Both topical and oral probiotics demonstrate measurable improvements in skin hydration, elasticity, and wrinkle depth by targeting the gut-skin axis. Topical formulations work locally by reinforcing tight junctions, increasing ceramide synthesis, and suppressing matrix metalloproteinases, while oral probiotics modulate gut dysbiosis to reduce systemic inflammation and restore extracellular matrix homeostasis. This dual-pathway approach addresses "inflammaging" — the chronic low-grade inflammation that drives skin barrier dysfunction and collagen degradation. The gut-skin axis connection represents a paradigm shift in dermatology, moving beyond surface treatments to address systemic microbial imbalances that accelerate aging. While clinical evidence shows genuine improvements in photoprotection and wound healing, this field remains nascent with significant limitations. Most studies lack adequate power and long-term follow-up data. Strain specificity remains poorly understood, and formulation stability challenges limit therapeutic consistency. The regulatory landscape for viable organisms in cosmetic applications creates additional barriers. Despite these constraints, microbiome-targeted interventions offer a biologically plausible mechanism for addressing age-related skin changes that traditional topical treatments cannot reach through systemic anti-inflammatory pathways.