We all know someone who looks remarkably young for their age - and others who seem to age prematurely. Skin, the largest organ in the body, is perhaps then the most visible sign of one's health. Can the visible differences in skin ageing actually predict health and lifespan?
In this article we share two scientific studies that provide insights into the role of lifestyle choices and genetics in skin aging. The first study, by Knaggs and Lephart (2023), explores how nutrition, sleep, exercise, and social connections influence skin health. The second study, by Gunn et al. (2009), examines how genetics and environmental factors like sun exposure affect the perception of aging.
As ever, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Links to all studies at bottom of page.
The Role of Lifestyle in Skin Aging
Knaggs and Lephart’s research highlights four key lifestyle factors that can slow skin aging and improve overall skin health:
Nutrition – A diet rich in antioxidants, vitamins, and polyphenols (such as those found in fruits, vegetables, and green tea) can reduce oxidative stress, which accelerates skin aging. The Mediterranean and plant-based diets, which emphasise whole foods and healthy fats, are linked to better skin hydration, elasticity and reduced wrinkle formation.
Sleep – Poor sleep quality and insufficient rest increase stress hormones and inflammation, weakening the skin barrier and contributing to premature aging. Sleeping less than five hours per night is associated with greater skin dehydration and slower recovery from environmental damage.
Exercise – Regular movement enhances circulation, delivering more oxygen and nutrients to the skin while reducing inflammation. Physical activity also supports collagen production, keeping the skin firm and resilient.
Social Connections – Strong relationships and community engagement reduce stress and inflammation, which have indirect benefits for skin health. Studies suggest that people with active social lives may experience slower overall aging.
The study emphasises that these factors work together - someone who eats well but lacks sleep and social connections may not see the full anti-aging benefits. It also suggests that future social media interventions could encourage better lifestyle habits to improve skin health.
Genetics vs. Environment in Facial Aging
The second study, led by Gunn et al. (2009), investigates why some women appear significantly younger than their chronological age. By analysing female twins, the researchers were able to separate genetic influences from environmental factors. Key findings include:
Skin Wrinkling and Sun Exposure – Wrinkles are a major factor in perceived age, and they are strongly influenced by sun damage. Sun-exposed skin tends to develop more wrinkles, making people look older. Genetics also play a role, but avoiding UV exposure is a controllable factor that can significantly slow visible aging.
Lip Size – Women with fuller lips were consistently perceived as younger. Lip volume is primarily determined by genetics but decreases with age.
Hair Changes – Grey hair and hair thinning contribute to an older appearance. While hair greying is mostly genetic, hair thinning is more influenced by environmental factors. Women who dyed their hair tended to be rated as younger.
Subcutaneous Fat Loss – Structural changes under the skin, such as reduced fat in the cheeks, contribute to an aged appearance. This is largely genetic, but lifestyle factors like nutrition and hydration may play a role in maintaining skin volume.
Researchers from the Longitudinal Study of Aging Danish Twins examined over 1,800 twins aged 70 or older. Independent assessors - including nurses, young men and elderly women - rated how old the participants looked from facial photographs. The researchers then tracked survival over seven years to see if looking older correlated with a shorter lifespan.
The findings were striking. Regardless of the assessors’ age, sex, or professional background, individuals who were perceived as older were significantly more likely to die sooner. This effect remained even after adjusting for actual age, sex, and upbringing, showing that perceived age is more than just a subjective impression - it reflects underlying health.
Above are 2 composite images - each image represents the average appearance of a group of 10 twins aged 70 (ranging from 69 to 71). The image on the left shows twins who appeared younger than their actual age, with an average perceived age of 64 (ranging from 57 to 69). In contrast, the image on the right represents twins who looked older for their age, with an average perceived age of 74 (ranging from 70 to 78). What differences do you notice? While not all participants maintained a neutral facial expression, research has shown that this does not affect the accuracy of perceived age assessments.
The study revealed that participants who looked older tended to have:
Weaker grip strength – A known marker of frailty and predictor of longevity.
Cognitive decline – Poorer performance on memory and mental agility tests.
Shorter telomeres – These protective caps on chromosomes shorten as we age. Those who appeared older had significantly shorter telomeres, suggesting their cells had undergone more wear and tear.
Additionally, perceived age correlated with physical function, mobility and general strength, further reinforcing its role as a biomarker of overall health. The study also suggests that both genetics and environmental factors contribute equally to how old a woman looks.
Another study by Gunn et al (2013) found that facial appearance and skin wrinkling may provide insight into biological aging and longevity, beyond traditional health markers. By comparing the offspring of long-lived individuals to age-matched controls, the study found that male offspring looked 1.4 years younger, and both male and female offspring had fewer wrinkles on sun-protected skin. Notably, women with the lowest cardiovascular disease (CVD) risk looked over two years younger than those with higher risk. However, no direct link was found between CVD risk and upper inner arm skin wrinkling. These findings suggest that facial aging may reflect overall health status and longevity potential, independently of age, smoking, sun damage, and body mass index.
How These Studies Connect
While the Gunn studies focus on genetic and environmental influences, the Knaggs and Lephart study highlights the role of modifiable lifestyle factors in preserving youthful skin. Together, they suggest that:
Genetics set the foundation for how skin ages, but lifestyle choices significantly impact the rate of visible aging.
Sun exposure is one of the most controllable risk factors for premature aging.
A healthy diet, regular exercise, good sleep, and strong social connections can complement genetic advantages or help counteract genetic predispositions for aging skin.
What This Means for You
Doctors have long used perceived age as an intuitive health indicator, and this study confirms that it has real clinical value. If you look significantly older than your actual age, it could be worth assessing your overall health - particularly muscle strength, cognitive function, and lifestyle habits.
Taking steps to improve your health - such as maintaining a balanced diet, staying physically active, reducing stress, and getting enough sleep - could not only help you feel better but may also extend your lifespan. Read more on what genetic based Mendelian randomisation studies tell us about longevity and lifestyle.
Final Thoughts
While we can’t change our genetics, we can influence how we age. This research highlights that looking older than your years might be an early warning sign worth paying attention to. Investing in your physical, mental, and social well-being could help you stay younger both inside and out.
Could your reflection in the mirror be revealing more about your future than you realise?
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Studies and Resources
The studies in review...
Knaggs, H.; Lephart, E.D. Enhancing Skin Anti-Aging through Healthy Lifestyle Factors. Cosmetics 2023, 10, 142. https://doi.org/10.3390/cosmetics10050142
Gunn DA, Rexbye H, Griffiths CE, Murray PG, Fereday A, Catt SD, Tomlin CC, Strongitharm BH, Perrett DI, Catt M, Mayes AE, Messenger AG, Green MR, van der Ouderaa F, Vaupel JW, Christensen K. Why some women look young for their age. PLoS One. 2009 Dec 1;4(12):e8021. doi: 10.1371/journal.pone.0008021. PMID: 19956599; PMCID: PMC2779449.
Gunn DA, de Craen AJ, Dick JL, Tomlin CC, van Heemst D, Catt SD, Griffiths T, Ogden S, Maier AB, Murray PG, Griffiths CE, Slagboom PE, Westendorp RG. Facial appearance reflects human familial longevity and cardiovascular disease risk in healthy individuals. J Gerontol A Biol Sci Med Sci. 2013 Feb;68(2):145-52. doi: 10.1093/gerona/gls154. Epub 2012 Aug 9. PMID: 22879455.
Other
Wong, C., Ng, J.Y., Sio, Y.Y. et al. Genetic determinants of skin ageing: a systematic review and meta-analysis of genome-wide association studies and candidate genes. J Physiol Anthropol 44, 4 (2025). https://doi.org/10.1186/s40101-025-00384-9
Bienkowska A, Raddatz G, Söhle J, Kristof B, Völzke H, Gallinat S, Lyko F, Kaderali L, Winnefeld M, Grönniger E, Falckenhayn C. Development of an epigenetic clock to predict visual age progression of human skin. Front Aging. 2024 Jan 11;4:1258183. doi: 10.3389/fragi.2023.1258183. PMID: 38274286; PMCID: PMC10809641.
Knaggs, H.; Lephart, E.D. Enhancing Skin Anti-Aging through Healthy Lifestyle Factors. Cosmetics 2023, 10, 142. https://doi.org/10.3390/cosmetics10050142
Wong QYA, Chew FT. Defining skin aging and its risk factors: a systematic review and meta-analysis. Sci Rep. 2021 Nov 11;11(1):22075. doi: 10.1038/s41598-021-01573-z. PMID: 34764376; PMCID: PMC8586245.
Cao C, Xiao Z, Wu Y, Ge C. Diet and Skin Aging-From the Perspective of Food Nutrition. Nutrients. 2020 Mar 24;12(3):870. doi: 10.3390/nu12030870. PMID: 32213934; PMCID: PMC7146365.
Y Esquirol, J Ferrieres, J C Marquie, S Huo Yung Kai, M Niezborala, E Berard, V Bongard, J B Ruidavets, VISAT group, P1548, Forehead Wrinkles and risk of all-cause and cardiovascular mortality over 20- year follow-up in working population: VISAT study, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy565.P1548, https://doi.org/10.1093/eurheartj/ehy565.P1548
Christensen K, Thinggaard M, McGue M, Rexbye H, Hjelmborg JV, Aviv A, Gunn D, van der Ouderaa F, Vaupel JW. Perceived age as clinically useful biomarker of ageing: cohort study. BMJ. 2009 Dec 10;339:b5262. doi: 10.1136/bmj.b5262. PMID: 20008378; PMCID: PMC2792675.
Gunn DA, Larsen LA, Lall JS, Rexbye H, Christensen K. Mortality is Written on the Face. J Gerontol A Biol Sci Med Sci. 2016 Jan;71(1):72-7. doi: 10.1093/gerona/glv090. Epub 2015 Aug 11. PMID: 26265730; PMCID: PMC4881821.
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