Appearances do not deceive: those who look younger are also healthier

Those who look younger than their actual age may be doubly blessed. A study links someone's external appearance and their state of health.

The study at a glance

Age was estimated from photos

In their cross-sectional analysis, the researchers used data from an ongoing population-based cohort study from the Netherlands. They drew on nearly 2,700 photographs and had staff assess the age of the people pictured. 

Each face was assessed by an average of 27 assessors who knew neither the actual age nor the medical history of the subjects. Then the difference between estimated and chronological age was calculated.

Youthful complexion keeps you healthy

In the next step, the participants were screened for numerous diseases. The results showed that those who were judged to be younger were, on balance, healthier. A statistically significant correlation was found for osteoporosis, COPD, cataract and age-related hearing loss. In addition, a youthful appearance was associated with better cognitive abilities. There was no association between appearance and cardiovascular or renal diseases.

In their analysis, the scientists also paid attention to lifestyle-related confounders such as smoking, sun exposure and increased BMI, each of which are risk factors for ageing in their own right. But even after adjusting for these confounders, the correlations remained.

Cell ageing and shorter telomeres

One possible explanation: wrinkling and an older appearance are associated with cell ageing, a decrease in fibroblasts and reduced collagen production in the skin. There is also a correlation between appearance and the length of the telomeres in the chromosomes, which in turn is considered a biological measure of cell ageing.

The study authors plead for even more research into the physiological processes and molecular mechanisms behind the ageing processes in order to substantiate the associations found.

The road ahead

No causality can yet be deduced from the observations. But in the future, appearance could become an additional biomarker for morbidity. So it may well be worth taking a closer look during the physical examination. The first, external impression could actually be the right one.


Mekić S, Pardo LM, Gunn DA et al. Younger facial looks are associate with a lower likelihood of several age-related morbidities in the middle-aged to elderly. British Journal of Dermatology, Volume 188, Issue 3, March 2023, Pages 390–395,