Skin Longevity Medicine: A Hierarchical Framework for Personalized Skin Health and Aging Intervention

The expanding framework of aging hallmarks and the emerging paradigm of precision geromedicine have created new opportunities for translating molecular geroscience into clinical skin health.Skin longevitydefined as the sustained maintenance of tissue function, structural integrity, and biological resiliencerepresents a conceptual shift from appearance-oriented anti-aging toward evidence-based, multimodal intervention.This review examines the scientific basis of skin longevity, including the cutaneous manifestations of aging hallmarks, dermal fibroblast senescence(definition), and extracellular matrix (ECM) degeneration, while identifying critical limitations in current fragmented intervention approaches.We propose a hierarchical intervention pyramid comprising five pillars: systemic metabolic and nutritional optimization, lifestyle and psychoneurobiological regulation, epidermal barrier maintenance and local epigenetic modulation, ECM homeostasis and regenerative injectables, and energy-based devices.This framework emphasizes temporal sequencing, biological synergy, and individualized precision strategies rather than isolated treatment accumulation.By integrating evidence from nutraceuticals, topical therapeutics, biostimulatory agents, and procedural interventions within a unified mechanistic hierarchy, this perspective aims to stimulate scholarly discourse and advance the development of personalized skin longevity medicine as a component of precision health.