Aesthetic Surgery Journal最新文献

Exosomes have gained increasing attention in aesthetic medicine for their regenerative properties and role in skin and hair rejuvenation. By stimulating collagen production, delivering growth factors, and supporting follicle regeneration, they offer a novel, noninvasive approach to facial rejuvenation and hair growth. A systematic review and meta-analysis were conducted to evaluate the clinical efficacy of exosome therapies in aesthetic indications. A comprehensive search of Medline, Embase, Cochrane, Trip Database, and ClinicalTrials.gov was performed on February 2, 2025. Eligible studies included human trials reporting outcomes on wrinkles, pigmentation, elasticity, skin texture, erythema, overall aesthetic improvement, hair density, or hair thickness. Thirty-nine studies were included: 26 focused on skin outcomes and 13 on hair outcomes. Meta-analyses were performed using random-effects models where percent improvement and standard error were available. Facial wrinkle reduction averaged 20.2% (95% CI, 15.3%-25.2%; P < .001). Additional skin-related outcomes improved by 14.7% to 23.4%, including pigmentation, elasticity, texture, erythema, and overall appearance. Hair density and thickness improved by 23.6% (95% CI, 18.1%-29.0%) and 18.0% (95% CI, 11.1%-24.9%), respectively. Nine ongoing clinical trials were identified across the United States, Iran, and China. Risk of bias in randomized controlled trials was assessed using the Cochrane risk of bias (ROB2) tool. Although heterogeneity and nonstandardized protocols limit generalizability, findings indicate consistent, meaningful improvements in both skin and hair outcomes. These results support further investigation of exosome therapies as a regenerative modality in aesthetic medicine. Level of Evidence: 3 (Therapeutic).

Acute radiation dermatitis (RD) is a common and significant adverse effect experienced by patients with breast cancer undergoing radiotherapy (RT). The authors of this study investigate the efficacy and safety of a topical cream infused with exosomes derived from adipose tissue-derived mesenchymal stem cells (ASC-EXOs) in reducing radiation-induced skin damage. Fifteen patients undergoing RT applied the cream to the radiation-treated areas starting the night before treatment initiation and continued use for 2 weeks posttreatment. The severity of RD was evaluated at baseline and at Weeks 2, 4, 6, and 8, using a 5-point Radiation Therapy Oncology Group (RTOG) grading scale. The peak RTOG score was observed at Week 6, aligning with the cumulative radiation exposure. Maximum RTOG grades of 0, 1, and 2 were recorded in 6.7% (1/15), 40% (6/15), and 53.3% (8/11) of patients, respectively. By Week 8, transepidermal water loss was decreased to levels below baseline. The overall occurrence of RD in this study was notably lower than that previously documented, emphasizing the protective effects of ASC-EXO-containing cream against radiation-induced skin injury. Level of Evidence: 4 (Therapeutic).

Background: Genitourinary syndrome of menopause (GSM) is a condition affecting peri and postmenopausal women. Er:YAG vaginal laser has been reported to improve symptoms through thermal remodeling, without tissue ablation. Exosomes are emerging biological mediators with regenerative and anti-inflammatory effects. Their use in combination with Er:YAG laser has not yet been extensively studied.

Objectives: The aim of this study was to evaluate safety and clinical efficacy of combining Er:YAG vaginal laser with topical intravaginal application of plant-derived exosomes (ASCEplus IRLV) for GSM symptoms.

Methods: Twenty women aged 45-63 years with GSM were enrolled between June and December 2023. Inclusion criteria were GSM symptoms, exclusion criteria included active infection, hormone therapy, or pelvic malignancy. Patients underwent 4 sessions of Er:YAG laser (4 J, 3600 pulses, 4 weeks apart), followed by intravaginal topical intervaginal application of 4 mL ASCEplus IRLV. Outcomes were assessed at baseline, 3 and 6 months with the Vaginal Health Index (VHI) and Female Sexual Distress Scale-Revised.

Results: Vaginal Health Index Scores improved significantly at 3 and 6 months. Female Sexual Distress Scale-Revised scores decreased significantly at 3 and 6 months and stabilized thereafter. Subgroup analysis showed consistent benefit across different baseline VHI ranges. Patients reported improvements in vaginal dryness, dyspareunia, and mild urinary incontinence. No adverse events occurred.

Conclusions: Combined Er:YAG laser and plant-derived exosomes is a safe, non-hormonal, regenerative option for GSM. The treatment improved vaginal symptoms, sexual function, and urinary complaints with durable effects. Larger controlled studies are needed to confirm these preliminary findings.

Level of evidence: 4:

Background: Needling radiofrequency (NRF) induces controlled dermal remodeling while preserving the epidermis. Rose stem cell-derived exosomes (RSCEs) possess regenerative and anti-inflammatory properties, but limited penetration restricts clinical utility.

Objectives: To assess whether RSCEs applied immediately after NRF enhance improvement in wrinkles, texture, and pores in Asian patients.

Methods: A prospective split-face study was conducted in 6 subjects (Fitzpatrick III-IV). Both facial sides received NRF, with RSCEs applied to one randomly assigned side. Standardized photography and Vectra Sculptor analyses were performed at baseline and at 1, 3, and 6 months.

Results: All subjects completed follow-up. NRF + RSCE produced significantly greater wrinkle reduction at 1 and 3 months (both P = .03), with faster early improvement and sustained remodeling at 6 months, whereas NRF-alone side/area showed rebound worsening. Texture responses varied by phenotype: collagen-deficient skin benefited more from RSCEs, whereas sebaceous-dominant skin responded better to NRF alone. For pores, overall differences were nonsignificant, but normal-function skin showed early acceleration with RSCEs, while sebaceous-dominant skin improved more with NRF alone.

Conclusions: Based on these preliminary observations, our findings suggest that adding RSCEs after NRF may provide additional benefit in improving several aspects of skin quality, including wrinkles, texture, and pore size. The response patterns indicate that RSCEs may act synergistically with the wound-healing environment created by NRF, potentially enhancing dermal remodeling beyond energy-based treatment alone. While these results support RSCEs as a promising adjunct for selected patients, larger controlled trials are required to validate these findings and define patient profiles most likely to benefit.

Level of evidence: 4 (therapeutic):

Exosomes have emerged as promising agents in regenerative medicine because of their ability to mediate intercellular communication, modulate inflammation, and promote tissue repair. However, their clinical application remains limited by issues of stability, bioavailability, and therapeutic consistency. Hybrosomes, engineered hybrid vesicles that combine exosomal membranes with liposomal structures, have been developed to enhance delivery, protect bioactive cargo, and prolong regenerative activity. The authors of this review aim to discuss the therapeutic efficacy of exosomes and hybrosomes in the context of skin regeneration and aesthetic procedures and evaluate their respective advantages and limitations. They aim to explore how bioengineered delivery systems may overcome current barriers to clinical translation. Studies were included if they evaluated exosome- or hybrosome-based interventions in wound healing or skin aging through in vitro, in vivo, or clinical models. Data regarding cellular proliferation, migration, angiogenesis, and inflammatory modulation were extracted and synthesized. The improved stability and delivery of hybrosomes enables sustained regenerative effects. The integration of liposomal architecture in hybrosomes may improve vesicle stability, extend bioactivity, and optimize delivery, potentially offering sustained regenerative benefits. However, future studies should include long-term clinical evaluations and standardized production protocols to establish hybrosome therapies as reliable and scalable interventions in regenerative and aesthetic medicine. Level of Evidence: 3 (Therapeutic).

The use of exosomes in regenerative aesthetics represents a conceptual shift. Although stem cells operate using an engraftment and differentiation method, exosomes mediate therapeutic effects through transfer of bioactive molecules that orchestrate regenerative cascades. These tiny particles have evolved from their initial characterization as cellular waste repositories to critical mediators of physiological processes. Laboratory research and clinical trials position exosomes as tailored biological messengers with tissue-specific tropism and immunomodulatory capabilities. Sourcing diversity, ranging from mesenchymal stem cells to immune cells and platelets, imparts distinct molecular signatures that determine therapeutic potential. Contemporary isolation techniques have progressed from ultracentrifugation to more sophisticated approaches yielding variable purity profiles. Regulatory frameworks span Section 351 of the Public Health Service Act governing minimally manipulated preparations, Section 361 therapeutics with specific drug indications, and Federal Food, Drug, and Cosmetic Act-regulated topical formulations, with international approaches varying significantly across jurisdictions. Clinical applications include photoaging remediation, scar remodeling, hair follicle regeneration, wound healing, postprocedure recovery and adipose tissue volumization, with mechanisms encompassing matrix remodeling, neovascularization, and immunomodulation. Emerging evidence supports efficacy in combination with energy-based treatments and microneedling. Future directions include cargo-engineered exosomes, stimuli-responsive release systems, and tissue-specific targeting. Developing GMP-compliant production and unified potency metrics will likely transition exosomes from supplementary components to primary agents in next-generation aesthetic protocols.

Background: Deep skin resurfacing with helium radiofrequency plasma produces rhytid and photodamage correction with significant tissue contraction. Although the outcomes can be quite impressive, the recovery process can be daunting and prolonged.

Objectives: The aim of this study was to demonstrate that topical application of human dermal fibroblast exosomes after deep skin resurfacing can significantly decrease the number of days to achieve re-epithelialization.

Methods: This study presents a retrospective review (July 2017-September 2025) of 101 patients. The patients were divided into 4 groups: Group 1 (n = 18, resurfacing only, no exosomes, age 36-75 years), Group 2 (n = 27, resurfacing only plus exosomes, age 30-82 years), Group 3 (n = 23, resurfacing plus facelift, no exosomes, age 50-80 years), and Group 4 (n = 33, resurfacing plus facelift, plus exosomes, age 54-77 years). The number of days to full re-epithelialization was compared between groups.

Results: For the resurfacing-only patients, days to re-epithelialization for Group 1 (no exosomes) ranged from 10 to 21 (median, 15.5; mean [standard deviation], 15.78 [3.26]), compared with Group 2 (exosome treated), which ranged from 6 to 16 days (median, 10; mean, 10.74 [2.50]) (P < .0001 and t-statistic = 5.54). For the resurfacing plus facelift patients, days to re-epithelialization for Group 3 (no exosomes) ranged from 9 to 21 (median, 15; mean, 15.48 [3.58]), compared with Group 4 (exosome treated), which ranged from 7 to 14 days (median, 10.5; mean 10.24 [2.24]) (P < .0001 and t-statistic = 6.22). The rates of complications were: Group 1, 3 of 18 patients (16.67%); Group 3, 3 of 23 patients (13.04%); Group 2, 0 patients; and Group 4, 1 of 33 patients (3.03%).

Conclusions: This 8-year series with 101 patients demonstrates that the application of topical exosomes decreased the days to re-epithelialization and the complication rates, highlighting their promising role in accelerated healing following deep skin resurfacing procedures.

Level of evidence: 4:

Exosomes are nanoscale extracellular vesicles that facilitate intercellular communication by transporting regulatory molecules, such as microRNAs, proteins, and lipids. Acting as "software updates" for cells, exosomes influence gene expression and cellular behavior without altering the genetic code. Their emerging roles in tissue repair, immune modulation, and age-related rejuvenation have positioned them as promising tools in regenerative and aesthetic medicine. The authors of this systematic review aim to explore the therapeutic potential of natural and bioengineered exosomes, focusing on their mechanisms of action and applications in regenerative therapies and aesthetic interventions. A structured literature search was conducted across PubMed, Scopus, and Web of Science, including English-language studies available online as of April 2025. Eligible studies consisted of original in vitro, in vivo, and clinical research examining exosome-based applications in tissue regeneration, wound healing, and anti-aging therapies. Studies were thematically grouped by exosome origin, engineering strategy, and therapeutic context. A narrative synthesis approach was employed because of methodological heterogeneity. Exosomes represent a novel class of therapeutic agents capable of modulating biological processes critical to repair and regeneration. In addition to mammalian-derived vesicles, plant-based and hybrid systems offer scalable, biocompatible platforms for targeted molecular delivery. The integration of exosome-based therapies with advances in cellular reprogramming and bioelectric signaling may further expand their clinical utility. However, broader clinical adoption will require continued research addressing safety, manufacturing scalability, regulatory challenges, and ethical considerations. Level of Evidence: 3 (Therapeutic).

Exosome therapy represents an emerging regenerative medicine approach for optimizing wound healing and reducing scarring. Extensive pre-clinical research on human placental mesenchymal stem cell-derived exosomes (hpMSC-exosomes) demonstrates significant therapeutic potential in aesthetic and reconstructive surgery applications. Despite compelling preclinical evidence supporting the efficacy of exosomes in wound healing, human clinical studies remain scarce. The author's current study includes 738 patients treated with hpMSC-exosomes over a 7-year period across multiple aesthetic and reconstructive indications, with 175 cases involving wound healing and 118 cases involving scar therapy. The objective of this systematic review and meta-analysis is to comprehensively evaluate the current evidence for hpMSC-exosomes in wound healing and scar therapy, analyzing their mechanisms of action, clinical applications, and safety profiles through a review of preclinical studies, safety data, and clinical case series in both animals and humans. Analysis of the author's series will be included. Information sources included PubMed, Cochrane Library, EMBASE, Web of Science, and ClinicalTrials.gov resulting in a meta-analysis of 21 global preclinical studies (323 animals) which demonstrated superior outcomes compared with controls across multiple parameters: wound healing rate, neovascular density, re-epithelialization rate, and collagen deposition. hpMSC-exosomes demonstrated accelerated wound healing through enhanced angiogenesis, reduced inflammation, improved collagen production, and immunomodulatory effects. Most studies utilized rodent models, with limited translation to human trials. Current human evidence is predominantly based on early-phase trials, case series, and observational studies. Large-scale, well-designed clinical trials are essential to advancing exosome therapy in wound healing and scar management. hp-MSC-exosomes represent a promising therapeutic modality for wound healing and scar therapy with demonstrated safety and efficacy. Standardization of manufacturing processes and FDA approval remain critical for widespread clinical implementation. Level of Evidence: 3 (Therapeutic).

Mesenchymal stem cell (MSC)-derived exosomes are emerging as cell-free bioregenerative platforms in aesthetic dermatology. Umbilical cord (UC-MSC) and adipose-derived (AD-MSC) exosomes are among the most studied sources, yet existing data derive from heterogeneous models that preclude direct comparison. No standardized head-to-head evaluation in a human skin aging model has been conducted. The aim of the study is to compare the regenerative and antiaging effects of UC-MSC and AD-MSC exosomes using a physiologically relevant ex vivo human skin aging model. MSCs were isolated and characterized per International Society for Cellular Therapy criteria. Exosomes were purified through differential ultracentrifugation and analyzed by nanoparticle tracking and flow cytometry. Cytokine cargo was profiled using multiplex assays. Human dermal fibroblasts and ex vivo skin explants were used to assess proliferation, senescence-associated β-gal activity, melanogenesis, senescence-associated secretory phenotype (SASP) suppression (interleukin-6, matrix metalloproteinase-9), and extracellular matrix (ECM) biosynthesis. Topical retinoic acid and resveratrol served as reference controls. Both exosome types increased fibroblast proliferation and reduced senescence. AD-MSC exosomes showed higher vascular endothelial growth factor (VEGF) content, driving angiogenesis and greater collagen and hyaluronic acid production. UC-MSC exosomes, enriched in transforming growth factor-beta and platelet-derived growth factor-BB (PDGF-BB), demonstrated stronger immunomodulatory activity and more pronounced SASP reduction in ultraviolet-damaged skin. Both reduced melanogenesis without altering melanocyte viability. UC-MSC and AD-MSC exosomes exhibit distinct yet complementary regenerative profiles. AD-MSC exosomes favor dermal ECM remodeling and hydration, whereas UC-MSC exosomes exert potent anti-inflammatory and photo-protective effects. These findings support their potential for personalized regenerative dermatology and combinatory exosome-based facial rejuvenation strategies.