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Burke. Plast Aesthet Res 2020;7:59 I http://dx.doi.org/10.20517/2347-9264.2020.154 Page 11 of 16

A B

Figure 5. The 52-year old smoker (A) has more severe, deeper periorbital wrinkles than her 57-year-old non-smoking cousin (B). These
cousins are neighbors who experienced the same environmental conditions throughout their lives (reprinted from Great Skin for Life,
with consent of the author)

[53]
many as non-smoking women . Smokers’ skin displays extensive aging with a leathery texture, dryness,
deep wrinkles, a crepe-like quality, and sagging. This appearance of prematurely aged skin can be clearly
seen in Figure 5. The 52-year-old smoker has far more severe periorbital wrinkles than her non-smoking
[55]
57-year-old cousin and neighbor . A further dramatic demonstration of the ravages of photoaging in
[56]
smokers was shown in photographs of identical twins with a greater than 5-year difference in smoking .
Especially upper eyelid skin redundancy, lower lid bags, molar bags, nasolabial folds, upper and lower lip
wrinkles, and jowls are markedly worse in the twin who smoked.

The other primary sources of indoor pollution, especially in underdeveloped countries, is cooking and
[57]
heating with coal or wood. In China, more than 20% and up to 70% of households cook with solid fuel ,
[58]
causing chronic obstructive pulmonary disease, compromised lung function, and lung cancer . To study
the effect on the appearance of the skin, Li et al. compared 405 women (of age 30 to 70 years) from
[59]
northern China with 857 women from southern China, using the standardized SCINEXA evaluation.
Correcting for age, cooking and heating with solid fuel significantly increased severe facial wrinkling by
5%-8% and by 75% the fine wrinkles of the hands.

Not only do underdeveloped countries suffer with indoor pollutants, but also throughout the world, gas
stoves spew pollutants (primarily nitrogen dioxide and carbon monoxide) which make indoor air factors
dirtier than outdoors, as reported by The Guardian (United Kingdom) recently. Candles and fireplaces
further contribute. No specific studies on the effect of these frequent enjoyments on aging skin have been
completed as yet, but certainly we know that these airborne contaminants are detrimental to skin.

SKIN CANCER
The most severe and devastating manifestation of photoaging is skin cancer. Here there is no doubt that
environmental pollution directly initiates and propagates skin cancer. The first realization of environmental
pollutants causing skin damage was in London in 1775 when Dr. Percivall Pott correlated SCC on the
underside of the scrotum after exposure to soot in young boy chimney sweeps .
[60]