Scientific Proof – How Smoking Makes You Look Older

“The Fountain of Youth” – Dr Chris Porter’s inside view of cosmetic surgery where he aims to help you to make the best possible informed choice and achieve your cosmetic surgery goals.

In a recent Plastic & Reconstructive Surgery journal article titled “Facial Changes Caused by Smoking: A Comparison between Smoking & Nonsmoking Identical Twins” specific components of facial aging secondary to smoking were identified. This was performed by comparing standardized photographs of identical twins with different smoking histories. The following is a summary of the study.

During the Twins Days Festival in Twinsburg, Ohio, from 2007 to 2010, 79 pairs of twins were identified, in which only one twin smokes or where one twin smoked at least 5 years longer than his or her counterpart. Questionnaires were obtained and standardized photographs were taken by professional photographers. A panel of three blinded judges analyzed the twins’ facial features and graded wrinkles and ranked age-related facial features.

The results showed that smoking twins compared with their nonsmoking counterparts had aged more causing upper eyelids sagging, lower lid bags, malar bags, heavy cheek folds, upper and lower lip wrinkles, and jowls. Other less significant features found in smokers included lower lid hyper-pigmentation, transverse and vertical forehead wrinkles and crows feet.

In conclusion, this study details the specifics of facial aging brought on by smoking, which primarily affects the middle and lower thirds of the face. It also demonstrated that a 5-year difference in smoking history can cause noticeable differences in facial aging between twins.

My personal philosophy is to ask smoking patients to quit 3 weeks prior to surgery, for both surgical and anaesthetic reasons. It has already been well documented that smokers have up to a 4-5 times greater complication rate after surgery in regard to wound healing, scarring, infections as well as slower recovery in regard to breathing and return to normal functioning. This study adds the bonus that if you stop smoking you will will also look younger than if you keep smoking. Now is a good time to quit!

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To Botox or Not to Botox? That is the Question.

I have just had the pleasure of attending the Australasian Society of Aesthetic Plastic Surgeons meeting in Sydney. Over four days a number of experts from Australasia and the world presented their techniques and philosophies for non-surgical cosmetic procedures. Two main ideas were discussed, the use of neuromodulators (Botox and Dysport) and fillers (Restylane and Juvederm). Botox is well known to many, Dysport effectively has the same mode of action for temporarily weakening facial muscles. Both Botox and Dysport have been used traditionally to reduce facial lines and creases, to smooth the skin and make a younger appearing face. What has been overdone is excessive application to the forehead, crows feet and between the eyebrows which results in a very unnatural, not at all youthful, paralyzed face with abnormal smile and often splayed apart eyebrows. Look at celebrities in the magazines or better still for a dynamic demonstration watch out for an aging female TV news anchor who cannot animate appropriately. The same problem has occurred with fillers, overuse in specific areas has, for example, lead to obvious trout lips. Thankfully both botox/Dysport and Restylane/Juvederm are temporary agents and wear off after 4-6 months and 8-12 months respectively. Fat grafting is an exciting and now proven technique for facial rejuvenation, it has the benefit of being permanent but accordingly must be performed by an experienced Plastic Surgeon.

The theme of the meeting was using these agents intelligently, applying them to specific structures, with a view to a balanced and individual approach. On the first day of the meeting I attended the Masterclass, a select small group aimed at facial anatomy and live demonstrations of injections. The content was fantastic but what really stood out was the difference in anatomical knowledge between the surgeons and non-surgeons. The surgeons were extremely comfortable and competent with their anatomy whereas the non-surgeons were really seeing this for the first time. Herein lies a problem, most botox and fillers are being injected by non-surgeons, effectively GPs who have completed a weekend course or two and are then deemed competent by the drug company marketing the product. Not surprising then that the products are often used in a less than ideal manner. Patients who are attended by such practitioners are only offered botox or fillers, these patients do not get the benefit of being assessed by a Plastic Surgeon who has both non-surgical and surgical techniques available – these patients will get a complete individualized management plan that may be purely non-surgical, surgical or may include both.

Facial rejuvenation should be the goal of botox and fillers, not creating a different facial appearance. A good idea is to look at a photo of yourself 5-15 years ago and hold it next to your face as you look in the mirror. What do you see and desire? Regaining the youthful characteristics takes an artist’s eye and a surgeon’s knowledge and steady hand. Botox and fillers certainly have a place in cosmetic surgery but must be applied by an intelligent practitioner who understands how faces are constructed and how they move dynamically. A little botox here and there, some filler there and here will work wonders if applied in a balanced manner.

As the face ages the skin changes, the face loses bulk and is affected by gravity. Traditionally facelifts and the like pulled back the aged and drooped skin but did nothing to address the loss of volume in the face. Now the combination of surgery, fillers and botox has really provided Plastic Surgeons with the complete package for facial rejuvenation. In your goal of facial rejuvenation, carefully choose a practitioner who has the full armamentarium of surgical and non-surgical techniques to assess and address your individual characteristics.