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J Clin Aesthet Dermatol. 2019 Aug;12(8):28-39. Epub 2019 Aug 1.

Impact of Smoking and Alcohol Use on Facial Aging in Women: Results of a Large Multinational, Multiracial, Cross-sectional Survey.

Goodman GD1,2,3,4,5,6,7,8, Kaufman J1,2,3,4,5,6,7,8, Day D1,2,3,4,5,6,7,8, Weiss R1,2,3,4,5,6,7,8, Kawata AK1,2,3,4,5,6,7,8, Garcia JK1,2,3,4,5,6,7,8, Santangelo S1,2,3,4,5,6,7,8, Gallagher CJ1,2,3,4,5,6,7,8.

Author information

Dr. Goodman is with Monash University in Clayton, Australia and Skin & Cancer Foundation Inc., in Carlton, Australia.
Dr. Kaufman is with Skin Associates of South Florida and the Skin Research Institute in Coral Gables, Florida.
Dr. Day is with New York University Langone Medical Center in New York, New York.
Dr. Weiss is with the Maryland Dermatology Laser, Skin and Vein Institute in Hunt Valley, Maryland.
Dr. Kawata is with Evidera in Bethesda, Maryland.
Drs. Garcia is with Allergan plc in Irvine, California.
Dr. Gallagher was an employee of Allergan at the time this study was conducted and the manuscript was written.
Dr. Santangelo is with Santangelo Consulting in Singapore.


Objective: Data on associations between facial aging and smoking or alcohol consumption are generally derived from small studies, and therefore, vary. The aim of this large multinational study was to determine more accurately which clinical signs of skin- and volume-related facial aging are associated with tobacco and alcohol use in women. Design: This was a subanalysis of a global, cross-sectional, Internet-based survey of self-reported facial aging. Participants: Women aged 18 to 75 years old (n=3,267) from the United States, Australia, Canada, and the United Kingdom who described themselves as white, Asian, black, or Hispanic were included. Measurements: Using a mirror, participants determined their own aging severity on photonumeric rating scales for 11 facial characteristics. Linear regressions were used to assess associations between each feature's severity and smoking status (never vs. current and former smoker); smoking pack years (0 versus 1-10, 11-20, and >20 years); alcohol use (none vs. moderate and heavy); and alcoholic beverage type, after controlling for body mass index, country, age, and race. Results: Smoking was associated with an increased severity of forehead, crow's feet, and glabellar lines; under-eye puffiness; tear-trough hollowing; nasolabial folds; oral commissures; perioral lines; and reduced lip fullness (p≤0.025) but not midface volume loss or visible blood vessels. Heavy alcohol use (≥8 drinks/week) was associated with increased upper facial lines, under-eye puffiness, oral commissures, midface volume loss, and blood vessels (p≤0.042). Conclusion: Smoking and alcohol consumption significantly but differentially impact skin and volume-related facial aging.


Facial lines; facial skin aging; impact of alcohol consumption; impact of tobacco use; volume-related aging


Conflict of interest statement

FUNDING:This study was funded by Allergan plc. DISCLOSURES:Dr. Kawata is an employee of Evidera. Dr. Garcia is an employee of Allergan. Dr. Santangelo is a paid consultant for Allergan, involved in data analysis, literature research, and editorial support, including manuscript preparation. Dr. Gallagher was an employee of Allergan at the time this study was conducted and the manuscript was written. The other authors have no conflicts of interest relevant to the content of this article.

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