At least at the cellular level, it seems altering gene expression makes old cells indistinguishable from young cells in the lab under a microscope. If you go by what Bill Andrews and Michael Fossel comment, iirc.
Some of them(Fossel, iirc) seem to believe that if gene expression is changed, the body will clear the garbage out. The inability to process garbage locally shouldn't be too concerning, as systems like the brain have the glymphatic system that routinely exports molecular garbage out(when it malfunctions you get neurodegeneration diseases, when not you get superagers with 20 year old brain function.). It is likely, imho, in young animals the lymphatic system plays a similar role and exports molecular garbage out of tissues. But with aging it is compromised, and along with increased garbage production, garbage starts to accumulate.
In human society houses don't process all of their garbage, they merely export it out for disposal or recycling, wouldn't surprise if nature does similar. Look at the brain for example, an extremely high metabolism organ, neurons have similar metabolic costs between species, yet we live 3 times as long as bonobos who share 98% of our genes. Our common ancestor likely had similar short lifespan, but to increase the lifespan, even tripling it, even of organs like the brain, it was mostly gene expression changes that allowed it, not novel radical mechanisms.-link to source
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