Skinspan: A Holistic Roadmap for Extending Skin Longevity With Evidence-Based Interventions.

Background: With the rise of regenerative medicine and geroscience, translational research has shifted focus from lifespan to healthspan-years lived in good health. Applied to aesthetic medicine, the authors introduce the concept of "skinspan," to both describe the period during which skin maintains a youthful, healthy appearance, and additionally to serve as a tool for the cosmetic consult.

Aims: The aim of this comprehensive review is to illuminate "skinspan" as a framework for guiding long-term skin health. The authors review the molecular drivers of skin aging along with appraise current evidence-based interventions and synthesize evidence into an algorithm to expand skin span.

Methods: A comprehensive literature review was conducted to examine the molecular hallmarks of skin aging: genomic instability, mitochondrial dysfunction, cellular senescence, and proteostasis decline, and how they are targeted by lifestyle modifications, pharmacologic agents, and aesthetic procedures. Each intervention discussed in this paper is categorized based on the strength of the available evidence for augmenting skinspan.

Results: Proactive interventions, including lifestyle interventions, topical agents, systemic therapies, and noninvasive procedures, show promise in mitigating aging mechanisms and preserving skin health. We recommend a first-line strategy of sun protection, topical retinoids, and antioxidants. Second-line interventions include laser and energy-based devices. Clinicians may also consider emerging therapies-including stem cell-based treatments, sirtuins, nicotinamide, and natural SIRT activators-as adjunctive third-line add-ons, while continuing to monitor the evolving evidence base.

Conclusion: The skinspan framework offers a holistic, evidence-based approach to skin longevity, promoting prevention, continuity of care, and patient education beyond isolated aesthetic interventions. To expand skinspan based on current evidence, we recommend a first-line approach of sun protection, topical retinoids, and antioxidants. Second-line interventions include procedures such as laser and energy-based devices. Clinicians may also consider emerging therapies-including stem cell-based treatments, sirtuins, nicotinamide, and natural SIRT activators-as adjunctive third-line add-ons, while continuing to monitor the evolving evidence base. A need exists for more randomized controlled trial studies to strengthen the evidence base.