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Facial wrinkling in smokers may signal pulmonary disease

Article-Facial wrinkling in smokers may signal pulmonary disease

Cambridge, England – While it has been well established that cigarette smoking is a major risk factor for premature aging of the skin, researchers in England have uncovered a connection that may link this type of wrinkling to pulmonary disease.

In a recent edition of Thorax (2006;61:568-671) Dr. Bip Patel, currently of the Department of Respiratory Medicine at the Royal Devon & Exeter NHS Foundation Trust, Exeter, England, describes a study where he and colleagues investigated the possibility that a connection may exist between skin wrinkling and chronic obstructive pulmonary disease (COPD).

Cigarette smoking has long been accepted as a risk factor for premature facial wrinkling. In 1991 research at the University of Utah established an almost fivefold increase in the incidence of facial wrinkling in heavy smokers over nonsmokers (Annals of Internal Medicine;1991:114,:840).

It is known that not all smokers develop COPD, and it may also be the case that not all smokers develop premature facial wrinkling.

"We hypothesized that these conditions could be likened to premature aging of the lung and skin," he tells Cosmetic Surgery Times, "and therefore that there may be a common susceptibility to COPD and skin wrinkling."

Method and results

For this study, conducted in Cambridge, England, 149 current and ex-smokers were recruited from a larger study aimed at identifying a genetic predisposition for the development of COPD.

Participants ranged from being completely asymptomatic to those with no evidence of COPD. Of the total group, 68 (45.6 percent) were confirmed to have COPD. Minimal or minor facial wrinkling (Daniell score <IV) was seen in 124 (83.2 percent) of the participants and 25 (16.8 percent) demonstrated severe wrinkling of the facial skin (Daniell score >=4). In tests of pulmonary function, forced expiratory volume in one second (FEV1) was found to be significantly lower in participants with wrinkles than in those without.

Data was also collected that allowed Dr. Patel and his group to analyze the final results independent of potential confounding factors such as age, the degree of sun exposure experienced by each participant and total pack years smoked. Overall, they found that excessive facial wrinkling was associated with a fivefold risk of COPD as well as a threefold greater risk of extensive emphysema, or emphysema affecting more than 10 percent of the lung.

Genetic connection?

Dr. Patel believes that a common mechanism or genetic susceptibility may be responsible for the results seen.

"We suspect that the common susceptibility to COPD and wrinkling has a genetic basis," Dr. Patel says. "However, the genes that are responsible for this have not yet been identified. The mechanism may be related to the loss of elastic tissues such as collagen and elastin in the lung and skin, but this is not yet proven."

Dr. Patel also notes that the wrinkling "...may be the consequence of metalloproteinases that are activated as a consequence of smoking or a defect in repair mechanisms that affects both the skin and lungs."


Cosmetic surgeons are already aware that the compounds in cigarette smoke cause vasoconstriction, decreasing the levels of circulating oxygen and impairing the healing process.

Smokers also run an increased risk of post-surgical tissue death or rejection.

When a patient wants correction of deep facial wrinkling Dr. Patel advises cosmetic surgeons to inquire about smoking history as well as the presence of any respiratory symptoms, particularly shortness of breath. If indicated, such patients should be considered for spirometry to look for evidence of undiagnosed COPD.

He says, "This increased risk (of airflow obstruction) is independent of cumulative tobacco exposure. Extensive facial wrinkling may be a marker of susceptibility to the effects of cigarette smoke and should promote the screening of affected individuals for airway obstruction.

"The etiology of facial wrinkling is likely to be multifactorial. I think that our research suggests that cigarette smokers who are heavily wrinkled are at greater risk of developing COPD and therefore they should be encouraged to quit."

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