INTRODUCTION: Chronological age has been identified as a major risk factor for a wide variety of pathologies, also serving as a mortality predictor. However, same-aged patients’ diverse health outcomes put its predictor role for reconsideration. Biological age is a measure based on physical, physiological, cellular, and biochemical parameters and might reflect a person’s aging process more accurately. A higher biological age or its isolated components have been associated with a higher risk of developing several chronic diseases and increased mortality risk. Perceived age, defined as how old a person looks to external evaluators, reflects the underlying biological age. Therefore, this review aimed to find whether perceived age is associated with mortality risk or comorbidity outcomes. METHODS: PubMed, EMBASE, and CINAHL were inquired on July 27, 2020. Mesh terms related to perceived age, mortality, and the most prevalent chronic diseases in the United States (including heart disease, cancer, and diabetes) were used. Studies were included if they (1) measured perceived age or isolated facial characteristics of old age, (2) measured mortality risk, mortality rate, or comorbidity outcomes, and (3) were in English. RESULTS: Of the 977 studies, 15 fulfilled the inclusion criteria. Follow-up periods ranged from 2 to 15 years. Same age younger-looking people were used as control groups in all studies. Four studies correlated perceived age with all-cause mortality risk. These studies found that mortality risk increased by 6%–51% in older-looking people (HR 1.06–1.51, P < 0.05) compared with controls. This association was found in women in only one study (HR 1.51, P < 0.05). One study correlated isolated facial characteristics with mortality risk, finding a decreased mortality risk in men with no gray hair (RR 0.81, P < 0.05) and increased mortality risk in women with arcus senilis (RR 1.13, P < 0.05 for half arcus; RR 1.25, P < 0.05 for complete arcus). Two studies measuring mortality rate found deceased patients to look between 1.04 and 1.15 years older than same-aged survivors (P < 0.05). Nine studies correlated perceived age or isolated facial characteristics with different comorbidity parameters. Older-looking people were found to have a higher carotid intima-media thickness (P < 0.01). Breaking down perceived age by facial characteristics, pigmentation showed a significant positive correlation with carotid intima-media thickness (P < 0.05). Younger-looking patients were found to have lower cardiovascular risk (P < 0.01). Additionally, gray hair increased the risk of myocardial infarction in men (RR 1.91, P < 0.01). Older-looking people were also found to have decreased cognitive function and lower bone mineral density (P < 0.01). Lastly, high wrinkle scores were associated with low forced expiratory volume in one second (P < 0.05), the extent of emphysema on computed tomography (P < 0.05), and increased the risk of chronic obstructive pulmonary disease (P < 0.05). CONCLUSIONS: Measurement outcomes differed among included studies and, although perceived age promises to be a useful predictor of mortality and comorbidities, further characterization of its role as a risk factor and its application in general practice is warranted.