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repair smoking damage

There aren’t many things in life I regret. Yes, maybe dating that cute, but unemployed and emotionally unavailable guy for two years wasn’t such a good idea, or religiously drinking two Diet Cokes a day during my first job out of college, but for the most part my motto is ‘you live, you learn and move on.’ Out of every mistake or fallen step in the past (and trust me there have been many), there’s only one I feel a strong pang of regret – smoking cigarettes. It happened during those “I’m invincible” years aka my early twenties. I’ve long since quit, but as the number of candles on my birthday cake increases my vanity kicks my younger self for partaking in such a bad habit. Signs of fine lines, rough texture and loss of a healthy glow are beginning to appear, most likely, a result of cigarette smoking. So now what? Do I live my life wearing the signs of my mistake or can the damage be reversed? I reached out to Los Angeles, CA based board certified plastic surgeons Dr. Sarmela Sunder and Dr. Kristina Tansavatdi (both have done extensive research and published studies on facial rejuvenation) to find out.


“Naturally as we age the skin and tissues aren’t as plump as they used to be,” explains Dr. Sunder, “Fat in the face begins to deplete and the body is unable to reproduce collagen and elastin as robustly as when you are in your twenties.” This thinning of fat and tissue means muscle movements can be seen more prominently and the creases formed from repeated facial movements begin to appear. (Even if you aren’t puckering around a cigarette, both mention that frequently sucking on straws can cause similar “smoker’s lines” to appear around the lips – FYI!). Throw in the mix cigarettes and the natural degradation is only compounded.

“The additives in cigarettes pollute the skin,” says Dr. Sunder, “but the main issue is the fact that Nicotine collapses the blood vessels so you aren’t getting as much blood flow, oxygen and nutrients to the skin. Any lines you are bound to have from facial expressions will appear deeper from smoking and the skin quality won’t look as shiny and healthy. Skin will look dry and dehydrated.”

But there’s hope. Both Dr. Sunder and Dr. Tansavatdi suggest with consistent treatment, maintenance and diligent protection of the skin (i.e. wearing sunscreen) significant repair can be done. 

How to prevent lines from deepening

“For a lot of people who have deep lines Botox isn’t going to make the deep lines go away, but it is going to prevent them from getting a lot deeper,” says Dr. Sunder.

Botox: “It prevents you from puckering quite as aggressively. When injected Botox can minimize or freeze the movement of a muscle. With a small dose the muscle will still work, but it wont work as strongly preventing the lines from deepening,” says Dr. Sunder, “I place it a couple of millimeters above the lipstick line in a few different spots around the lip.”

How to improve skin quality

“The damage that has been done has affected the collagen and elastin,” says Dr. Sunder, “so you want to do something that will kick start the collagen production.”

Micro-needling: “Micro-needling is a series of needles that punctures the skin and creates controlled injuries. It makes your body think, oh, I have this trauma here I need to fix it. It reverses some of the collagen damage by forcing your body to repair the injury and lay down new collagen,” says Dr. Sunder.

Fractional Radio-frequency: “Another option is micro-needling with radio frequency built into it. There’s a machine called Venus Viva. The micro-needles go into the skin, but right at the tip of the needles radio frequency is released which creates controlled injury points with heat added to it,” says Dr. Sunder, “You get more trauma to the area, which means your body repairs it even more than just using micro-needles.”

How to treat fine lines

“With deeper lines and poor skin quality,” says Dr. Sunder, “you want to wipe it clean and start all over. Laser resurfacing procedures wipe out the superficial layers of skin and encourage new skin to grow and fill in those lines.”

CO2 Laser: “With CO2 you are resurfacing the skin in some areas,” says Dr. Tansavatdi, “but leaving some pockets intact. The laser also goes through the skin and down to the dermis stimulating collagen. It’s a treatment that involves two weeks of redness and swelling; and the redness continues for 2-3 months before its gone.”

Dermabrasion: “The gold standard, which a lot of people don’t do anymore because it’s so aggressive is dermabrasion. Not microdermabrasion, but old school dermabrasion,” says Dr. Sunder, “Essentially you’re taking sandpaper to your skin and sanding the skin down to a deeper level. You look pretty raw and beat up for a week and then new skin grows back.”

“It’s a good technique,” says Dr. Tansavatdi, “The problem is you could get hypo-pigmentation (loss of pigment) or hyper-pigmentation (excessive pigment). You are going deep enough to shave down the skin so it’s basically at the base of the fine lines and then stimulating new collagen in all of these lines. It’s a good tool to use, but it’s usually the last tool in my tool belt after we’ve exhausted other options, and clients have to understand the risks associated.”

How to treat deep wrinkles

“The other thing that helps for people who have really deep lines is filler. You can go in and put filler into each individual line,” says Dr. Sunder.

Hyaluronic Acid Fillers: “You could inject each line around the lips with filler or you could inject it using a fanning technique,” says Dr. Tansavatdi, “One of the things that happens from aging and smoking is we lose volume in our lips. By putting volume underneath the entire lip to plump it forward minimizes the appearance of lines. The other thing I will do is inject filler along the border of the lip to minimize lines that bleed into the border.”

“With laugh lines and lip lines, when you inject them with filler it doesn’t last very long because you are moving the area so often it dissolves quickly,” says Dr. Sunder, “If you couple it with botox it helps so that you aren’t puckering as much, but for the laugh lines you can’t really botox that area since you wont be able to smile and talk properly. That’s why the only treatment for those deeper laugh lines is to inject them with filler.”

No matter which route you decide to take in reversing the signs of skin damage caused by smoking the first step is to quit, as continued smoking will further age skin and inhibit proper healing post any of the above treatments. So ditch the cigs and take solace knowing with a little investment of time and money, you could be looking like your younger self. No more regrets. 

For more on micro-needling read  – “Microneedling, The Gentler Option For Improving Skin Texture.” 

And check out  – “Turn Back Time With The No-Knife Face Lift” – for details on tightening up any saggy skin.


Written by Amy Chang, founder + editor; Image source: Vogue 2006, Mario Testino


Disclaimer: Any information in the publications, messages, postings or articles on the website should not be considered a substitute for consultation with a board-certified dermatologist or plastic surgeon to address individual medical needs. Your particular facts and circumstances will determine the treatment which is most appropriate for you. And the outcomes.

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