Your Skin Isn’t The Only Thing That Ages You: The Future Of Aging Aesthetics

The beauty industry has always focused on the skin—trying to perfect the texture, evenness, suppleness, firmness, and vibrancy. These are worthwhile endeavors, of course. The skin is our body's most visible and largest organ, so it’s only normal that we've invested time and resources into it, especially with age. 

But beauty and aging is much deeper than the skin. Of course, I mean that in a philosophical, feel-good way, but I also mean it in a very real one: How you age depends on changes to the bone, lymph system, muscle, fat tissues, and then the skin. And yet for decades, mainstream beauty has been solely fixated on just the surface.

But how we approach aesthetics is beginning to shift. With non-invasive, in-office procedures, advancements in at-home tools, more sophisticated and nuanced approach to injectables, and even next-gen topicals, we can actually address all of the factors that contribute to aging.

“We truly didn't know that much about facial aging 20 years ago. Even in the last 10 years, it’s shifted,” aesthetic rejuvenation specialist Lisa Goodman, MPAS, founder of GoodSkin Clinics, told me during a recent conversation. Goodman has long championed a multifaceted approach to aging. She’s shaped my point of view on beauty in many ways, and I consider her one of my favorite sources.

Goodman explains that in the past, practitioners didn’t take the different layers of the face into account. “For example, the way they were using filler really didn't encompass this whole facial structure. The bone and fat was not even a conversation when you got trained,” she says.

Many of these fillers are meant to mimic the look of bone and fat (which we lose with age), so to ignore them entirely in the education process is alarming. And this lack of proper education led to less-than-ideal results.  

For example, as Beverly Hills board-certified plastic surgeon Ben Talei, M.D. explains, one specific type of calcified filler called Radiesse, which is a boney paste. When placed correctly, it doesn’t cause a problem—but what some practitioners do is inject it just under the skin, rather than in deeper layers on the bone. Talei explains they do this because it’s believed to induce collagen production. However, as Talei explained to me, this is not the kind of collagen you want, as it’s in fact scar tissue. So, it may smooth over the skin temporarily, but in the long run, it’s creating unhealthy, rigid dermal layers underneath. 

And this was all in an attempt to rid the face of fine lines, the bane of many people’s existence. The thing is that the wrinkles were never the crux of the problem: "Wrinkles are a sign of life. Wrinkles are earned. Wrinkles do not make people look bad,” Goodman told me. 

As a caveat: It’s good to care for your skin. I spend most of my job reporting on skin care. And personally, I take meticulous care of my own. I certainly do not think it’s an unworthy topic. However, it is important to remember that aesthetics is not just about this skin.

We need to broaden our horizons of what a beauty routine really looks like—because in reality, so much more goes into it. Earlier this year, Goodman joined me on my podcast Clean Beauty School to discuss the many elements of facial aesthetics, which include bone structure, muscles, lymphatic system, fat, and skin.

For example, she explains that bone loss1 is a major driver of facial aging, notably for women. "Women will tend to lose bone in their midface and next to their nose. And that's why women will have a longer upper lip with age, and that's one of the telltale signs of aging that most people don't even realize," she says. 

And fat loss can be particularly notable around the eyes, resulting in more prominent under-eye circles. "Under the eyes, for both men and women, is the first place we lose fat pads. Science shows that this starts happening in your twenties2," she says. "So your under-eye fat will recede faster than the fat pads in the rest of the face." 

And finally, changes to muscle balance can exacerbate facial asymmetry3, which studies show tend to worsen with age. "Muscle is something that needs to be evaluated on each person because it's so individual," Goodman notes. 

As for the lymphatic system—part of your body’s detoxification pathways—the circulation tends to slow with age4. 

“Just because the generation before us screwed up filler and injectables because they didn’t treat it like it should be used, doesn’t mean these things are bad,” says Goodman. “It's just really thinking, where should this actually go, where does it wind up, and how should it be used?”

Take for example, neuromodulators (commonly called Botox). These are most commonly used as wrinkle-reducers, but Goodman explains that one of their best use cases is as muscle rehabilitators. "We can help people with muscle issues and imbalances by using neurotoxins as a rehabilitative tool—it's so much more than just a 'wrinkle reducer,'" she says. "If you rehabilitate the muscles, you can help people stay more symmetric."  

What’s to come is even more exciting. In the not-so-distant future, I predict stem cell technology will expand to soaring new heights. (I’m not the only one, check out our other trend report about skin longevity for more information.) There are roadblocks in its way—currently the FDA has only approved clinical trials for certain use cases, such as blood transfusions—but the hope is that new clinical trials will be approved with time so peer-reviewed research can start catching up to what practitioners are seeing with off-label use. 

In the meantime, many practitioners and clinics are using stem cell therapies for skin and hair regeneration treatments with impressive results. For example, Goodman’s bicoastal clinic GoodSkin Clinic uses filler combined with stem cells, platelet-rich plasma injections (PRP) and/or platelet-rich fibrin injections (PRF) to treat under eye circles and hollowness. This helps create a smoothing, lifting appearance around the eyes—rather than appearing puffy, which can sometimes happen with under-eye filler.

Labs, such as Acorn Biolabs, are even harvesting and storing stem cells for those willing to shell out the money for it. The idea here is that you can extract healthy, youthful stem cells now, so they can be used in regenerative medicine treatments in the future—some treatments we haven’t even dreamed up yet. Ideally, these stem cells can be used for aesthetic rejuvenation, but also for disease treatment and injury. You’re leveraging your younger self’s health for your future self’s benefit. 

There’s a lot of exciting stuff happening in the world of aesthetics. But unfortunately, most of it is still very costly and location-prohibitive. The hope is that eventually, these will become more widely available. However, it’s difficult to say when these might trickle down to a mass audience. 

So where does that leave us in the meantime? We turn to lifestyle dermatology to relearn the building blocks of a healthy body. 

For healthy bones—something we certainly can’t address with topical treatments—we have to look to vitamin D, consume enough calcium, and encourage a healthy microbiome. It is also important to reduce or eliminate lifestyle habits that accelerate bone loss, such as excessive alcohol intake, smoking tobacco, and marijuana use.

Muscular health can be addressed with some beauty tools, such as microcurrents. Microcurrent devices are tools that emit low (micro) levels of electrical currents that stimulate muscles, improve strength, and promote ATP production in the cells, which encourages overall increased cellular energy. However, muscular health also requires diet and lifestyle intervention as well: to maintain strong, balanced muscles, we must eat enough protein, reduce tension, and prioritize posture. 

Ultimately it’s understandable why we’ve focused so much attention on the skin—it’s much easier to fix and treat in some ways. Just slather on a cream and you’ll magically fade away dark spots and erase wrinkles, we’re promised. But aging and facial aesthetics is so much more than that. 

Ideally, in the future we’ll better understand that how we care for our bones, muscles, lymph, and bodies is intrinsically linked to how we age—not just because it affects the skin, but because it influences our facial appearance. Essentially, we’ll finally look past the skin, which will ultimately benefit the skin. 

As for the future of facial treatments, we’ll see technologies that address things like fat and bone loss, by using the power of our own bodies to regrow them. Of course, we'll still use technologies that exist today—such as radiofrequency, neuromodulators, lasers, and the like—just used with more sophistication and discernment.