We all know the risk of smoking on the health including lung damage, heart disease, increased risk of cancer, and others. But many people do not know the effects that smoking cigarettes has on the skin over time. A study conducted by Dr. Haruko Okada and colleagues at Case Western Reserve University in Cleveland, Ohio published in the November 2013 issue of Plastic and Reconstructive Surgery demonstrates these effects. The study compared photographs of twins, one of which smoked and the other did not, or one of which smoked at least five years longer than the other. The photographs of the smokers demonstrated significantly more signs of facial aging including eyelid laxity, under eye bags, fine lines, deep lines, sagging skin, and discolorations. In the image from the study shown here, the twin on the right smoked 14 years longer than his brother. Although they are the same age, the smoker has more wrinkles and deeper wrinkles and appears older. Like sun exposure, smoking leads to the formation of harmful free radicals in the skin. These harmful free radicals have multiple effects. They damage the collagen in the skin, the protein that holds the skin tight, leading to fine lines, wrinkles, and sagging. It also leads to discolorations which are commonly known as age spots. Sunscreen can block the harmful effects of the sun, but it can not protect the skin from the free radicals generated from smoking. Topical antioxidants such as vitamin C can neutralize these free radicals to prevent aging. But the best way for smokers to prevent aging is to quit smoking. Other elements of a healthy lifestyle include sun protection, eating a healthy diet, getting regular exercise, and getting enough sleep. Making healthy lifestyle choices will lead to healthy and youthful appearing skin.