Doris Day, MD, on Redefining Anti-Aging in Dermatology

For years, aesthetic dermatology has been framed through an “anti-aging” lens—one that emphasizes correction, reversal, and resistance. In her keynote presentation at South Beach Symposium 2026, Doris Day, MD, FAAD, encouraged clinicians to rethink that posture, not by abandoning intervention, but by redefining its purpose. “It isn’t one or the other,” she explained in an interview with Dermatology Times. “You’re not going with the flow exactly. You’re not fighting it exactly. You’re just optimizing your best self.”

That reframing reflects a broader evolution in aesthetic medicine, one that blends evidence-based procedural care with insights from longevity science, lifestyle medicine, and patient behavior. “We’re taking all of the knowledge we have—both holistic, Eastern, Western longevity—and we’re applying it to aesthetics,” Day said. Central to this integration is a recognition that skin is not merely cosmetic. “Your skin isn’t just a cover of your body. It’s giving information, and it’s conveying information both outward and inward.”

This biologic perspective has practical consequences, particularly when it comes to fibroblast health. Fibroblasts do not age in a straight line. Early in life, they are efficient and responsive. In midlife, often around perimenopause, they become metabolically exhausted. Later, many enter senescence, contributing to inflammation while losing reparative capacity. Because most aesthetic treatments depend on fibroblast responsiveness, this trajectory matters.

“We’ve been very good at stimulating skin,” Day noted during her presentation, “but everything has its limits, including fillers and biostimulators.” When exhausted fibroblasts are repeatedly pushed with aggressive resurfacing or high-intensity treatments, the result may be delayed healing, prolonged erythema, and minimal improvement. In this context, poor outcomes are often not technical failures, but biologic ones.

Rather than abandoning stimulation, Day advocated for a longevity-based model that emphasizes cellular support before cellular demand. Central to this approach is mTOR (mechanistic target of rapamycin), a signaling pathway that regulates growth, metabolism, autophagy, and senescence. Unlike other aging pathways, mTOR intersects with all hallmarks of aging. Selective inhibition of mTOR complex 1, while preserving mTOR complex 2, has been shown to improve cellular resilience across species.

Emerging data on topical rapamycin analogs suggest that pretreating exhausted fibroblasts may restore more youthful behavior, improving autophagy and reducing senescence markers. When stimulation is applied afterward, collagen production improves without accelerating cellular decline. “We’re learning about not just the skin,” Day explained, “but the cells that make the skin and the cells that give the skin its resilience and firmness.”

This philosophy extends beyond procedures to patient behavior and long-term outcomes. Day emphasized that aesthetic care can act as a gateway to healthier choices. “My goal is to not just help my patients look better, but to be better,” she told Dermatology Times. “They do age better. They make better life choices. They quit smoking, they drink less, they get less sun, they get better sleep, they manage their stress, they start exercising.”

Rather than prescribing drastic lifestyle overhauls, she focuses on achievable change. “I show them how it’s easy, that you just do little things,” she said, describing simple resistance exercises and daily movement. “It’s movement. You can build in lots of little movements.”

This holistic mindset has become especially relevant with the rise of GLP-1 receptor agonists. While Day views these medications as valuable tools—“I think GLP ones are going to be a mainstay of menopausal therapy and healthy aging”—she cautioned against unsupervised use. “Some people take it too far,” she said. “They just keep on losing weight… and nobody checks in, nobody asks anything about what they’re doing.”

In her practice, patients using GLP-1 therapies are enrolled in structured programs that emphasize collagen support, resistance training, adequate protein intake, and skin preservation. “The idea is not to get calories in,” she explained. “The idea is to get the right nutrients in.” This approach reflects her broader philosophy: aesthetic outcomes are inseparable from systemic health.

Day also addressed the pursuit of the “natural look,” emphasizing anatomy, balance, and realism. “As you age, you’ll still be beautiful, but you’ll be a different beautiful,” she said. “The foundation is different. The whole house is different. It’s a new house.” Attempting to recreate youthful fullness without respecting structural change often disrupts facial harmony, particularly around the eyes.

What does not have to change, she emphasized, is skin quality. “If I can improve skin quality in a 70- or 80-year-old, they will look younger and more usable, and they will look better.” Patients, she noted, rarely comment on laxity when they recall relatives who aged well. “They don’t talk about laxity. They talk about skin.”

Ultimately, Day’s vision for aesthetic dermatology is neither passive acceptance nor aggressive correction. It is thoughtful optimization—respecting biology, supporting longevity, and helping patients feel confident at every stage. “Each house is beautiful in its own way,” she said. “You just have to respect the foundation.”

Reference

1. Day D. Rewriting the skin’s future: regeneration, longevity and the next era of aesthetics. Presented at: South Beach Symposium 2026; February 5-7, 2026; Miami Beach, FL.