When Tiger Woods injured his knee and needed major ACL surgery in 2008, he had platelet-rich plasma (PRP) injections, a form of stem cell therapy, to accelerate his recovery. The list of professional athletes turning to regenerative medicine for expedited healing is a long one, but treatments extend far beyond the sports arena: Stem cell therapy has been used by doctors for years to help treat everything from multiple sclerosis to COPD. However, when it comes to aesthetics, PRP treatments for hair restoration and skin rejuvenation haven’t been as reliable, and the results aren’t consistent, as the quality of patients’ platelets vary based on age, health and other factors. As such, the scientists return to the lab in search of the next best thing: Meet exosomes, the next generation of stem cell therapy.
What Are Exosomes?
“Exosomes are simply messengers,” says New York dermatologist Doris Day, MD. “They are membrane-bound vesicles—or small bubbles—that are released from stem cells and naturally attracted to areas of inflammation. They carry growth factors and other anti-inflammatory, immune-supportive and antioxidant elements to places that need them.” Atta Behfar, MD, PhD and founder of biotech company Rion, describes an exosome as words between two cells. “It’s essentially a message from one cell to another,” he explains. “There are billions of types of exosomes in our bodies, and depending on which cells secrete those exosomes, and what state those cells are in—healthy, stressed or dying—you can get dramatically different signals. We’ve established a way to derive exosomes from human platelets as a resource for tissue regeneration, including for use in aesthetic applications, such as hair loss and facial wrinkles.”
New York facial plastic surgeon Yael Halaas, MD is one of many doctors taking part in the tremendous amount of research going on to understand the individual purposes of exosomes. “Though the science is incredibly promising, there is currently no FDA indication for exosomes for medical usage—this is also the case for PRP— so companies cannot make claims that they can be curative.” The collective call for FDA regulation also stems from R&D. “Every company has a proprietary method for obtaining their exosomes and a different manufacturing process, and some ‘bad operators’ have already been shut down,” Dr. Halaas adds.
The Difference Between Exosomes + PRP
Exosomes are said to be more potent and reliable than PRP and PRFM (platelet-rich fibrin matrix), which we first learned about in 2016 and are still used in doctors’ offices around the world. Both PRP and PRFM help speed up the wound-healing process by creating new skin cells, collagen and blood vessels, but New York dermatologist Marina Peredo, MD says they are inconsistent, dependent on the patient’s age and condition, and contain only a few key growth factors. “Exosomes are 100-percent consistent and contain 10 to 100 times more growth factors than PRP and PRFM. Moreover, exosomes are immediately available and do not necessitate drawing and processing any blood from the patient.”
New York dermatologist Julie Russak, MD says the biggest difference between PRP and exosomes is that PRP is extracted from our own platelets taken from our own blood, but exosomes come from stem cells—from sources like fat, umbilical cord or bone marrow. “The growth factors in our PRP may be weaker depending on our age and health status,” she explains. “Exosomes contain growth factors and signaling molecules for regeneration and healing, which are extracted from inside the fresh cell. Many are from embryonic stem cells, too, which are brand-new cells that have the most regenerative potential possible.”
How Exosomes Are Used in Skin Care
Exosomes may have a big role to play in skin care, as they can employ their signal molecules to stimulate cell regeneration and boost collagen production. “The advantage of using exosomes in skin care over stem cells is that they have extremely low immunogenicity with high hemocompatibility, meaning anyone can benefit from them,” says Dr. Russak.
A new skin-care line called (Plated) SkinScience (under the Rion Aesthetics umbrella) is using its platelet-derived Renewosome technology in its topical Intensive Serum that can be purchased online and in select doctors’ offices. “(Plated) is the first-and-only brand in the United States leveraging the power of platelet extract in a ready-to-use serum,” says Dr. Halaas, who co-authored a paper on the efficacy and tolerability of the product in the Aesthetic Surgery Journal. “The results of our 12-week data were quite remarkable, and participants showed considerable improvement in photodamage, redness and signs of aging.”
There’s also promise for acne patients due to exosomes’ robust antiinflammatory capabilities. “The inflammatory stage in acne precedes the pustule or active lesion phase, so anything we can do to reduce inflammation goes a long way for the patient,” says Indianapolis facial plastic surgeon Greg Chernoff, MD, who leads the largest series of exosome studies in the world, with 500 patients over five years. “In our acne patients, we saw dramatic reductions in inflammation pustules and comedones within 15 to 30 days of topical exosome application.”
Exosome Use for Hair Restoration
In recent years, PRP and PRFM have been a go-to for treating hair loss and thinning hair in-office, but exosomes are carving their path in this category, too. “As we age, the cells in our scalp and hair begin working less and less, producing thinner hair until they give up completely,” explains Dr. Russak. “We call this slowing-down process senescence, and what we want to do is basically give the cells an energy boost by injecting exosomes and signaling them to perk up a little bit and start working harder. That’s the whole idea behind both PRP and exosome regeneration.”
Dr. Chernoff says he was always “relatively underwhelmed” with what PRP and PRFM were doing for alopecia, and we’ve heard similar sentiments from other doctors. “We know that because hair loss is genetic, there’s nothing we can put on the scalp to magically grow new hair, but there are things we can do to increase blood flow to the scalp and extend the growth phase of the hair,” he explains. “Exosomes cause more hairs to be in the growth phase than the resting phase. On some of our patients’ biopsies, the exosomes also increased dermal papilla cells in the hair follicle—the area of largest growth in the follicle. Therefore, I like to describe exosomes as ‘nuclear PRP’ because we’ve seen much better results, and quicker, than we ever saw with PRP or PRFM.”
The earlier patients address their hair loss issues, the better chance they have of improvement and slower progression, says Dr. Day. “I don’t see as much of a benefit when exosomes are used topically on the scalp after microneedling, but I do see excellent results in many cases when they’re injected. I also prefer exosomes over PRP for patients who have autoimmune diseases or autoimmune hair loss because I believe they eliminate even the theoretical risk of worsening the condition.”
In-Office Facial Rejuvenation With Exosomes
Dermatologists and plastic surgeons are utilizing exosomes as an adjunct to in-office treatments. “I use Exovex by Exocel Bio, which is a serum I apply to the skin immediately after a treatment such as microneedling, microneedling with radio frequency or Clear + Brilliant,” Dr. Peredo explains. “It relieves the burning sensation, reduces redness, and dramatically reduces downtime and inflammation. It can reduce the downtime associated with energybased devices by 80 percent.”
Aside from microneedling, another method of delivering exosomes into the skin topically is The SaltFacial, a three-step treatment. “It first exfoliates the surface of the skin to remove the stratum corneum with sea salt, as opposed to the aluminum hydroxide crystals used in normal microdermabrasion,” Dr. Chernoff explains. “Then we use ultrasound to propel the exosome emulsion into the skin. Lastly, the patient lays under a wraparound panel system of high-power LEDs for 20 minutes. There are thousands of papers in the literature on LED light therapy—you’re fertilizing the garden after you’ve planted the seeds, if you will.”
In a double-blinded, placebocontrolled study on the use of exosomes for aging skin, Dr. Chernoff and his team found that after three applications of exosomes monthly for three months, patients experienced a significant improvement in wrinkles, pores, evenness of skin and vascularity, and a decrease in pigmentation. “We were able to quantify our results using a 3-D camera that measures changes in the skin,” he says, noting that the exosomes used were from Kimera Labs and derived from human placental mesenchymal stem cells.
HydraFacial also sees the promise of exosomes, and as such, recently announced its partnership with biotech company Organicell to co-create a first-to-market exosome booster that will be available as a customized add-on during HydraFacial treatments. “Once developed, we expect this exosome booster will provide amazing benefits to any skin type, but it will be of particular interest to those wanting to address aging,” says Jwala Karnik, MD, executive vice president of global strategy and partnership at The BeautyHealth Company (HydraFacial’s parent company). “Most people forget that skin is an inflammatory state, and the exosomes will aid in reducing inflammation and promoting an environment more conducive to increasing collagen and elastin to reveal a youthfullooking complexion.”
Using Exosomes to Care for Keloid Scars
Another area where exosomes have been a game changer is keloid scars. One clinical study included 21 patients, all of whom had between four and eight previous attempts to remove their keloids, and they always came back. “We cut the keloids off using a carbon dioxide laser handpiece and then applied exosomes,” Dr. Chernoff explains. “And as we published in our paper, after two years, only three of the patients had a recurrence, and they were all in a hair-bearing region. We discovered that folliculitis acted as the nidus for the keloids to come back, so, we cut the scars off again, fried the heck out of the hair follicle with our hair removal lasers, and then applied exosomes. Now those patients are 18 months without recurrence.
What We Can Expect From Exosomes in the Future
For the years ahead, companies like Rion Aesthetics have more industry-disrupting goals in mind. “We’re looking to move the current field of medical aesthetics, which is mired in PRP and things like hyaluronic acid fillers that degrade over time, to something more rigorous and reproducible using exosomes,” says Dr. Behfar. “For example, in hair restoration, each dose of exosomes would be the same, perform the same way, and really work. When it comes to filler, why not pair the hyaluronic acid with a regenerative technology— a biologic like exosomes—that can help skin regenerate from the inside out as the hyaluronic acid degrades? This is the objective, and now we must do FDA-governed clinical trials to prove this.” We look forward to the results of these trials, and we predict more companies will follow suit. But for now, we’ll keep our finger on the pulse of current innovation.
