Exosomes
| Best used: Injected off label | Caution: May not work | Best for: Adjunct treatment |
| Comments: Marketing hype over real science as of 2024. | Mode of action: Cellular messenger | Science Score: ** |
What is the best way to utilize exosomes?
Exosomes are best used as off label injections over fluffy microneedling with topical application. Here is why-
- Injections gets 100% of the product into the skin
- Topical application of exosomes after procedures such as microneedling or TargetCool only gets between 2-5% of the product into the skin itself. The majority of exosomes sit on the skin’s surface.
What do I frequently mix with exosomes?
My standard cocktail is based upon the science of injectables, namely a mix of –
Hybrid complex hyaluronic acids
Polynucleotides
Neurotoxin; modulates smooth muscle fibers & vessels to improve skin quality & reduce pore sizing
Starting you on a very low dose of isotretinoin, say 5 to 10 mg for the first few weeks or months.
Starting you with an anti inflammatory during or even before the course of Oratane / Accutane
Using a pre-treatment peel prior to escalation. Frequently used peels pre or during treatment include salicylic acid or retinoic acid 1-3%
Manual extraction of acne cysts, whitehead & blackheads
Laser assisted cyst extraction for submarine comedones (probably the best solution)
Reducing your dose of isotretinoin if you have a significant flare
Direct injection of cysts with very dilute anti-inflammatories
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Why are exosomes not approved for injections?
The answers are commercial & regulatory. Commercially it is much better for the company to have their product listed as ‘non-injectable’. Depending on where you reside in the World, this means dermal therapists, nurses, & aestheticians can perform exosome therapy as the product is not injected. In comparison, dermal fillers & collagen stimulating injectables are administered via physicians or via physician supervision. This limits the volume of sales by the exosome company.
Regulatory bodies. It is far easier to get approval from regulatory bodies such as the TGA, FDA & CE for products that are applied topically, as opposed to injectables. This reflects the commercial aspects of exosome therapy.
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So, if they can’t be injected, what is the next best thing?
I use the Potenza RFM by Cynosure with a special tip called the Fusion tip to infuse exosomes. This tip provides negative then positive pressure to push exosomes into the channels formed by RF microneedling.
The pressure generated by the device enhances the delivery of drugs such as dermal fillers, Rejuran polynucleotides, collagen stimulating injectables & exosomes. With a higher concentration of exosomes (& quantifiable more absorption), the results are much better than on-label microneedling.
Are exosomes better than dermal fillers?
They act via different pathways, however their end goal is upregulation of collagen production.
Collagen stimulating dermal fillers are, in general, much better than exosomes as they are injected into the deeper layers of skin (dermis or the subcutaneous fat). They create more inflammation, & hence results in more collagen stimulation than exosomes. Additionally they can be tailored to provide projection, volume or neocollagenesis depending on the type of injectable used.
If you are on a tight budget, I would recommend dermal fillers & or soft tissue injectables over exosomes. Here is a quick summary of dermal soft tissue collagen stimulators-
- High & low hybrid HAs: best for hydration, though they can marginally stimulate collagen & adipose tissue production (in a lab or petri dish).
- CAH or calcium hydroxyapatite: great for a mix of volume & fibrosis
- PLLA or PDLLA: as above with less projection & more volume
- PCL or polycaprolactone: Best for fibrosis but at the expense of inflammation. Minimal volume changes
- PN or polynucleotide: best for skin quality over volume
Jessner TCA peel, one session
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👉This is a medium depth peel. Occasionally I prep with retinoic acid beforehand, but thin skin like this patient, RA is not needed. I scrub with acetone, then coat with 2-4 layers of Jesser. I then have a cup of coffee then come back to finish off with TCA at 35%
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😁Was having a friendly banter with my mentor & close friend @aprofphilipbekhor last night. Peels vs lasers. Why do I like peels? My chill out time. No loud noises apart from the patient's muffled screams 😱😱(joking). Despite the tech of lasers, I still like looking carefully at end points from peels. It is tactile, much like driving a manual car vs an automatic. Sure the latter is easier, but sometimes it’s the challenge to get the downshift perfectly matched, or the epidermis so evenly gray that the entire sheet slides from the dermis. It’s old school cool
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👊🏻Disclaimer: You do need to watch your peel patients more closely cf. NA laser patients, that is fact💯
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#tca #jessner #jessnertca #chemicalpeels #dermatologist #dermatology #drdavinlim #skinrejuvenation
TCA peels are a simple way to rejuvenate skin. This picture is over a decade old, but I still enjoy peels over lasers (more tactile). It’ much like driving a older vintage car, it’s slower to get to your destination but the drive is more enjoyable🚘
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🔬Skin science: TCA can be applied as a superficial, medium (most common) & deep peel. In this case I employed it as a medium depth peel, to the upper papillary dermis. In some cases I combine it with Jessner for deeper penetration
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👉Downtime: 5- 8 days depending on the strength and coats
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😢Pain: Tolerable with topical application of numbing and skin cooling. I do give oral conscious sedation if deeper peeling
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👍🏻Good for: Skin type 1-2+, pigment, freckles, sun damage, solar keratosis, mild to moderate wrinkles, lentigos/ age spots
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👎🏼Not good for: Darker skin, deep wrinkles, melasma
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#chemcialpeels #TCApeel #jessner #jessnerTCA #skinrejuvenation #skinlightening #skinbrightening #davinlim #dermatology #skinscience
Can exosomes treat acne scars?
Yes, however the question should be rephrased as – are exosomes the best treatment for acne scarring? In that context the answer is no. Though they can marginally improve acne scars, exosomes as monotherapy (often combined with microneedling), acne scarring should be treated based upon the scar signature, namely matching each scar type with a particular treatment modality & not the other way around. Examples include TCA for ice pick scars, lasers & surgical subcision for rolling scars & soft tissue injectables for atrophic scars.
In the context of clinically significant volume replacement, exosomes fall short of collagen stimulating dermal injectables such as PLLA, PDLLA, CAH & hyaluronic acid injectables.
Can exosomes treat dark circles?
Yes, however the question should be rephrased as – are exosomes the best treatment for dark circles? In that context the answer is no. The management of dark circles is more complex than one treatment, or a skin care ingredient. Depending on the cause of dark undereye circles I use a combination of-
- Injectables: such as HA fillers, CAH washes, & Rejuran polynucleotides
- Vascular lasers: for redness & blood vessels in the under eye area
- Pigment lasers: such as pico or Q switch
- Peels: such as Cosmelan or Vi Precision
- Skin care & fluffy treatments to reflect light (boron, peptides, ascorbic acid, retinol)
Exosomes vs tretinoin, which is better?
So you want to compare a $70 tube of tretinoin cream to a bottle of exosomes in the range of $600 to $800? Factor in 3 sessions of exosomes & you are investing in the order of $2000. Here is the quick math, $70 vs $2000. You would think that 2 K worth of marketing (exosomes) would be 30 times better than tretinoin, but this is not the case.
Tretinoin works via RAR or retinoid receptor binding with messaging to different cell types. The results, though subtle, are etched in science.
Exosomes work (in theory) via cellular messaging, the results are hit & miss. IMO you are better off spending $1800 on a laser procedure that WILL give results, & 3 tubes of tretinoin.
Are exosomes better than PRP?
2024 (exosomes) vs 2010 (PRP), nearly 15 years of regenerative progress & the answer is still not clear cut, however here is a snippet of insight-
PRP is limited by the donor’s health & regenerative process (ie. you are the donor). It is dependent on age & your own regenerative capability. Exosomes are exogenous & do not rely on your ‘platelet count’ or concentration.
| Type | Application | Ease of use | Rate limiting factors |
| Exosomes | Not injected. | Comes in a vial | Source of exosomes |
| PRP | Requires injection. | Requires processing & handling of blood products. | Age & health of the donor (YOU!) |
Having said that, there are no head to head studies, including blinded double sided studies (one side treated with exosomes & one side treated with PRP). Ideally a study should involve n > 100 patients, randomized left to right split faced study, with before & afters rated by 3 or more independent assessors that are blinded to which side got what. The bottom line, there are pros & cons for each.
IMO, if you are going to invest in any one of these treatments, you may want to consider other alternatives that are better in producing reproducible outcomes such as pico + Rejuran or Profhilo + lasers.
If I have to spend the same amount on exosomes vs another procedure, what is better?
So, you have between $600 to $800 to spend (the cost of one exosome therapy), or up to $2200 for 3 sessions, these are other (better) options that will give you better results-
- Sun Damage: one Fraxel HD, cost? $1490, infinitely better results.
- General skin rejuvenation: Fraxel HD + CO2, cost $2400- $2900, infinitely better results.
- Mild wrinkles: Fraxel HD, infinitely better results.
- Acne scars: Profhilo or CAH + subcision from $1790, infinitely better results compared to even 3-4 sessions of exosomes.
- Pigment: pico or chemical peels.
- Volume loss: dermal fillers, predictable, reproducible, safe.
- Hair loss: this is where exosomes may produce better results with less side effects compared to medical therapy (drugs) or PRP. Probably the only time I will pick exosomes over mainstream therapy.
If your scars improve, it is NOT directly because of Accutane, it is due to your body’s immune system repairing itself for the inflammatory response caused by acne. Note however there have been formal scientific studies showing that mild acne scars can respond to topical retinoids including Adapelene. I suspect that this is universally seen when any therapy reduces inflammation & modulates expression of TIMP/ tissue metalloproteinases. More research will be needed in the future.
Does this mean I don’t believe in exosomes?
On the contrary, I, personally receive exosomes therapy however the flipside is that –
- I combine exosomes with other mainstream treatments such as polynucleotides, tox, soft tissue injectables. It works better in combination.
- I get exosomes injected, way off label, but at a much higher concentration in the dermal layers of skin (as compared to microneedling exosomes).
- I get exosomes for free (or at cost). If I had to place exosomes on my budget list, it would be at the end of the list. Place lasers, tox, fillers, & chemical peels way ahead of exosomes.
IMO, exosomes represent the ‘icing on the cake of skin rejuvenation.
Davin’s ProTip on the use of Exosomes
Exosomes are the new trending PRP of skintherapy. Taking a step back in time, PRP was the trend over 15 years ago, as a solution to everything from hair loss, acne scar management, skin rejuvenation, volume replacement, dark circles & more.
Though there is a trend towards exosome therapy for skin rejuvenation, I am very guarded as there is more marketing out there (especially on social media), as compared to real science. If you have tried other procedures & would like to then take your skincare & anti-aging a step above, consider exosomes (injected not needled).
