Preliminary Insights From a Split-Face Study on Skin Quality Changes After Needling Radiofrequency With or Without a Plant-Derived Exosome-Based Formulation Over 6 Months

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.