NAD+ supports the energy production and DNA repair that skin cells rely on, and one human study found it falls with age in skin. That makes a link with visible ageing plausible, but not proven. No published trial has shown that NAD+ injections improve wrinkles, firmness or tone. The strongest skin data belong to sunscreen and topical niacinamide.
This article is for adults who have seen NAD+ described as an anti-ageing treatment and want to know how much of that holds up. It covers what NAD+ does in skin, what human research has measured, how injections differ from skincare, and which habits have better evidence behind them.
Educational content, not medical advice. NAD+ is not intended to diagnose, treat, cure or prevent any disease. Speak to a licensed prescriber before starting any injectable protocol, especially if you are pregnant or breastfeeding, have active or historic cancer, atrial fibrillation, a weakened immune system or a transplant, or take regular medication. Show any new or changing mark on your skin to a doctor.
How skin ages
Two processes run side by side. Intrinsic ageing is the slow, internal kind: cells divide less often, less collagen is made, and skin gets thinner and drier. Extrinsic ageing comes mainly from sunlight. A widely cited 2002 review in Archives of Dermatology described how ultraviolet exposure switches on enzymes that break down collagen, on top of the slower loss that comes with time.
That second process matters for everything that follows. Much of what people call ageing skin, such as coarse lines, uneven tone and rough texture on the face and hands, is sun damage. Any honest discussion of a product has to start there.
What NAD+ does in skin cells
Skin cells use NAD+ for the same jobs as every other cell, which our explainer What is NAD+ covers in full. Three of them are relevant to skin:
- Energy. Making collagen and renewing the outer layer of skin both cost energy, and NAD+ is central to how mitochondria produce it.
- DNA repair. Sunlight damages DNA in skin cells. PARP enzymes repair that damage, and they use up NAD+ as they do so.
- Sirtuins. These NAD+-dependent enzymes help regulate how cells respond to stress.
A review in the Journal of Investigative Dermatology Symposium Proceedings also proposed that sun-driven damage to mitochondrial DNA contributes to photoageing. It is a credible model, and it gives a reason to look at NAD+. But a reason to look is not a result.
Does NAD+ fall in ageing skin?
The direct human evidence is one study. In 2012, researchers published in PLoS ONE an analysis of pelvic skin samples from 49 people, from newborns to age 77, taken during unrelated surgery. NAD+ fell with age in both men and women, while DNA damage rose. In men, higher PARP activity went with lower NAD+.
Two limits are worth noting. The study measured skin that rarely sees the sun, so it says little about the face. It also shows a correlation at one point in time. It cannot tell us whether low NAD+ causes visible ageing, or whether raising it would change how skin looks.
What the human trials show
This is where the word "NAD+" gets stretched. Most of the persuasive skin data come from niacinamide, also called nicotinamide, a form of vitamin B3 that cells can recycle into NAD+. It is related to NAD+, but it is a different substance, used in a different way.
| What was tested | Who and how | What was found | Does it apply to NAD+ injections? |
|---|---|---|---|
| Daily sunscreen (Hughes et al., 2013) | 903 adults under 55 in Australia, 4.5 years | 24% less skin ageing than occasional use | No, but it sets the benchmark |
| 5% niacinamide moisturiser (Bissett et al., 2004) | 50 women aged 40 to 60, 12 weeks, split-face | Improved fine lines, spots, texture, redness and yellowing against moisturiser alone | No. Applied to the skin, and the authors worked for the manufacturer |
| Topical nicotinamide (Tanno et al., 2000) | Skin cell and human skin barrier work | More ceramides and related lipids, and a stronger skin barrier | No. Tested on the skin surface |
| Oral nicotinamide 500mg twice daily (Chen et al., 2015) | 386 people with previous non-melanoma skin cancers, 12 months | Fewer new non-melanoma skin cancers than placebo | No. A medical setting, with no cosmetic outcome |
| Oral nicotinamide (Allen et al., 2023) | Organ transplant recipients | No significant reduction in new skin cancers | No. It shows that results do not carry across groups |
Oral nicotinamide in those cancer trials is a dermatology question, not a beauty one, and neither study tells you anything about wrinkles. We include them because they often get quoted out of context. If you have had skin cancer, speak to your dermatologist. NAD+ is not something to start without medical advice in that situation.
What the research does not show
- No trial of NAD+ injections for skin. We know of no placebo-controlled study that has measured wrinkles, firmness, hydration or tone after subcutaneous NAD+.
- No evidence that injected NAD+ reaches facial skin in a useful amount. Subcutaneous bioavailability above 90% describes absorption into the body, not delivery to a particular tissue.
- No evidence of a collagen effect in people. Claims that NAD+ rebuilds collagen rest on biology and lab reasoning, not on measured human results.
- No proof that it reverses ageing. Nothing here shows that NAD+ turns back skin ageing, and we do not claim that it does.
The 2021 review in Nature Reviews Molecular Cell Biology is a good summary of the wider field: the biology of NAD+ in ageing is strong, while human outcome data lag behind. For skin, that gap is especially wide.
You may also read about a "glow" after an injection. The warmth or flushing some people feel is a short-lived side effect, covered in our guide to NAD+ injection side effects. It fades within minutes and says nothing about the condition of your skin.
What has better evidence for skin
If visible ageing is your main concern, these come well before NAD+. They are also cheaper.
| Habit | Why it matters | Strength of human evidence |
|---|---|---|
| Daily broad-spectrum sunscreen | Limits the main external cause of skin ageing | Strong, including a long randomised trial |
| Topical retinoids | Long-studied for fine lines; some need a prescription | Strong |
| Topical niacinamide | Helps tone, texture and barrier | Moderate; small trials, some funded by industry |
| Not smoking | Smoking is linked with earlier wrinkling | Strong observational evidence |
| Sleep, diet and moderate alcohol | Support general health, and skin along with it | Indirect |
A dermatologist can also advise on options for specific concerns. If your skin worries you, that is a better first step than any supplement or injection.
Where NAD+ fits, realistically
The sensible way to think about NAD+ is as a general cellular protocol that may suit some adults, not as a skin product. People usually choose it for energy and everyday resilience, and those are the areas our other articles examine, including NAD+ for energy and fatigue. Even there the evidence is modest. Any change in skin should be treated as a possible side benefit, and one that you may never notice.
If you try it, keep your skincare the same for at least a couple of months so you can tell what is doing what. Take a photo in the same light at the start and again later, as impressions alone are unreliable.
The usual reference protocol is 50mg per injection, which is 0.3ml or 30 clicks on the pen, or 25 units on a U-100 syringe with a vial. It is taken daily on days 1 to 3, then every other day. The dosage calculator shows the numbers for each device, and the complete UK guide to NAD+ injections covers the rest. Rotate your injection sites as well, to avoid bumps or bruises at one spot.
If you decide to try NAD+
- To see how you respond: the NAD+ Trial Kit includes the pen and one 500mg cartridge.
- For a full first month: the NAD+ Discovery Kit includes the pen and two 500mg cartridges, roughly five weeks of protocol.
- If you are comfortable with a syringe: the NAD+ Injection Kit, 2 × 1000mg ships two sealed vials with needles, wipes and a sharps bin.
You can compare the full range in the NAD+ collection. Delivery is free across the UK, and subscriptions can be paused or cancelled at any time. If you have a question first, contact us.
Frequently asked questions
Does NAD+ reduce wrinkles?
That has not been shown. No published placebo-controlled trial has found that NAD+ injections reduce wrinkles. Topical niacinamide, a related vitamin B3 compound, has shown improvement in fine lines in small trials, but that is a different substance applied in a different way.
Is NAD+ the same as niacinamide?
No. Niacinamide is a form of vitamin B3 that cells can recycle into NAD+. NAD+ is the finished coenzyme. Results from niacinamide creams do not automatically apply to NAD+ injections.
Does NAD+ increase collagen?
There is no good human evidence that it does. Collagen production needs cellular energy, so the idea is plausible, but no trial has measured a collagen increase in people after NAD+ injections.
Can I use NAD+ alongside my skincare?
Nothing suggests that a normal skincare routine interferes with NAD+ injections. Keep using sunscreen every day, and avoid injecting into skin that is irritated or freshly treated.
How long would skin changes take to appear?
Nobody knows, because this has not been studied for injections. Skin renews over weeks and the topical niacinamide trial ran for 12 weeks, so a few days is too soon to judge anything. You may notice no change at all.
Is NAD+ safe if I have had skin cancer?
Do not start NAD+ without medical advice if you have active or historic cancer, including skin cancer. Speak to your dermatologist or oncologist first.
Sources
- Massudi H et al. Age-associated changes in oxidative stress and NAD+ metabolism in human tissue. PLoS ONE, 2012.
- Fisher GJ et al. Mechanisms of photoaging and chronological skin aging. Archives of Dermatology, 2002.
- Krutmann J, Schroeder P. Role of mitochondria in photoaging of human skin: the defective powerhouse model. Journal of Investigative Dermatology Symposium Proceedings, 2009.
- Hughes MC et al. Sunscreen and prevention of skin aging: a randomized trial. Annals of Internal Medicine, 2013.
- Bissett DL et al. Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin. International Journal of Cosmetic Science, 2004.
- Tanno O et al. Nicotinamide increases biosynthesis of ceramides as well as other stratum corneum lipids to improve the epidermal permeability barrier. British Journal of Dermatology, 2000.
- Chen AC et al. A phase 3 randomized trial of nicotinamide for skin-cancer chemoprevention. New England Journal of Medicine, 2015.
- Allen NC et al. Nicotinamide for skin-cancer chemoprevention in transplant recipients. New England Journal of Medicine, 2023.
- Covarrubias AJ et al. NAD+ metabolism and its roles in cellular processes during ageing. Nature Reviews Molecular Cell Biology, 2021.
