Can the Pursuit of an Ageless Face Redefine Medicine? Exploring Dermatology’s Role in the Quest for Immortality

J Clin Aesthet Dermatol. 2025;18(8):27–29.

by Aaron Cheng, BA, BS; Harrison Shawa, MD; Zachary Uttke, BS; and David G. Cotter, MD, PhD

Mr. Cheng is with the Long School of Medicine at the University of Texas Health San Antonio in San Antonio, Texas. Dr. Shawa is with the Division of Dermatology at the Department of Internal Medicine at Washington University in St. Louis in St. Louis, Missouri. Mr. Uttke is with the Department of Molecular Biology, Cell Biology, and Biochemistry at Brown University and the Warren Alpert Medical School of Brown University in Providence, Rhode Island. Dr. Cotter is with Las Vegas Dermatology and the University of Nevada Las Vegas School of Medicine in Las Vegas, Nevada.

FUNDING: No funding was provided for this article.

DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.

Abstract: Recent years have witnessed significant growth in aging research due to groundbreaking discoveries in gerotherapeutics and an ever-increasing interest in longevity. Such advances beg the question, what if the physical and functional declines we associate with aging were no longer inevitable, but instead treatable through the next frontier of medical innovation?  In this article, we explore the broader social and ethical implications of advancing healthspan and mitigating age-related decline. We also highlight dermatology’s unique role as a catalyst of aging research, serving as a model for integrating aesthetic and functional innovations. Finally, we discuss the curious role and the ethical challenges of the aesthetic dermatology industry in the healthspan debate. Keywords: Aging, gerotherapeutics, healthspan, ethics, aesthetics

From Lifespan to Healthspan: Challenging the Inevitability of Aging

The quest for immortality has fascinated humanity for thousands of years. Yet, aging and death remain inescapable. While “no one gets out alive,” life expectancy (LE) has increased steadily over the last 150 years, largely due to advancements in income, nutrition, education, sanitation, and medicine.¹ Consequent to eliminating many early causes of mortality, chronic disease’s prevalence has increased alongside LE, resulting in increased time and resources spent managing illness and disability.² Although LE has increased, healthspan, defined as the length of time spent in good health, has not necessarily extended into these added years.

Aging research has largely focused on the functional and molecular impairments in cell metabolism in hopes of modulating longevity.³ Beginning in the early 2000s, the National Institute of Aging’s Interventions Testing Program evaluated the effects of rapamycin, showing that its inhibition of the mTOR pathway extended both the median and maximal LE of mice.⁴ Other groups showed that rapamycin slowed the progression of several age-related conditions, including neurodegenerative diseases, cardiovascular disease (CVD), and cataracts.^5–9 Although these findings are promising, cost is a main limitation of gerotherapeutics. For example, sirolimus, the first introduced rapamycin analog, carries an average cost of $226 for 30 tablets (0.5mg), a price that remains prohibitively high for widespread use.¹⁰ This raises an important ethical question: should we pursue advancements that not everyone can immediately access? In the context of aging and healthspan, this dilemma becomes even more pronounced, as the stakes transcend individual wellbeing, extending into the realm of healthcare equity.

Implications of Advancing Healthspan

Advancing healthspan has far-reaching implications for individuals, healthcare systems, and society as a whole. For individuals, preventing age-related decline (ARD) can significantly extend the time spent in good health, enabling prolonged years of productivity in the workforce, increased independence, and an enhanced quality-of-life.¹² For healthcare systems, prioritizing healthspan could yield substantial economic benefits by delaying the onset of chronic age-related conditions such as CVD and cognitive decline, reducing the need for expensive, long-term care.¹³ By the year 2040, 40 percent of all adults in the United States are expected to have CVD with an economic burden surpassing one trillion dollars.^14,15

Additionally, chronic diseases are projected to cost the global economy a staggering $47 trillion by 2030, further straining the already overburdened healthcare systems.¹⁶ A focus on mitigating this growing burden through gerotherapeutics could reduce healthcare costs and improve resource allocation. Furthermore, improving healthspan would enhance individual wellbeing, address ongoing health crises, and potentially foster a society where health and vitality are institutionally prioritized. However, the far-reaching benefits of implementing these gerotherapeutics hinge on our ability to equitably distribute them among various populations and demographics.

Historically, innovations in healthcare and technology often precede equitable access. For example, groundbreaking chemotherapy treatments were initially available only to the financially privileged before becoming widely accessible.¹¹ The high cost of drug discovery, development, and translation from the lab to clinical practice account for high initial consumer drug prices.¹¹ Principles of healthcare economics dictate that as medical and technological innovations advance, consumer prices should decrease over time depending on certain market conditions.¹⁷ This pattern suggests that while disparities may exist early on, gerotherapeutic advancements have the potential to become more affordable and accessible. Therefore, this approach is ethically justified, as it represents a natural extension of modern medicine’s goals, with historical trends indicating that the high initial costs of medical advancements often decrease over time.

Aging Research as a Continuation of Traditional Medical Efforts to Treat and Prevent Disease

Modern medicine, fundamentally aimed at reducing suffering and delaying death, has already extended LE through several advancements.¹ While medicine has been instrumental for diminishing causes of early mortality, age-related conditions have become increasingly prevalent over the past century. Having solved many of the common causes of mortality that previously plagued society, such as communicable and perinatal diseases, medicine is now tasked with treating age-related conditions such as CVD, cancer, neurodegeneration, and metabolic dysfunction. With the medical field’s new focus on these chronic illnesses, advancements in medicine focusing on the biology of aging will be more impactful than targeting individual diseases. Just as with rapamycin, medications that target molecular pathways common to the biology of aging have the potential to treat multiple age-related diseases simultaneously. By targeting the root causes of ARD and prolonging healthspan, medicine’s longstanding mission to improve both quality and quantity of life are fulfilled.

Dermatology—Where the Business of Beauty Begets Breakthroughs

Dermatology sits at the intersection of medicine, scientific and cosmetic innovation, and therapeutic applications. Understanding the molecular underpinnings of epidermal, dermal, and subcutaneous aging may enable dermatology to serve as a model to extend healthspan.^21,22 In recent years, growing evidence has highlighted the potential for cosmetic treatments to serve medical purposes while providing insights into the mechanisms underlying both visible and functional signs of cellular aging. For example, ablative and non-ablative lasers, initially used for cosmetic rejuvenation, are currently being studied for their potential to prevent non-melanoma skin cancers, marking a significant step toward integrating cosmetic procedures with clinical care.^18,23,24 Using a transcriptomic approach, scientists analyzed the gene expression changes of patients treated with an ablative fractional laser, which is known to increase epidermal thickness, increase dermal collagen, and decrease dermal elastin, among other molecular changes. Their findings indicate that using an ablative fractional laser activated biological processes implicated in wound healing and tissue regeneration, which led to rejuvenation of long-lived extracellular macromolecules in the skin. Additionally, they found that treated skin adopted a more youthful molecular signature, with reversal of many age-related gene expression changes, suggesting overall healthier skin.²⁵ In accordance with laser therapies, many topical medications used within dermatology affect skin aging. Examples include topical 5-fluorouracil, a medical treatment for actinic keratoses and superficial keratinocyte carcinomas, and retinoids such as tretinoin; both have been shown to ameliorate photoaging.^26–28 These examples highlight putative ways in which dermatologic approaches to mitigate ARD could be applied to other organ systems.

Regardless of whether the biological mechanisms of skin aging contribute to discoveries that will increase healthspan or LE, understanding the biology of aging in the skin remains essential. If we are successful in extending human LE, the cumulative burden of skin cancer and other age-related cutaneous disease will likely rise, underscoring the need for strategies to prevent and manage them.

Balancing Gerotherapeutics for Aesthetics Versus Function

Medical innovation naturally raises complex ethical questions, especially when balancing the pursuit of anti-aging treatments for aesthetics versus functionality. Cosmetic interventions, such as lasers and skin rejuvenation procedures, are often sought after for their ability to enhance outward appearance. However, they also inherently reduce the risk of skin cancer and mitigate other skin conditions, such as vascular and inflammatory lesions.^18,19 This highlights a moral dilemma in this industry: to focus on advancing aesthetics, which typically caters to the affluent, or to prioritize functionality, which addresses broader public health concerns.

Regardless of the intended objectives of anti-aging initiatives, the cosmetic dermatology market has grown substantially in the United States. The American Med Spa Association recently reported that the total number of medical spas in 2023 was 10,488, a 17.9-percent increase from the previous year.²⁰ Additionally, the medical spa industry in the United States is projected to surpass $17 billion in revenue in 2025 and is steadily growing by more than $1 billion per year.²⁰ As the industry expands, access to costly procedures may exacerbate existing inequalities in healthcare. For example, specific laser treatments range from $200 to $3,000, with an average out-of-pocket expense of approximately $2,000 for ablative laser and $1,100 for non-ablative laser procedures.²¹ Such prices make these treatments largely unattainable for the majority of people. While not inherently contentious for cosmetic purposes, financial limitations to these procedures depict an example of inequity that stems from their anti-aging effects—some elective procedures performed with cosmetic intent also ameliorate cellular aging. The rapid growth of the cosmetic dermatology market highlights the undeniable demand and economic potential of aging research. To maximize its societal value, the industry must balance aesthetics and function, demonstrating how aging research can simultaneously enhance quality of life and address broader public health concerns.

Conclusion

Aging research is an integral part of modern medicine’s mission to reduce suffering and improve quality-of-life by addressing innate biological processes. Dermatology plays a key role in this process, offering treatments that both improve skin health and also provide valuable insights into aging and disease prevention. While it’s important to consider ethical questions like accessibility and affordability, the contributions of aging research, especially in dermatology research, are undeniably beneficial. This work has the potential to improve lives on both an individual and societal level and its continued growth is essential for building a healthier, more robust future.

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