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Weekly · Sunday Morning

Five longevity claims.
Worth your time.
Every Sunday.

Last Sunday

Rapamycin extends mouse lifespan 9–14%
NAD+ precursors reverse aging in humans
Blue-light glasses improve sleep quality
Walking 10 min after meals blunts glucose
Verdict change — caffeine half-life downgraded

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#13 – Brett Kotlus, M.D.: How to look younger while we live longer — Whalespan

Content›Video›#13 – Brett Kotlus, M.D.: Ho…

#13 – Brett Kotlus, M.D.: How to look younger while we live longer

Peter Attia1h 49m · 2019-12-23

Support Rate

63%

125 of 198 claims supported

Support rate

125 of 198 claims supported

125 supported73 partial / not

Claims from this content

134

✓Well SupportedUVA radiation is associated with skin aging, while UVB radiation is responsible for sunburn.✓Well SupportedMany inexpensive vitamin C serums degrade over time, necessitating more expensive, stabilized formulations.✓Well SupportedCapsular contracture after breast augmentation occurs in approximately 3% of cases, potentially higher with textured implants.✓Well SupportedIngesting enough Vitamin C to achieve optimal skin levels would likely cause gastrointestinal issues.◐Partially SupportedPlatelet-rich plasma (PRP) can be prepared as leukocyte-rich or leukocyte-poor.

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Attia walks back the clinic protocol: too aggressive for healthy adults

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A. Volkovreader

4h

Bookmarking — the dossier-vs-overview split is the right call. Most of the time I want overview; sometimes I want receipts.

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Would love a "what would change this verdict" RSS feed. Sign me up if it exists.

✓Well Supported

Genetics provide a starting point for health but do not dictate the endpoint, as lifestyle choices can alter health outcomes regardless of genetic predisposition.

✕Not SupportedSunscreen ingredients are endocrine-disrupting chemicals that are applied to children during their development.

✓Well SupportedSunscreen benefits plateau above SPF 30 for UVB protection, and a broad-spectrum sunscreen is recommended for protection against both UVA and UVB.

◐Partially SupportedRetinol is available over-the-counter, while retinoic acid requires a prescription.

◐Partially SupportedA natural-looking face is characterized by subtle curves, shadows, and lines, not complete smoothness.

◐Partially SupportedVitamin C works better for skin health when combined with vitamin E, but many topical vitamin C products oxidize easily.

◐Partially SupportedPlatelet-rich plasma (PRP) can be produced relatively inexpensively by spinning blood, obtaining the supernatant, spinning again, and adding calcium chloride.

◐Partially SupportedBio-printing will enable the future printing of organs and replacement of blood vessels, organs, and skin.

◐Partially SupportedBotox can be used preventatively before dynamic lines become fixed creases.

◐Partially SupportedAesthetic treatments should be customized to each individual's unique situation.

◐Partially SupportedA concentrated PRP preparation can be achieved by reducing initial blood volume and removing platelet-poor plasma.

◐Partially SupportedTopical vitamin A derivatives, such as retinoic acid and retinol, promote collagen synthesis, increase skin cell turnover, and reduce wrinkles and skin pigment.

◐Partially SupportedPrescription retinoic acid costs $80-$100 per tube and lasts approximately three months with adequate application.

◐Partially SupportedRetinol is a less potent form of retinoic acid with fewer side effects, making it suitable for initial use in anti-aging skincare.

◐Partially SupportedChemical peels are generally safe for all skin tones and offer controllable treatment depth.

◐Partially SupportedFacial volume in the jawline and cheekbones can decrease by 10-15% from age 20 to older ages.

◐Partially SupportedNon-surgical fat reduction devices using heat or cold can effectively reduce subcutaneous fat by approximately 20% per treatment course.

◐Partially SupportedA gradual increase in cosmetic procedures, driven by peer influence and providers, can lead to exceeding natural dimensions and losing facial contours.

◐Partially SupportedFDA approval for medical devices primarily indicates that the device is not harmful, rather than guaranteeing efficacy.

◐Partially SupportedRepeating Botox injections targeting specific facial muscles can soften lines over time by reducing muscle contraction.

◐Partially SupportedThe eyes are the first facial feature to show signs of aging due to high movement, thin skin, and potential enlargement of under-eye fat pads.

◐Partially SupportedA skincare regimen with sunscreen, topical vitamin C, and retinol can produce significant anti-aging results.

◐Partially SupportedLow-grade lasers like Clear and Brilliant have low risk and may not require a doctor.

◐Partially SupportedThe mechanisms of fat grafting, including stem cell effects, are not fully understood.

◐Partially SupportedMore powerful lasers may require anesthetic injections, topical anesthesia, or sedation, and are often combined with surgery.

◐Partially SupportedIndividuals with an MD can perform cosmetic procedures like Botox and filler injections, regardless of specialized training.

◐Partially SupportedPeter Attia has performed over a thousand to two thousand filler procedures and thousands of blepharoplasty procedures.

◐Partially SupportedFacial skin may appear to age more than other sun-exposed areas due to differences in tension and laxity.

◐Partially SupportedFractional lasers create dots and leave normal skin in between, unlike chemical peels which remove skin continuously.

◐Partially SupportedAn etched line is a wrinkle visible on the forehead when facial muscles are relaxed.

◐Partially SupportedInjecting nano fat, which is the stromal vascular fraction, may support fat grafts with growth factors.

◐Partially SupportedThe average cost for a PRP with microneedling facial treatment is $800 to $1200.

◐Partially SupportedThe primary risk of the PRP facial procedure, besides infection, is financial loss.

◐Partially SupportedPRP with microneedling is recommended every couple of months or every six months.

◐Partially SupportedDeeper microneedling depths increase bleeding.

◐Partially SupportedPatients undergoing breast augmentation should be informed about the possibility of reoperation, especially given that busy surgeons may perform 20 procedures weekly.

◐Partially SupportedCustom implants can be designed using 3D scanning and CT scans to precisely fit individual anatomy and desired shape.

◐Partially SupportedWhen considering cosmetic procedures, it is advisable to ask about the number of procedures a doctor has performed to gauge expertise.

◐Partially SupportedMaking small, consistent changes over time leads to significant long-term improvements in health and disease risk reduction.

◐Partially SupportedHyaluronic gel filler injected with a blunt-tipped cannula, approached from the cheek, can be used to treat under-eye hollows and puffiness, replacing lost fat or disguising enlarged fat pads.

✕Not SupportedPeter Attia is skeptical of PRP's widespread claims and feels underwhelmed by his own experience with PRP for scalp hair loss prevention.

✕Not SupportedPRP treatments for hair growth can sometimes be ineffective and are potentially oversold.

✕Not SupportedStem cells are currently viewed as a cure-all in medicine and cosmetic procedures, similar to how PRP is perceived today.

◐Partially SupportedSPF measures protection against UVB radiation, with SPF 15 providing 15 times longer protection against redness compared to unprotected skin.

◐Partially SupportedMost people do not apply enough sunscreen, and reapplication every two hours is necessary.

◐Partially SupportedInorganic sunscreens, typically using zinc or titanium, work by reflecting UV rays.

◐Partially SupportedThe American Academy of Dermatology recommends protecting children from the sun and using sunscreen, noting that vitamin D can still be synthesized even with sunscreen use.

◐Partially SupportedThe difference in UVB protection between SPF 30 and SPF 50 is minimal, with SPF 30 offering approximately 96% protection and SPF 50 offering approximately 98% protection.

◐Partially SupportedMicronized versions of inorganic sunscreen ingredients like zinc and titanium result in less visible white residue.

◐Partially SupportedAreas like the face, hands, and chest require protection to prevent premature aging and brown spots.

✕Not SupportedOctinoxate is a hormonal disrupter and should be avoided in sunscreens.

✕Not SupportedChemical sunscreens that absorb UV light and convert it to heat may worsen conditions like melasma.

✕Not SupportedUV radiation is scientifically proven to correlate with skin cancer.

◐Partially SupportedOculoplastic surgeons possess specialized knowledge of the anatomy around the eyes due to their five-year training.

◐Partially SupportedThere are 8-12 genes that offer significant protection against chronic disease.

◐Partially SupportedReferrals from nurses or scrub techs are important when selecting a provider for cosmetic procedures due to their first-hand knowledge.

◐Partially SupportedPatients should inquire about management and costs of complications from cosmetic procedures.

◐Partially SupportedCoolSculpting (cryolipolysis) reduces subcutaneous fat by freezing fat cells to induce apoptosis.

◐Partially SupportedFuture implants could be created from cultured cells grown on a biodegradable scaffold.

◐Partially SupportedMoisturizing creams with SPF 15 can be a good alternative for those who dislike the smell or greasiness of traditional sunscreens.

◐Partially SupportedConsistent sun protection is associated with whiter skin, fewer wrinkles, and a younger-looking face.

◐Partially SupportedPatients should ask their cosmetic surgeon about connecting with previous patients to discuss their experience and potential complications.

◐Partially SupportedHyaluronic acid fillers are biocompatible, generally safe, and reversible.

◐Partially SupportedGlobal volume loss in the face, including the lips, occurs with aging and can be addressed by reinflating lips.

◐Partially SupportedLooking approximately seven to ten years younger than one's current age may be a reasonable target for aesthetic enhancement.

◐Partially SupportedMaintaining a youthful appearance from a past age can lead to an unnatural, distorted look.

◐Partially SupportedFacial skin ages differently than back skin due to differences in movement, laxity, sebaceous gland density, and muscular expression.

◐Partially SupportedPhenol peels carry higher risks but potentially greater benefits for skin rejuvenation, requiring ekg monitoring for arrhythmias.

◐Partially SupportedReviewing cosmetic surgeons' photo galleries assesses their best work and natural-looking results.

◐Partially SupportedPatients taking 5-alpha reductase inhibitors may respond differently to hair loss treatments.

◐Partially SupportedMinor cosmetic interventions can lead to significant positive shifts in self-perception and demeanor.

◐Partially SupportedUV radiation is correlated with skin cancer.

◐Partially SupportedAging changes in the face are influenced by intrinsic genetic factors and extrinsic factors like sun exposure.

◐Partially SupportedBotox, Xeomin, and Dysport are all types of botulinum toxin type A with similar effects, though minor molecular differences exist.

◐Partially SupportedPeter Attia dedicates approximately 10% of his energy to monitoring emerging longevity interventions.

◐Partially SupportedEnergy devices like Thermage and Ultherapy stimulate collagen synthesis and contraction for facial tightening.

◐Partially SupportedLip filler results require repeat treatments every six to eight months.

◐Partially SupportedUnder-eye filler can last one to five years due to less facial movement in that area.

◐Partially SupportedLip filler typically causes swelling for about two days.

◐Partially SupportedPlatelet-rich plasma (PRP) preparation involves activating platelets with calcium and concentrating them.

◐Partially SupportedPlatelets and red blood cells can be distinguished by density differences after spinning down blood.

◐Partially SupportedErbium and CO2 lasers are common for skin resurfacing, with varying energy settings and provider experience influencing patient suitability.

◐Partially SupportedThe 'Vampire Facial' uses platelet-rich plasma derived from a patient's own blood for facial rejuvenation.

◐Partially SupportedThe vampire facial procedure uses a microneedling pen with adjustable depths from 1mm to 2mm.

◐Partially SupportedSun exposure over many years leads to solar elastosis, characterized by collagen and elastin loss, decreased skin thickness, and telangiectasias and brown spots.

◐Partially SupportedApheresis is a complex procedure used to isolate specific blood cells that requires precise knowledge and carries significant risks.

◐Partially SupportedGrowing ears from cartilage-producing cells on biodegradable scaffolds is a research area with challenges in scaffold development.

◐Partially SupportedSPF ratings do not measure UVA protection.

◐Partially SupportedBotox has expanded indications beyond cosmetic use to include treatments for bladder spasms, vocal cord spasms, torticollis, migraines, and axillary hyperhidrosis.

◐Partially SupportedModern Botox injection techniques use smaller amounts spread over larger areas to achieve natural-looking results.

◐Partially SupportedBotox can be injected into the lower eyelids to make eyes appear more open and reduce squinting wrinkles.

◐Partially SupportedBotox can be used to subtly lift the corners of the mouth, reducing a frowning appearance.

◐Partially SupportedBotox injections above the lip can reduce a gummy smile.

✕Not SupportedBotox injections in the forehead can cause misery for two to three months due to inability to lift the brow and keep sweat out of the eyes.

✕Not SupportedThe effectiveness of PRP with microneedling for skin issues is not well-proven.

✕Not SupportedGeneric consent forms for medical procedures often fail to adequately discuss probabilistic or expected complications and subsequent management steps.

✕Not SupportedOver-injection of Botox into the frontalis muscle can result in an inability to raise the eyebrows.

◐Partially SupportedPlatelets at the site of injury release chemical signals that promote healing and clot formation.

◐Partially SupportedUV exposure from sunlight is hypothesized to cause fat atrophy over many years.

◐Partially SupportedConfirming that a PRP provider has a proven method for concentrating platelets is important for effective treatment.

◐Partially SupportedOver-the-counter retinol products may contain moisturizers or hyaluronic acid to mitigate dryness and can be used every second or third day or with a short exposure if dryness occurs.

◐Partially SupportedRetinol is primarily recommended for nighttime use and does not necessarily increase sun sensitivity, as sun exposure breaks down retinol.

◐Partially SupportedLaboratory-derived fibroblast growth factor (FGF) shows promise for long-lasting facial volumization.

◐Partially SupportedMeeting with multiple doctors (2-4) is worthwhile to ensure a good fit and avoid inattentive providers.

◐Partially SupportedUnder-eye filler can brighten the face, reduce the appearance of bags, and alleviate a tired look.

◐Partially SupportedBotox can be used in smaller amounts spread over a larger area to improve facial appearance, such as turning up the corners of the mouth or reducing a gummy smile.

◐Partially SupportedFractional lasers like Erbium and CO2 lasers can be effective for skin resurfacing by creating microscopic treatment zones that leave some normal skin intact.

◐Partially SupportedDarker skin types may age better due to denser connective tissue and pigment offering some UV protection.

◐Partially SupportedFat tissue is an endocrine tissue and a source of stem cells.

◐Partially SupportedTopical vitamin C acts as an antioxidant, protects against UV damage, and is a cofactor for collagen synthesis.

◐Partially SupportedEnsure non-surgical fat reduction devices are FDA-approved and not counterfeit.

◐Partially SupportedTaking a selfie while lying down can reveal the impact of gravity on facial aging.

◐Partially SupportedThere is a genetic motivation for people to want to look good to present themselves favorably to potential mates.

◐Partially SupportedFacial ligaments experience wear and tear from movement, similar to joint wear and tear, contributing to aging.

◐Partially SupportedAsking a doctor which procedures they refer out can provide insight into their honesty.

◐Partially SupportedA skincare regimen including morning vitamin C, evening retinol, and sunscreen applied on top of serums is an effective anti-aging plan.

◐Partially SupportedSeparating application times between sunscreen and vitamin C serums by a few minutes prevents interaction.

◐Partially SupportedTopical vitamin C may help reverse existing sun damage in skin with lower vitamin C levels.

◐Partially SupportedDark bottles are used for vitamin C products to prevent oxidation from light exposure.

◐Partially SupportedThe proposed mechanism for PRP in hair growth involves stimulating stem cells, increasing blood flow, and prolonging the hair growth cycle.

◐Partially SupportedPRP treatments for hair growth, involving injections every three to four months, can be uncomfortable and may not yield significant results, potentially working better for females.

◐Partially SupportedHormones like 5-alpha-reductase can counteract the potential benefits of PRP for hair growth.

◐Partially SupportedCombining topical minoxidil or undergoing hair transplantation with PRP treatments is a common approach for hair restoration.

◐Partially SupportedPlatelet-rich plasma (PRP) has shown some success in facial rejuvenation and treating orthopedic injuries, and was pioneered in the dental realm for dry sockets.

◐Partially SupportedMicroneedling with PRP may build collagen but observable benefits might not justify the procedure.

◐Partially SupportedThe vampire facial procedure involves applying PRP to the skin surface and needling it in, or injecting it directly under the skin like a filler.

◐Partially SupportedFacial aging results from the degradation and thinning of skin, fat, muscle, bone, and ligaments.

◐Partially SupportedChemical peels can rejuvenate skin but carry risks such as burns and scarring.

◐Partially SupportedEffective cosmetic injectables require understanding underlying facial anatomy, musculature, and tissue, not just wrinkles.