Understanding exosomes in facial esthetics and skin aging

BACKGROUND: Skin aging is a multifactorial process mediated by intrinsic (genetic and metabolic) and extrinsic (environmental) factors leading to functional and structural deterioration, including wrinkles, loss of collagen and elastin, as well as various pigmentation disorders. Exosomes, the smallest subset of extracellular vesicles, have emerged as potent cell-free regulators of intercellular communication with significant regenerative potential. This scoping review synthesized available in vitro, in vivo, and clinical evidence investigating the role of exosomes in facial esthetics and skin rejuvenation. METHODS: A comprehensive literature search was conducted up to January 2nd, 2026, using PubMed, Scopus, Web of Science, and Google Scholar. Search terms included ((extracellular vesicle) OR (exosome)) AND ((esthetic) OR (aesthetic) OR (rejuvenation)). All in vitro, in vivo, and human clinical studies were included without restriction. RESULTS: A total of 54 studies (from 472 records) were included: 27 in vitro, 16 in vivo, and 29 clinical studies (several overlap). In vitro outcomes demonstrated that exosomes improved cell viability, proliferation, and migration, while enhancing extracellular matrix formation (collagen, elastin, fibronectin) and upregulating antiaging-associated gene expression. These impacts were accompanied by alleviated inflammation, oxidative stress, and regulation of senescence and autophagic signaling. Animal research supported these outcomes, showing enhanced fat graft retention, improved angiogenesis, facilitated dermal remodeling, and epidermal thickening, together with expedited wound repair and reduced expression of matrix metalloproteinases and inflammatory regulators. Clinical studies consistently report decreases in wrinkles, pore size, erythema, scarring, and hyperpigmentation, along with improved skin elasticity, texture, hydration, and thickness. Both patient-reported and clinician-assessed outcomes, including the Global Aesthetic Improvement Scale, demonstrate positive outcomes. Additional advantages included decreased acne severity, shorter recovery times, and fewer adverse effects. CONCLUSIONS: Exosomes showed substantial regenerative potential in facial esthetics and skin antiaging. Nevertheless, heterogeneity in study methodologies and the limited number of high-quality RCTs require further well-designed studies to establish optimized protocols and ensure long-term efficacy and safety.