to give up smoking.

The characteristic feature is the "smoker’s face" or "cigarette skin" which describes the characteristic wrinkled skin or prematurely aged skin of persons who had smoked for many years. It takes 20 years of smoking to produce a smoker's face.

The characteristic features include:

  1. Increased facial wrinkling in the form of prominent lines.
  2. A slightly red-orange complexion
  3. An ashen, pigmented, pale or gray overall skin appearance
  4. Puffiness of the face
  5. Gauntness (thinness / boniness) of facial features with prominent underlying bony contours
  6. A prematurely older appearance is also a typical symptom of long time smokers

Squinting in response to the effect of the smoke or puckering of the mouth while smoking can lead to wrinkles around the mouth and eyes. Also, hollowness of the cheeks giving them a gaunt appearance can result as a result of sucking on cigarettes.


What is the effect of smoking on our skin’s structure?

  1. As a result of smoking,the skin’s elastic fibres break down resulting in thick, inelastic, yellowish, wrinkled skin, changes which are very similar to those seen in skin damaged due to over-exposure to the sun.
  2. An enzyme responsible for degrading collagen (the main supporting structural component of our skin) is found to be increased in smokers - as a result of which collagen is broken down to a larger extent resulting in wrinkles.
  3. Genetic factors also play a role as not all smokers show the typical smoker’s face.
  4. Tobacco smoke makes the skin dry by reducing the facial surface moisture as well as vitamin A levels which is important for reducing the effects of aging.
  5. Smoking also releases a lot of free oxygen radicals which have a devastating effect on the skin.

Effect on skin’s blood circulation

Healthy skin depends on the good circulation of highly oxygenated blood to carry nutrients to the skin and remove waste products from it. Chronic smoking and nicotine in particular narrows the blood vessels to the skin (of the hands and legs especially) as a result of which blood flow, oxygen and nutrients to the skin is reduced. Smoking also produces carbon monoxide. All these factors lead to a build-up of harmful substances in the skin which causes a lot of damage to the skin. Sometimes, patients can even develop pressure sores.

Delayed wound healing

In fact, the decreased concentration of oxygen in the blood is the greatest threat to wound healing and hence smokers show delayed wound healing time. The relationship between smoking and poor healing has been noted by many surgeons and hence the patients are required to stop smoking before any planned surgery.

Other effects

Prolonged smoking also causes discoloration of the fingers and fingernails on the hand used to hold cigarettes. Smoking also results in a yellowing of the teeth and is a cause of (bad breath).

An association between smoking and graying of hair has been found by some researchers.

Smoking and Psoriasis

Compared with non-smokers, smokers have a two to threefold higher risk of developing psoriasis, a chronic skin condition which, while not life-threatening, can be extremely uncomfortable and disfiguring.

Smoking and skin cancer

Smokers also have an increased incidence of precancerous lesions, skin cancers on the lips and in the mouth cavity.


Prevention is better than cure. Hence, total cessation of smoking is the primary goal for treating all problems.

Patients going for any planned surgery should stop smoking 1 month prior to the surgery to allow smooth wound healing.

Use of sunscreens should be advised side by side to prevent the harsh effects of the sun.

An oral antioxidant vitamin (containing vitamin A,C,E, zinc, selenium) should be advised.

A topical retinoid (Tretin / Retino-A 0.025%) should be advised for reducing fine lines and wrinkles.

The "smoker's" wrinkles around the mouth can be treated with dermal filler substances (such as Restylane). Other prominent lines on the forehead or around the eyes due to squinting can be treated by Botox (Botulinum toxin) injections.

For fine lines, microdermabrasion or laser surgery also is a good option.

However, if the patient continues to smoke, then the wrinkles can come back.