A consortium of aging researchers has advanced a unified theoretical framework positioning cellular and molecular replacement as the primary mechanism for extending healthspan. The Nature Aging perspective argues that therapeutic interventions should focus on systematically replacing damaged cellular components, organelles, and even entire cell populations rather than attempting to repair age-related dysfunction. This represents a paradigm shift from traditional approaches that target individual aging pathways or attempt to slow deterioration processes. The replacement framework could reshape how we approach age-related diseases and longevity interventions, potentially accelerating development of cellular reprogramming therapies, organelle transplantation, and regenerative medicine approaches. While the theoretical foundation appears robust, translating replacement strategies into clinical practice faces substantial technical hurdles. Current cellular reprogramming techniques remain inefficient and carry safety risks, while organelle replacement therapies are still experimental. The framework's emphasis on wholesale replacement over incremental repair may prove more applicable to some tissues than others, given varying regenerative capacities across organ systems. Nevertheless, this unified conceptual approach could provide the theoretical scaffolding needed to coordinate disparate anti-aging research efforts and guide resource allocation toward the most promising replacement-based interventions.