Clinical Advances in Exosome-Based Therapies for Aesthetic Medicine: A Systematic Review and Meta-analysis of Human Clinical Trials

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).