During the last 20 years, at least five studies have examined the association between cigarette smoking and facial wrinkling. Although there are methodological concerns with each of these studies, the data are consistent with the conclusion that smoking causes skin wrinkling that could make smokers appear unattractive and prematurely old. Cigarette smoking has been shown to decrease capillary and arteriolar blood flow in the skin, perhaps damaging connective tissue components that are important to maintaining the integrity of the skin. Americans are highly motivated to avoid or eliminate facial wrinkles. The association of smoking and facial wrinkling may be important evidence to convince young persons not to begin smoking and older smokers to quit.