Smoker vs Non-Smoker Identical Twins: 7 Photo Comparisons

Does smoking really make you look older? Photos of identical twins give one of the clearest answers. Identical twins start life with the same genes, so when one smokes and the other does not, much of the difference that appears on their faces over the decades can be put down to habits rather than heredity.

The seven pairs below circulated widely after US media covered research by Dr Bahman Guyuron, a plastic surgeon in Cleveland, Ohio, who spent years photographing twins at the Twins Days Festival in Twinsburg. In each picture one twin has smoked, or has smoked for many more years, than the other. Before scrolling to the answers, try to spot the smoker. The clues are usually around the eyes and the mouth rather than the forehead.

Each photo has a short caption with what is known about that pair. After the gallery you will find what the research measured, why tobacco smoke ages skin, a few popular myths, and practical help for anyone who wants to stop.

What the identical twin study found

Dr Guyuron's best-known paper on the subject appeared in the journal Plastic and Reconstructive Surgery in November 2013. His team photographed 79 pairs of identical twins with an average age of 48; 57 of the pairs were women. In every pair, either one twin smoked and the other never had, or one had smoked at least five years longer.

Plastic surgeons who did not know the smoking histories then graded each face. The smokers scored worse on sagging upper eyelids, bags under the lower lids, deeper lines running from the nose to the corners of the mouth, wrinkling of the lips and sagging jowls. The forehead and the crow's-feet area showed few differences. The authors reported that even a five-year difference in smoking duration could produce visible changes.

Pairs 1 to 3: when both twins smoke

Pair 1

This one is a trick: both brothers smoke. The twin on the right, however, has smoked for 14 years longer, and it shows most in the deeper folds beside his mouth and the heavier skin under his eyes. The photo was published by Today alongside its coverage of the twin research.

Pair 2

Again both sisters are smokers, but the twin on the left has smoked for about 17 years longer. Look at the pronounced bags under her eyes and the extra fine lines around her lips, the two zones the 2013 study flagged most often. This image circulated through the viral site Diply.

Pair 3

The twin on the right has smoked for 16 years and has also spent a lot of time in the sun. Ultraviolet light is the other major cause of premature skin ageing, so her face shows the combined effect of two habits. Researchers try to separate the two, but in real life they often go together. Photo via Today.

The same two women seen from the side. In profile the difference along the jawline and under the chin is easier to see; sagging of the lower face was one of the clearest findings in the twin research. Photo via Today.

Pairs 4 to 7: one smoker, one non-smoker

Pair 4

The smoker is the twin on the left. She had smoked around half a pack a day for 14 years, while her sister had never smoked. Notice the slightly hollower cheeks and deeper lines beside the nose. This image circulated through Diply.

Pair 5

The woman on the right is the smoker. Her face has more wrinkles overall and her lips look thinner, which fits the lip wrinkling and loss of fullness that the surgeons in the study scored. Photo via Today.

Pair 6

Here the twin on the right smokes. The gap is subtler than in some other pairs, a reminder that the number of cigarettes, the years of smoking, sun exposure and weight changes all play a part in how a face ages. Photo via Today.

Pair 7

The sister on the left is the smoker. Compare the area under the eyes and the corners of the mouth with her twin's. These are the spots where smoking tends to leave its mark first. This image circulated through Diply.

Why tobacco smoke ages the skin

Dermatologists usually point to a few overlapping effects. Nicotine narrows blood vessels, so the skin receives less oxygen and fewer nutrients. Chemicals in smoke speed up the breakdown of collagen and elastin, the proteins that keep skin firm and springy. Smoke also produces large numbers of free radicals, which damage cells in a way similar to sunlight.

Habits add to the chemistry. Pursing the lips around a cigarette thousands of times a year deepens the vertical lines above the upper lip, and squinting against smoke may contribute to lines around the eyes. Smokers also tend to heal more slowly, which is one reason surgeons ask patients to stop before an operation.

The face is only the visible part. According to the US Centers for Disease Control and Prevention, cigarette smoking and secondhand smoke cause more than 480,000 deaths in the United States every year, nearly one in five. Smoking causes cancer, heart disease, stroke, chronic lung disease and type 2 diabetes, and it weakens the immune system.

Myths worth dropping

• "A healthy diet cancels out smoking." Eating vegetables and fruit is good for everyone, but no food or supplement neutralises tobacco smoke. Claims that "alkalizing" foods detoxify a smoker's body have no scientific support; the body keeps its blood pH in a narrow range regardless of diet.
• "Vitamin pills protect smokers." High-dose beta-carotene supplements, a form of vitamin A, were linked to a higher rate of lung cancer in smokers in large trials. Anyone thinking of taking supplements should talk to a doctor.
• "It is too late to bother quitting." The CDC says quitting has health benefits at any age, however long or heavily someone has smoked.
• "Light or occasional smoking is harmless." The twin research found visible changes with as little as five extra years of smoking, and health risks rise even at low levels.

If you want to quit

Many smokers need several attempts before they stop for good, and that is normal. Counselling and approved medications, such as nicotine replacement, roughly double the chances of success compared with willpower alone. In the US, the free quitline 1-800-QUIT-NOW connects callers to local support; in the UK, the NHS offers free local stop smoking services. A doctor or pharmacist can help choose the right approach.

The following video, shared on TED's Facebook page, accompanied the original version of this gallery.

Sources: American Society of Plastic Surgeons (2013): Face it, twins who smoke look older; CDC: Cigarette smoking; photos via Today, NBC News and Diply.

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