How Smoking Affects the Skin

As today is World No Tobacco Day, we are publishing a two-part series exploring how smoking affects the skin.

At Harley Academy we believe in a “skin first” approach to injectables. Just as an artist prepares their canvas, so must an injector tackle skin issues before getting to work.

Given smoking remains a common habit, it is crucial that aesthetics practitioners understand its effects on the skin. Most notably, premature skin ageing.

In Part One of this series, we interview Dr Carol Mastropierro, a Level 7-trained cosmetic doctor and clinical trainer at Harley Academy. She explains the science behind how smoking affects the skin, why it causes skin laxity and wrinkles.

In Part Two, we speak to aesthetics expert, cosmetic nurse prescriber, Harley Academy senior clinical trainer and Allergan Institute faculty member, Natalie Haswell. She details how to treat smokers’ lines and shares her insights on technique and product selection.

Skin Ageing How Smoking Affects Skin Health Harley Academy aesthetic medicine injectables training courses how to treat smoker's lines filler training Level 7 copy

A cosmetic doctor explains how smoking affects the skin

Why is smoking bad for your skin?

“Everybody knows that smoking is bad for you. I think it’s also common knowledge that smoking is associated with various systemic disorders and different types of cancer,” advises Carol, listing the following:

– Lung cancer

– Stomach cancer 

– Blood cancer

– A specific type of skin cancer known as squamous cell carcinoma

– Different types of cancer of the oral mucosa.

“It is also associated with different types of hair loss,” she continues. “But something I don’t think many people know is that smoking is one of the main factors in ageing. Specifically, premature ageing and skin atrophy.”

“Studies into smoking and skin ageing actually date back to the early 1970s. Even then, a large study showed a positive correlation between the number of cigarettes smoked per year and participants’ levels of skin ageing.”

In addition to prematurely ageing your skin, smoking can also cause or may exacerbate the following skin issues:

– Dehydrated skin

– Dull, dry skin

– Psoriasis

– Hidradenitis suppurativa (acne inversa)

– Cutaneous lupus erythematosus

– Rosacea.

The science of how smoking affects the skin

“When you smoke, there are over 400 different chemicals which are introduced into the body. For the body to get rid of these, they need to be broken down and processed,” explains Dr Carol. 

“Whilst they are being broken down, they release and activate something called a ROS – reactive oxygen species – system. ROS is what we would generally refer to as “oxidants”; these involve molecules, for example peroxide, different alpha oxygens, hydroxyl radicals. They are negatively charged molecules that tend to bind to everything that they find.”

“Of course, the body is very clever. It has a system to fight these radicals through scavenger receptors. These receptors bind to the radicals and get rid of them,” she notes.

Oxidative stress

“The problem with smoking, especially over a long period of time, is that it causes oxidative stress. This happens when there are just too many of these types of dangerous molecules and the scavenger receptor system becomes overwhelmed and cannot get rid of them all.”

“So the ROS molecules, the oxidants, are left free to go and bind to everything – any type of molecule they can find, including our DNA,” Dr Carol explains. “Then, because of this direct damage created to our DNA by the ROS system, a different type of molecule is hyperexpressed. This is called the matrix metalloproteinases (MMPs).”

“Everybody has MMPs; they are completely normal and play an important role in getting rid of the old cells and producing new ones. Again, the body is really, really clever. This mechanism is tightly regulated. We have metalloproteinases which destroy our collagen cells, then we have tissue inhibitors of metalloproteinases (TIMPs), another enzyme which will counteract the effects of the MMPs.”

Impaired collagen production and skin repair 

“Because smoking causes hyperexpression of the MMPs, it leads to an imbalance between the degradation and production of collagen cells in our skin,” she states. 

“Collagen has a lifespan of about 3 months and it does take up to 3 months for it to start producing again. So, with this imbalance, with the overexpression of these metalloproteinases – especially metalloproteinases 1 and 3 – there will be an excessive degradation of collagen. This happens so fast that the body just cannot keep up with it. It cannot produce enough collagen to replenish that which is being destroyed due to smoking. In turn, it starts creating what we call trophoelastin. This is a different type of elastin which is not as functionally efficient as the elastin our skin would usually produce if it had more time.”

“Because of this dermal matrix breakdown and the acculturation of this abnormal trophoelastin, our skin repair function is impaired. This results in skin laxity.”

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Dr Carol’s excellent explanation is the reason for what’s often known as “smoker’s face”, the symptoms of which include: 

– Dull, dry, less supple skin

– Early onset lines and wrinkles

– Lines and Wrinkles which may deepen prematurely

– Sagging and jowls forming due to skin laxity 

– Formation of vertical “smoker’s lines” also known as “barcode lines” around the mouth from the physical action of smoking 

– Hyperpigmentation issues due to smoking’s effect on melanin production.

How can we prevent premature ageing due to smoking?

“The obvious answer is to never start smoking!” says Dr Carol. And with that, it’s over to Natalie Haswell for Part 2 of this series: How to Treat Smoker’s Lines…

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