The Difference Between Cellular Aging and Visible Skin Aging

Lately, there’s been growing conversation around cellular aging, but what does it actually mean? We know our cells age along with the rest of our body, but how does that process affect our appearance and is there anything we can do about it? We asked the experts to break down what cellular aging really is—and how it differs from the aging we can see. Ahead, they answer your biggest questions.

Featured Experts

What Is Cellular Aging vs. Visible Aging?

“Think of cellular aging as what’s happening under the hood of a car, while visible aging is the exterior paint job and bodywork,” says Omaha, NE dermatologist Daniel Schlessinger, MD. Cellular aging refers to the biological processes occurring at the molecular and cellular level that drive aging from within.

At the cellular level, these changes affect how cells function, communicate and regenerate. “This includes DNA damage, telomere shortening, mitochondrial dysfunction, oxidative stress from free radicals and the gradual, age-related decline in cellular repair mechanisms,” he explains.

Visible aging is what we see on the surface of the skin, including fine lines, wrinkles, age spots, loss of elasticity, uneven texture and sagging skin, explains Omaha, NE dermatologist Joel Schlessinger, MD.

How Cellular Aging Leads to Visible Skin Aging

“When cells become dysfunctional over time, they start sending harmful signals to neighboring cells, leading to higher inflammation, tissue degradation and a weakened skin barrier,” says OneSkin cofounder and CEO Dr. Carolina Reis Oliveira. “That eventually shows up as visible aging, so visible aging is the symptom; cellular aging is the root cause.”

That relationship isn’t always linear. “You can have significant cellular aging occurring without visible signs appearing yet,” adds Dr. Daniel Schlessinger. Conversely, you can have visible aging that appears more advanced than the underlying cellular health would suggest, particularly due to sun damage and other external factors.” He compares it to a car with a beat-up exterior but a strong engine.

The Role of Senescent Cells in Skin Aging

One of the key biological drivers behind cellular aging—and its visible effects—is cellular senescence, a state of permanent cell cycle arrest that plays a central role in how aging unfolds in the skin, explains West Palm Beach, FL dermatologist Kenneth Beer, MD.

“Cellular aging involves the accumulation of senescent cells that have stopped dividing but remain in the tissue, releasing inflammatory signals that accelerate aging,” adds Joel Schlessinger, MD.

According to Dr. Beer, as different cells become senescent, we see different signs of visible aging, including dark spots, laxity, wrinkles and uneven texture.

How to Address Cellular Aging

“Addressing cellular aging requires a more comprehensive approach that targets the underlying biological mechanisms rather than just treating surface symptoms,” says Dr. Joel Schlessinger.

Dr. Daniel Schlessinger agrees, emphasizing the importance of a dual approach. “It’s about combining medical-grade skin-care products with protective measures and healthy lifestyle habits that support optimal cellular function,” he says. “You can’t focus on just one aspect and expect comprehensive results.”

In practice, that means starting with prevention, then building from there. Here’s some of what they recommend doing to address cellular aging.

Prevention

As with visible aging, prevention is critical to addressing cellular aging, so lather on the sunscreen daily. “Sunscreen can help decrease reactive oxygen species and damage from UV exposure,” explains Dr. Beer.

Without consistent SPF, other interventions won’t perform as effectively. Daily use of broad-spectrum sunscreen helps prevent ongoing DNA damage and oxidative stress that drive both cellular and visible aging, says Dr. Joel Schlessinger.

Skin Care

The foundation of a great skin-care routine “starts with powerful antioxidants like vitamin C, vitamin E, ferulic acid, resveratrol, and polypodium leucotomos, which neutralize free radicals and reduce oxidative stress at the cellular level,” explains Dr. Joel Schlessinger. “These ingredients act as cellular protectors, shielding DNA and mitochondria from damage.”

“Retinoids and retinols are also important because they’re some of the few ingredients with proven ability to influence cellular behavior,” he continues. “These vitamin A derivatives work at the skin’s surface to increase cell turnover, stimulate collagen production and actually regulate gene expression related to aging.”

While many traditional skin-care products focus on correcting surface-level damage, some newer approaches aim deeper. “To address cellular aging, you have to work at the molecular level,” says Dr. Oliveira. That means “activating skin cells to behave more like younger cells.” Innovative ingredients, such as OneSkin’s proprietary peptide OS-01, are designed to target biological markers of aging, not just how skin looks on the surface.

In-Office Treatments

“Beyond creams and ointments, we have a variety of treatment options in the office ranging from lasers and chemical peels to injectables, biostimulators and platelet-rich plasma,” says Dr. Joel Schlessinger. “These all work to send signaling molecules that communicate with cells to promote repair and stimulate collagen synthesis. They help maintain the communication pathways that naturally decline as we age.”

Dr. Daniel Schlessinger also points to advancements in energy-based treatments as particularly promising. “Low-level light therapy, radiofrequency microneedling and fractional resurfacing can stimulate cellular repair mechanisms and improve mitochondrial function, essentially jumpstarting cells to function more efficiently,” he explains.

Dr. Beer also recommends resurfacing lasers and microneedling, which boost collagen production through controlled injury. In addition, poly-L-lactic acid injectables such as Sculptra “stimulate neocollagenesis, can decrease inflammation and promote epidermal stem cell proliferation.” Hyaluronic acid injections may offer similar benefits, he adds, noting they can also help reduce the inflammatory burden associated with senescent cells.

Lifestyle

“What’s really fascinating is how much cellular aging is influenced by factors beyond what we put on our skin,” says Dr. Daniel Schlessinger, who points to sleep quality, stress management, regular exercise and diet as key contributors.

“Sleep is like your body’s maintenance shift: when cellular repair happens. Without adequate sleep, you’re essentially skipping crucial repair time. On the flip side, chronic stress accelerates cellular aging through increased cortisol and inflammation.” Consider it your reminder to prioritize a truly good night’s sleep—tonight and beyond.