Longevity in Aesthetic Dermatology: Review of the Literature

ABSTRACT Background Aesthetic dermatology is increasingly framed within a skin longevity paradigm that emphasizes sustained skin quality and functional preservation rather than short‐term cosmetic change alone. This review looks at evidence relevant to skin longevity, integrating biologic mechanisms of skin aging, approaches to outcome measurement, exosomes and lifestyle contributors, as well as key safety and regulatory considerations. Most outcomes discussed reflect surrogate, short‐term, or cosmetic measures rather than validated indicators of long‐term skin health, and this limitation is discussed explicitly. Methods This is a narrative (non‐systematic) review; a targeted PubMed/MEDLINE search (January 2015–May 2026) and a validated evidence‐grading framework (GRADE) were used, as detailed in the Methods. Extracellular matrix remodeling and collagen depletion, oxidative stress, chronic low‐grade inflammation, cellular senescence, and reduced reparative capacity consistently link to clinical dyspigmentation, photodamage, textural change, laxity, and dermal thinning and/or volume loss. Skin healthspan is measured across studies, using approaches that include photoaging scales, standardized photography, patient and investigator assessments, and objective measures such as hydration, transepidermal water loss, and elasticity. Results Interventions are reviewed, including prevention, topical therapies, energy‐based devices, injectables, and emerging regenerative or biologic approaches, with the most consistent evidence supporting prevention and well‐studied topicals. Procedural and regenerative modalities show greater variability in durability, safety, and evidentiary maturity. Conclusion Based on the integrated literature, a phenotype‐guided approach may help operationalize skin longevity in clinical practice. Patients can be stratified according to dominant aging patterns, including photodamage, texture change, laxity, or volume loss, with interventions selected to address both upstream drivers and downstream structural consequences.