Drawing on experimental and clinical evidence, the authors report that multiple immune cell populations, including macrophages, Langerhans cells, dendritic cells, mast cells and innate lymphoid cells, are directly involved in organising normal skin structure. Through close interaction with keratinocytes, fibroblasts and vascular networks, immune cells influence epidermal layering, hair follicle formation, angiogenesis and long-term tissue stability.  

The review describes immune signalling as a fundamental component of normal skin biology. During development and throughout life, immune cells provide regulatory cues that support controlled tissue remodelling, repair and adaptation to physiological and environmental stressors.  

These findings have relevance for regenerative aesthetic medicine, where many treatments aim to influence inflammation, fibroblast activity and tissue remodelling rather than produce immediate structural change. Biostimulatory injectables, energy-based devices and combination protocols operate within the same immune-regulated environment outlined in the review, helping to explain why improvements in skin quality are typically gradual and biologically driven.  

Overall, the paper supports a model of skin biology in which immune regulation underpins tissue development, maintenance and repair, aligning with regenerative approaches that prioritise long-term skin quality and functional restoration.