Elle Magazine
Nature vs. Nurture
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These women are identical twins. Their genes
are exactly the same; their skin is not. The difference,
a new study finds, is purely environmental —
sun, smoking, and even stress. Patricia Beard reports.
Every August, Twinsburg, Ohio, host two action-packed
days of parades, contests, and festivities for Twins
Days, a celebration of twins, both fraternal and
identical. The event draws nearly 3,000 sets of
twins — close to 1,000 of which are identical
and female. Dressed in matching ensembles,
the twins parade through the town, and compete in
contests such as "Most-Alike Females" and "Most
Clever Outfit." There's a talent show for twins,
featuring singing, dancing, drumming, baton twirling,
lip synching to country music, and an eerie twin
performance known as the "Mirror Act."
Amid the fanfare and the bandstands, the celebration's
organizers set up booths and invite those doing
twin-related research to submit proposals. Over
the years, identical twins — who provide scientists
with one of the few existing ways to really measure
nature vs. nurture — have been studied exhaustively:
twins and multiple sclerosis, twins and alcoholism,
Alzheimer's, cancer, mental disorders, heart disease.
Darrick E. Antell, MD, a top Manhattan plastic
surgeon with a wood-paneled Park Avenue office and
a roster of celebrity and socialite clients, came
to Twinsburg after searching the medical literature
for information on aging — specifically, whether
genetic or environmental factors were most important
in the way people ended up looking as they aged.
There was very little, surprisingly.
Temporarily stumped, he heard himself say something
that eventually lead him to undertake his own research:
The clue came from his response to patients who
asked him how long their face-lifts would last.
He would reply, "Let's say you had an identical
twin, and you had a face-lift that made you look
eight years younger, but your twin didn't have a
face-lift. You would always look eight years younger
than your twin, even as you both continued to age."
Twins was the magic word. Antell
began thinking about what would happen if, instead
of one twin having a face-lift while the other didn't,
the twins had made contrasting lifestyle choices.
Would they, too, age differently?
Next stop, Twinsburg. Antell and his associate,
Eva Taczanowski, arrived equipped with a battery
of cameras, film, an ecru bedsheet for a photo backdrop,
and stacks of questionnaires. During the two days
of the festival, as twins lined up outside their
booth, the team took hundreds of photographs and
conducted interviews, talking personally to most
of the twins and collecting their filled-in questionnaires.
Gay
and Gwyn were among the twins whose different lifestyles
had created a dramatic aging gap. For the early
part of their lives, they were indistinguishable,
except to those who knew them best. By the time
Antell photographed the sisters, their pictures
— taken within minutes of each other —
looked like before-and-after shots of the same woman
after ten to fifteen hard-wearing years had passed.
Photographic evidence to the contrary, not only
are Gay and Gwyn genetically identical; in many
ways, their lives have followed similar patterns.
Both are divorced, one with three grown children,
the other with four. They have pursued comparable
careers: Gay is a retired registered nurse and medical
technician; Gwyn is a retired medical technician.
Both women have been prescribed medication for hypothyroidism
and undergone estrogen replacement. Both suffer
from regular headaches. Neither has had a serious
illness, although Gay has high blood pressure, and
takes a beta-blocker. When he took their histories,
Antell found that the differences in their
lifestyles were the kind that show up on a face.
Gay, the "older" twin, had lived in California
for thirty years, baking in the sun year-round,
sometimes as a nudist. She smoked a pack of cigarettes
a day for four years, used marijuana heavily for
seven, and drank wine and beer socially for ten
years. She also had a history of depression, exacerbated
when one of her children contracted leukemia and
died.
Gwyn,
by contrast, who has considerably fewer wrinkles
and finer-textured skin, lives in Maryland where
she has had only moderate sun exposure, has never
smoked or drank alcohol, and never had the sort
of tragedy her sister suffered when her son died.
Sun exposure, smoking (both cigarettes and marijuana),
and deep emotional stress, Antell hypothesizes,
caused Gay's more pronounced wrinkles, age spots,
enlarged pores, and leathery skin.
Kathleen and Karen, in their fifties, have even
more in common than Gay and Gwyn. They both live
in Maryland, where they grew up. They each have
one child. They look as though they might have modeled
a few years back, perhaps for "Which twin has a
Toni?" ad. They arrived at Antell's booth
with similar haircuts and lipstick shades, wearing
matching coral-red polo shirts and pearl-stud earrings.
But they, too, no longer looked identical: Kathleen
appeared older by several years.
How did that happen? Kathleen explained that she
had smoked a pack of cigarettes every day for thirty
years, while Karen has never smoked. Kathleen spent
more time sunning herself. (Karen also takes an
estrogen replacement drug, Premarin, which she has
used since she had a hysterectomy in 1985). As for
anxiety, Kathleen, who is married, suggested stress
as a contributing factor to her wrinkles; Karen
who is divorced, didn't mention stress in her questionnaire.
When Antell returned from Twinsburg, he
spread the hundreds of photos out and studied the
questionnaires the many sets of twins had filled
in. The evidence was clear: When one identical twin
looked noticeably older than the other, the two
most consistent factors were that the older-looking
twin had a history of sun exposure and smoking,
while the other did not.
Antell ranks smoking as the number one culprit.
"It's a total-body problem." he says. "Smoking decreases
the blood flow to your skin, and of course the liver,
heart, and kidneys. It retards healing time —
we insist that patients stop smoking two weeks prior
to surgery," he says. "What we see in the face of
a smoker is a window to what has happened inside."
Once the damage has been done, can it be undone?
Yes and no. Antell has performed plastic
surgery on seven sets of twins, including Gay and
Gwyn. "With plastic surgery, we treated laxity of
skin and wrinkles," Antell says. He explains
that the techniques used on Gay were more aggressive.
Gay and Gwyn are now considerably more in balance,
but Gay still looks a few years older. For Antell's
other twin clients, less extreme measures include
laser resurfacing, chemical peels, and topical treatments
such as Retin-A, all of which he says improve the
quality of the skin, shrink enlarged pores, and
fade age spots.
Antell reports that until they saw his photographs,
most of the twins thought they still looked identical
(and some, like a pair of Mennonite sisters in their
sixties who had live the cleanest of lives, were,
in fact, indistinguishable). The twins who had a
substantial appearance gap were surprised when they
realized how different they looked. "They look at
each other more than they look in the mirror, so
they don't see themselves side-by-side that often,"
says Antell. How about the post-photo shock
reaction? "A lot of them wanted to have plastic
surgery," says Antell, " not just the 'older' twin,
but both of them. They want to look alike again."
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