Background: Clinical features of the skin in persons who smoke include increased wrinkling, gauntness, and discoloration that has been termed smoker’s face. The histologic changes in the sun-exposed skin of these patients have not been previously elucidated. Objective: The purpose of this study was to assess the amount of elastosis in the sun-exposed skin of smokers and nonsmokers. Methods: We evaluated the skin from the forehead and cheeks of 17 smokers and 14 nonsmokers for the presence of elastosis. With the use of a computer-generated analysis of tissue sections at 4 different levels, the amount of elastotic material was expressed as an average percent of the field staining for elastic tissue. Patients were also evaluated for the presence of other malignancies, arsenic and radiation exposure, and previous skin cancers. Results: There was a significantly greater amount of elastosis (P < .05) in the skin of patients who smoked compared with those patients who did not. No significant differences were found between the 2 groups with regard to the other parameters evaluated. Conclusion: Cigarette smoking is associated with an increase in elastosis, which may contribute to the clinical features of “smoker’s face.” (J Am Acad Dermatol 1999;41:23-6.)