Michele Perry

RN Registered Nurse | Advanced Aesthetics Practitioner BSc (Hons) Nursing

Michele Perry, RN, BSc (Hons) is an Advanced Aesthetics Practitioner and Registered Nurse with over 20 years of experience in healthcare. Drawing on a background in community nursing, wound care, infection prevention, and senior healthcare leadership, she takes a holistic and evidence-based approach to aesthetics.

Michele is passionate about supporting patients to achieve healthy, resilient skin through a combination of advanced treatments, patient education, and optimisation of the internal factors that influence ageing, healing, and overall wellbeing.

• Instagram: https://www.instagram.com/sublime_skin_aesthetics

Inflammaging: How Stress, Cortisol, and Lifestyle Factors Drive Chronic Inflammation and Influence Aesthetic Outcomes

Introduction

As aesthetic medicine continues to evolve, there is growing recognition that skin health cannot be viewed solely through the lens of external treatments. While injectable therapies, regenerative procedures, and medical-grade skincare remain valuable tools, the internal physiological environment plays a significant role in determining both skin quality and treatment outcomes.

Among the most influential internal factors is chronic stress. Through its effects on cortisol production, immune regulation, inflammation, and skin barrier function, chronic stress has been increasingly recognised as a contributor to premature ageing, inflammatory skin conditions, and impaired healing (Chen and Lyga, 2014).

Beyond its effects on wellbeing, chronic stress contributes to “inflammageing” – a state of persistent low-grade inflammation associated with accelerated biological ageing (Franceschi and Campisi, 2014). Understanding this relationship is increasingly relevant in aesthetic medicine, where inflammation, collagen degradation, and impaired tissue repair can directly influence skin quality and treatment outcomes.

For practitioners committed to prevention, longevity, and patient-centred care, recognising the influence of stress and lifestyle factors offers an opportunity to support patients beyond the treatment room.

Understanding the Stress Response

Stress is a normal physiological response that enables the body to adapt to challenges. Activation of the hypothalamic-pituitary-adrenal (HPA) axis triggers the release of cortisol and other stress hormones, helping maintain homeostasis during periods of acute stress (Slominski et al., 2013).

However, chronic activation of this system can have detrimental effects. Prolonged cortisol elevation has been associated with immune dysregulation, increased inflammatory activity, impaired tissue repair, and altered skin barrier function (Dhabhar, 2014).

Research demonstrates that chronic stress can influence:

• Immune function
• Inflammatory cytokine production
• Skin barrier integrity
• Wound healing
• Collagen synthesis

(Chen and Lyga, 2014; Dhabhar, 2014)

Collectively, these mechanisms contribute to chronic skin inflammation and may influence how patients respond to aesthetic treatments.

Cortisol and the Skin

The skin is increasingly recognised as an active neuroendocrine organ capable of both producing and responding to stress mediators (Slominski et al., 2013).

Increased Inflammatory Activity

Chronic stress promotes the release of pro-inflammatory cytokines, which may exacerbate inflammatory skin conditions including acne, rosacea, psoriasis, and atopic dermatitis (Arck et al., 2006).

For aesthetic practitioners, this may present as increased skin reactivity, sensitivity, or recurrent inflammatory flare-ups that affect treatment planning and patient satisfaction.

Impaired Skin Barrier Function

Psychological stress has been shown to impair epidermal barrier recovery and increase trransepidermal water loss (Choi et al., 2005).

A compromised skin barrier can contribute to dryness, irritation, sensitivity, and reduced resilience to environmental stressors. These factors can influence both baseline skin quality and post-procedure recovery.

Accelerated Skin Ageing

Chronic cortisol exposure has been associated with reduced fibroblast activity and impaired collagen synthesis (Chen and Lyga, 2014).

Persistent inflammatory signalling may also contribute to inflammageing, characterised by progressive connective tissue breakdown and reduced regenerative capacity (Franceschi and Campisi, 2014).

The concept of the skin ageing exposome highlights how cumulative exposure to internal and external stressors, including psychological stress, lifestyle factors, environmental pollutants, and behavioural habits, collectively contributes to visible skin ageing (Krutmann et al., 2017).

Delayed Healing

Stress-related immune dysregulation may impair wound healing and tissue repair (Gouin and Kiecolt-Glaser, 2011).

Given that many aesthetic procedures rely on controlled tissue injury and regeneration, healing capacity remains an important consideration when assessing treatment readiness and expected outcomes.

Lifestyle Factors That Influence Chronic Skin Inflammation

Stress rarely exists in isolation. Several lifestyle factors interact with inflammatory pathways and may compound the effects of chronic cortisol elevation.

Sleep Quality

Sleep plays a critical role in tissue repair, immune regulation, hormonal balance, and skin recovery.

Poor sleep quality has been associated with increased inflammatory markers, impaired barrier recovery, reduced skin hydration, and accelerated skin ageing (Irwin, 2015; Oyetakin-White et al., 2015).

Research has shown that individuals with poor sleep quality demonstrate increased signs of intrinsic skin ageing and slower recovery from environmental stressors compared with those achieving restorative sleep (Oyetakin-White et al., 2015).

For aesthetic patients, chronic sleep deprivation may negatively affect both skin quality and recovery following treatment.

Nutrition

Diet significantly influences inflammatory pathways throughout the body.

Diets high in refined carbohydrates, ultra-processed foods, and excess sugar have been associated with increased oxidative stress and inflammatory signalling (Singh et al., 2017).

Conversely, dietary patterns rich in vegetables, fruits, fibre, polyphenols, omega-3 fatty acids, and antioxidants may help support healthy inflammatory regulation and overall skin health.

Physical Activity

Regular moderate exercise has been shown to support immune function, improve stress resilience, and reduce chronic inflammatory burden (Gleeson et al., 2011).

In addition to its systemic benefits, exercise may support skin health through improved circulation and nutrient delivery.

Smoking and Alcohol

Smoking and excessive alcohol consumption are well-established contributors to oxidative stress, collagen degradation, and premature skin ageing (Morita, 2007).

Addressing these factors forms an important component of preventative skin health strategies.

Implications for Advanced Aesthetic Practice

The influence of chronic stress and lifestyle factors extends beyond skin appearance alone.

Emerging evidence suggests that elevated systemic inflammatory burden may influence tissue repair mechanisms and healing responses following procedures that rely on regeneration and collagen remodelling (Gouin and Kiecolt-Glaser, 2011; Dhabhar, 2014).

This may be particularly relevant when performing treatments such as:

• Polynucleotides
• Collagen stimulators
• Microneedling
• Radiofrequency procedures
• Laser treatments

Although direct evidence within aesthetic medicine remains limited, the biological pathways linking stress, inflammation, and tissue repair suggest that optimising internal health may help create a more favourable environment for treatment success.

Integrating Lifestyle Assessment into Consultation

Holistic consultation remains one of the most valuable tools available to aesthetic practitioners.

Alongside assessment of facial anatomy and skin quality, consideration should be given to factors including:

• Stress levels
• Sleep quality
• Nutritional habits
• Physical activity
• Smoking status
• Alcohol consumption

These discussions can provide valuable insight into factors that may be contributing to chronic inflammation, impaired healing, or suboptimal treatment outcomes.

Importantly, they also help strengthen patient engagement and encourage a more collaborative approach to care.

Practical Strategies for Supporting Skin Health

While practitioners should always work within their professional scope, patient education can play an important role in supporting long-term skin health.

Supportive strategies may include:

• Encouraging stress-management techniques such as mindfulness and relaxation practices
• Promoting healthy sleep hygiene
• Supporting anti-inflammatory dietary habits
• Encouraging regular physical activity
• Discussing smoking cessation and alcohol moderation where appropriate

These interventions should not be viewed as alternatives to aesthetic treatments but as complementary strategies that may help optimise the internal environment in which healing and regeneration occur.

Clinical Pearls for Aesthetic Practitioners

• Chronic stress influences skin health through cortisol-mediated inflammatory pathways (Slominski et al., 2013)
• Elevated cortisol may impair collagen synthesis, skin barrier function, and wound healing (Chen and Lyga, 2014)
• Chronic low-grade inflammation contributes to inflammageing and accelerated tissue ageing (Franceschi and Campisi, 2014)
• Sleep, nutrition, exercise, and lifestyle habits significantly influence inflammatory burden
• Internal health may influence treatment response, recovery, and long-term outcomes
• Holistic assessment supports preventative and patient-centred aesthetic care

Personal Clinical Perspective

Throughout my nursing and aesthetic practice, I have frequently observed the impact that stress and lifestyle factors can have on skin health and healing. Patients often seek treatment for visible concerns, yet many are simultaneously navigating demanding careers, family responsibilities, disrupted sleep, and ongoing life pressures.

Over the years, I have witnessed how periods of heightened stress can appear to influence wound healing, recovery, and overall wellbeing. These observations, alongside the growing body of evidence linking stress, cortisol, inflammation, and skin health, have reinforced my belief that optimal outcomes are achieved when we look beyond the presenting concern and consider the patient as a whole.

As both a healthcare professional and a mother, I understand how challenging it can be to prioritise self-care amidst everyday demands. This understanding has shaped my holistic approach to assessment and treatment planning, ensuring that conversations around lifestyle, stress, sleep, and wellbeing form part of the patient journey.

By supporting patients internally as well as externally, we can often achieve more meaningful, sustainable, and long-lasting outcomes.

Conclusion

Chronic stress, cortisol dysregulation, and lifestyle factors play an important role in skin inflammation, ageing, and tissue repair.

By recognising these influences and incorporating lifestyle awareness into patient consultations, aesthetic practitioners can support more personalised, preventative, and effective care.

Ultimately, the future of aesthetic medicine lies not only in treating visible concerns but also in understanding and addressing the internal factors that influence skin health, resilience, and longevity.

References

• Arck, P.C. et al. (2006) ‘Neuroimmunology of stress: Skin takes centre stage’, Journal of Investigative Dermatology, 126(8), pp. 1697–1704.
• Chen, Y. And Lyga, J. (2014) ‘Brain–skin connection: Stress, inflammation and skin ageing’, Inflammation & Allergy Drug Targets, 13(3), pp. 177–190.
• Choi, E.H. et al. (2005) ‘Psychological stress alters skin barrier function’, Journal of Investigative Dermatology, 124(3), pp. 587–595.
• Dhabhar, F.S. (2014) ‘Effects of stress on immune function’, Nature Reviews Immunology, 14(6), pp. 374–388.
• Franceschi, C. And Campisi, J. (2014) ‘Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases’, The Journals of Gerontology: Series A, 69(Suppl 1), pp. S4–S9.
• Gleeson, M. Et al. (2011) ‘Exercise, immunity and inflammation’, Nature Reviews Immunology, 11(9), pp. 607–615.
• Gouin, J.P. and Kiecolt-Glaser, J.K. (2011) ‘The impact of psychological stress on wound healing’, Immunology and Allergy Clinics of North America, 31(1), pp. 81–93.
• Irwin, M.R. (2015) ‘Why sleep is important for health’, Annual Review of Psychology, 66, pp. 143–172.
• Krutmann, J. Et al. (2017) ‘The skin ageing exposome’, Journal of Dermatological Science, 85(3), pp. 152–161.
• Morita, A. (2007) ‘Tobacco smoke causes premature skin ageing’, Journal of Dermatological Science, 48(3), pp. 169–175.
• Oyetakin-White, P. Et al. (2015) ‘Does poor sleep quality affect skin ageing?’, Clinical and Experimental Dermatology, 40(1), pp. 17–22.
• Singh, R.K. et al. (2017) ‘Influence of diet on the gut microbiome and implications for health’, Nutrients, 9(10), 1079.
• Slominski, A.T. et al. (2013) ‘The skin as an endocrine organ’, Physiological Reviews, 93(3), pp. 1027–1081.