The Trouble With Longevity

Longevity is a hard endpoint because it assumes a future benefit that is implied rather than demonstrated and by itself clinically unverifiable in a world where instant gratification rules. It is a holistic concept that relies on a mechanistic explanation, and well-aging is a clinically vague concept in an industry where the winner gains the right to call themselves “Transformative”. That’s not to say there are no clinical benefits, but rather that they are not unique or superior, and cannot be visualized with traditional protocols in a compelling way. Glow, Radiance, Vitality and Energy hardly make for striking clinical photos.

Cosmetic claims live in one of 3 categories: the product works better, the product works faster, or the product works differently (although occasionally, as technology evolves, a new way of visualizing an old benefit emerges, creating a 4th category). Most current innovation fits squarely in the third category, and longevity certainly does, but it is so much more. Educators and Sales reps are most often faced with comparative requests (how is it compared to X, why is it better than Y, etc…) prompted by the budgetary limitations of each account. 

Longevity-based skincare is usually focused on one or more of the following biotargets, all functionally intertwined with each other:

• Mitochondria and cellular respiration: Since the mitochondria serves as the powerhouse of the cell, stress response mechanisms that protect the cell from oxidation and excessive inflammation either originate there or involve factors produced within it. Protecting mitochondria from damage (remember mitochondrial DNA has no repair enzymes) is a common strategy.
  

• Autophagy and cellular detoxification: Autophagy is a dynamic process that enables the cell to recycle its waste into metabolites that can be reused to synthesize new molecules. It is the main cellular detoxification pathway.
  

• Cell death management (Senolytics): Extending healthy cellular lifespan involves activating cell death of senescent, unhealthy cells.
  

• Chromosomal protection and care: Protecting DNA from deterioration, in particular telomeres, and stimulating repair enzymes is a good approach for prolonging healthy cell lifespan. 
  

• Stem cells and their byproducts: This is where the most recent scientific trend in the aesthetics industry resides. Human growth factors, PRP, Exosomes and most recently genetic boosting of genes such as Klotho are all part of the regenerative skincare wave. 
  

The Aesthetics business frequently struggles with the “works differently” category, partly because holistic has not historically been associated with technically advanced technologies, and partly because it is still the world of Before-and-After photographs, and photos do not capture evidence of longevity very well since it is a dynamic rather than a static concept. No matter how science-savvy an account is, even if there is an understanding of the mechanism of action, the purchase decision will always involve a comparison with what is currently on shelf, and competing with images of more tangibly transformative technologies is not easy.

So it is no surprise that most clinical evidence on this type of technology consists of post-procedure recovery tracking. After all, the ability to bounce back from injury is a marker of health, and procedures such as ablative laser resurfacing, diabetic ulcer treatment, peels or microneedling provide the perfect canvas for evidence-based clinical claim substantiation. The parameter there becomes healing speed, neatly moving the product from a “works differently” category to the “works faster” or “works better”. This is a great strategy that features a more immediate benefit without losing the technical innovation aspect.

In the end, it is the ability to shift claim category that allows medical-grade brands to compete in the Regenerative platform. When it comes to this trend, it’s not about being nimble with products, it’s about being nimble with claims.