Aging is a multi-faceted phenomenon that shows its effects on the skin while also transpiring deep within the body’s underlying tissues and metabolic systems. Every choice impacts longevity to some degree; even emotional and mental health directly affects stress and cortisol levels, which manifest on the skin and impact a patient’s inclination towards longevity. The landscape for longevity and all that it encompasses continues to advance and unfold at a hyper-fast pace. An intriguing and exciting sector of science, longevity-based treatments and therapies are making their way into the world of aesthetics, shaping the new segment known as Integrative Aesthetics.
Skin and the Science of Longevity
The skin significantly affects overall longevity, technically known as “skin longevity.” According to Stephanie Manson Brown, MBBS, MRCS, MFPM, vice president and head of clinical development & scientific innovation and skincare R&D at Allergan Aesthetics, an AbbVie Company (Chicago, Ill.), longevity science focuses on understanding the biological processes of aging and how to slow them down to improve health span. Research in this field is rapidly advancing, with specific initiatives designed to generate knowledge among leaders in medicine. “In 2019, Allergan established Science of Aging, a program to convene worldclass experts to share the latest innovations in aging and longevity, explore novel targets for unmet patient needs, and drive the future blueprint for aesthetic medicine,” she stated.
Dermatologist Doris Day, MD, (New York, N.Y.) shared that physicians know that the skin does more than reflect the inner workings of the body; it affects how the body ages, too. The skin is responsible for several critical functions, such as aiding in water balance, temperature control a
nd touch receptors. “Its health is vital to longevity by supporting and maintaining effective barrier function and immune health,” Dr. Day explained. With a deeprooted focus on longevity, she tells her patients that looking better is one thing, but feeling and being healthier and better is another.
As Dr. Manson Brown noted, skin aging varies from patient to patient, reflecting genetics and lifetime exposures. “The skin, which is the outermost protective layer of the body, is exposed to internal (genetic, metabolic and endocrine) factors and external (ultraviolet radiation, pollution and smoking) stimuli that drive the aging process,” she shared.
Where Longevity Meets Aesthetics
The skin is the body’s largest organ and mirrors internal health, but skin age is determined by deoxyribonucleic acid (DNA) methylation,1 a molecular method of measuring the cellular age of tissues, organs and skin. “Changes in DNA methylation patterns influence gene expression in skin cells, affecting collagen production, cellular repair mechanisms and inflammation response. These changes contribute to signs of aging such as wrinkles, sagging and loss of elasticity,” explained Shakiba Kaveh, PhD, chief executive officer (CEO) of Mitra Bio (London, England, U.K.).
Research on longevity addresses skin-related changes by exploring the fundamental biological processes that contribute to skin aging, such as cellular senescence, telomere shortening and oxidative stress. “By understanding and potentially mitigating these processes, longevity research aims to improve skin aging. Strategies such as promoting cellular rejuvenation, enhancing skin barrier function, and protecting against oxidative damage through antioxidants are integral,” stated Dr. Kaveh.
Proactive treatments, including protective and repair products, can help to improve skin longevity. Daily use of sunscreen protects collagen and DNA, while skincare and anti-aging treatments maintain collagen, elastin and hydration to reduce lines, wrinkles and laxity. Dr. Kaveh stressed that preventive measures can also reduce age-related diseases, enhancing overall health and quality of life. “Maintaining healthy skin through proactive care can prevent skin cancer and other issues, contributing to a longer, healthier lifespan. Evidence indicates that skin damage can lead to secondary effects throughout the body, driving inflammation, muscle and bone loss and cognitive decline,” she shared. “Improving skincare habits could mitigate the harmful effects of aging and improve overall health.”
However, Dr. Manson Brown believes longevity science and aesthetic medicine are in the early stages, prompting Allergan to initiate the Science of Aging program. “It bridges discoveries from aging science and longevity to aesthetic medicine. Skin aging is rapidly progressing and is now anchored around 12 fundamental hallmarks of aging, including chronic inflammation, stem cell exhaustion and telomere attrition. These mechanisms underpin aging in all cells, tissues and organs, including the skin.”
Aesthetics for Longevity
Improving the skin’s health with the right aesthetic treatments can increase overall longevity while keeping the skin healthier longer. When an aesthetic routine focuses on prolonging longevity through skin health, the skin looks better and functions optimally. “Investing in skin health is an important part of a holistic approach to pursuing good health,” Dr. Mason Brown shared.
Dr. Day noted that some treatments, like fillers, do not enhance overall skin quality, which is critical for longevity. “In my practice, I use treatments that improve skin appearance and skin cell regeneration like ultrasound to lift and tighten, and broadbrand light (BBL) and erbium lasers to repair collagen.” 
She added that treatments focusing on regeneration lead to improvements in both skin aging and longevity, as they enrich the skin’s structure and function beyond the treatment itself.
Hormone replacement therapy (HRT) also has a place in extending longevity. According to Dr. Day, HRT is often necessary for women in their 40s and 50s when estrogen levels, critical for skin and hair health, start to decline. “Female patients lack information to understand the benefits of early estrogen replacement during perimenopause, which allows them to age better with improved longevity. The average female patient loses up to 30% of collagen in the skin post-menopause. Starting HRT while in perimenopause, when hormone levels are altered just enough, is ideal. When patients come into my office and say, “My face just fell apart!” I refer them to Ob/Gyns and functional medicine doctors to get started on HRT, which is life-changing, especially for skin and hair.”
When considering treatments that will further skin longevity, timing is everything. “The younger, the better,” confirmed Dr. Day. She recommends ultrasound treatments once per year to patients in their 30s and twice per year for those in their 50s and 60s. Dr. Day also suggests BBL twice a year to help with superficial blood vessels, and a thulium laser peel to eliminate sun damage including sun-damaged skin cells. “When patients do these treatments, it helps prevent a buildup of sun damage that can turn into pre-cancers and skin cancers.”
Simple lifestyle changes can also extend longevity beyond what is available at the physician’s office. Dr. Day cites nasal breathing, which produces nitrous oxide to kill viruses and improves oxygenation, to aid in skin healing and function. “Slow breaths reduce stress and cortisol, benefiting the skin.” Quality sleep, a nutrient-dense diet,2 daily sunscreen, high-quality skincare, adequate hydration, and regular exercise are also crucial for enhanced longevity.3
Integrating Longevity into the Aesthetic Practice
Providing aesthetic-based longevity treatments and therapies in the aesthetic practice is not a brand new concept. According to Dr. Day, she and many of her colleagues have been paying attention to longevity for some time. “In the past, many dermatologists did not have the tools to help people look and age better, which made things challenging. But now we have more tools to help patients look and age better, and these treatments and therapies improve their stress levels, moods and behavior. When patients like how they look, they exercise more and eat better. Some treatments, like lasers, directly impact skin longevity, which is why many dermatologists use them with exosomes and peptides to nourish the skin and amplify longevity.”
In addition, Dr. Kaveh explained that many aesthetic practices can use biomarkers such as methylation to track the efficacy of their treatments. “Mitra Bio has developed a clock to measure the rate of skin aging from the skin tissue itself so we can measure whether the intervention has slowed down the process,” she shared.
The Future of Longevity in Aesthetics
No two people are alike, so a well-rounded approach to longevity should be customized to each patient. “We have embarked on an initiative to gather data from a wide spectrum of racial backgrounds and demographics,” Dr. Manson Brown shared. “We are pioneering evidence-based products that focus on the root causes of aging versus the symptoms, such as regenerative stem cells, rebuilding tissue and harnessing biomaterials.” She added that Allergan is also building a tissue bank that will enable the Company to conduct genomic and proteomic analyses.
Multiple scientific areas address both cellular and molecular aspects of skin aging. According to Dr. Kaveh, one is epigenetics, which examines changes in gene expression that are influenced by environmental exposures and lifestyle choices and aims to modify them for healthier aging. “There is also cellular senescence,4 where scientists investigate how to prevent and/or reverse the process in which cells stop dividing and functioning properly,” she described. “By developing treatments to clear senescent cells or restore their function, researchers aim to maintain youthful skin.”
Equally as important is telomere biology. As Dr. Kaveh shared, telomere compounds (at the end of chromosomes) shorten with each cell division, their lengths being markers of cellular aging. “Scientists are exploring ways to preserve or extend telomeres to enhance the lifespan and health of skin cells, potentially delaying wrinkles and sagginess.”
Artificial intelligence (AI) also impacts longevity, which Dr. Manson Brown believes is vital to living better. “It may reverse age-associated processes at scale and allow for real-time tracking of health parameters, allowing people to take a more active role in their health. AI is also helping us understand the wider determinants of health, including how the environment influences genes, yielding new insights and solutions to achieve healthy longevity.”
Another area of skin science that is being studied more closely is the skin microbiome. “It is not just about skin structure and function; those microbes living on the skin are essential and must keep growing because they do a lot to help against aging,” Dr. Day said. “When we study the diversity of the skim biome and what has happened, and health, disease and aging, by resetting that biome to a more youthful one, skin discoloration, aging, redness, and even skin cancer can all improve.”
The Final Takeaway
The intersection of functional medicine and aesthetics brings focus to improving skin longevity, health span and quality of life. This is the science of longevity. “The science of longevity seeks to transform our approach to aging, and its ultimate goal is not just extending lifespan, but also ensuring those extra years are lived with vitality and minimal disease,” Dr. Kaveh asserted. As research into skin longevity continues, she affirmed that scientists will continue to develop comprehensive strategies to maintain youthful, healthy skin, contributing to overall longevity and well-being.
References:
1. Gill D, Parry A, Santos F, Okkenhaug H, Todd CD, Hernando- Herraez I, Stubbs TM, Milagre I, Reik W. Multi-omic rejuvenation of human cells by maturation phase transient reprogramming. eLife. 2022 Apr 8;11:e71624. doi: 10.7554/ eLife.71624. PMID: 35390271; PMCID: PMC9023058.
2. Ducharme, Jamie. Researchers may have found a way to slow human aging. Time. Published February 9, 2023. Available at: https://time.com/6254236/slow-human-aging/. Accessed July 11, 2024.
3. Marshall, Michael. The unexpected ways your skin impacts your health and longevity. New Scientist. Published February 28, 2024. Available at https://www.newscientist.com/article/ mg26134802-900-the-unexpected-ways-your-skin-impactsyour- health-and-longevity/. Accessed: July 11, 2024.
4. Lang, Katharine. New clues to slow aging? Scientists use genetic rewiring to increase lifespan of cells. Medical News Today. Published April 30, 2023. Available at: https://www. medicalnewstoday.com/articles/longevity-scientists-usegenetic- wiring-to-increase-cells-lifespan. Accessed July 11, 2024.
