Enhanced Healing and Outcomes With Human Dermal Fibroblast Exosomes: Case Series Combining Deep Helium Radiofrequency Plasma Skin Resurfacing, Facelifts, and Exosomes

Abstract Background Deep skin resurfacing with helium radiofrequency plasma produces rhytid and photodamage correction with significant tissue contraction. Although the outcomes can be quite impressive, the recovery process can be daunting and prolonged. Objectives The aim of this study was to demonstrate that topical application of human dermal fibroblast exosomes after deep skin resurfacing can significantly decrease the number of days to achieve re-epithelialization. Methods This study presents a retrospective review (July 2017-September 2025) of 101 patients. The patients were divided into 4 groups: Group 1 (n = 18, resurfacing only, no exosomes, age 36-75 years), Group 2 (n = 27, resurfacing only plus exosomes, age 30-82 years), Group 3 (n = 23, resurfacing plus facelift, no exosomes, age 50-80 years), and Group 4 (n = 33, resurfacing plus facelift, plus exosomes, age 54-77 years). The number of days to full re-epithelialization was compared between groups. Results For the resurfacing-only patients, days to re-epithelialization for Group 1 (no exosomes) ranged from 10 to 21 (median, 15.5; mean [standard deviation], 15.78 [3.26]), compared with Group 2 (exosome treated), which ranged from 6 to 16 days (median, 10; mean, 10.74 [2.50]) (P < .0001 and t-statistic = 5.54). For the resurfacing plus facelift patients, days to re-epithelialization for Group 3 (no exosomes) ranged from 9 to 21 (median, 15; mean, 15.48 [3.58]), compared with Group 4 (exosome treated), which ranged from 7 to 14 days (median, 10.5; mean 10.24 [2.24]) (P < .0001 and t-statistic = 6.22). The rates of complications were: Group 1, 3 of 18 patients (16.67%); Group 3, 3 of 23 patients (13.04%); Group 2, 0 patients; and Group 4, 1 of 33 patients (3.03%). Conclusions This 8-year series with 101 patients demonstrates that the application of topical exosomes decreased the days to re-epithelialization and the complication rates, highlighting their promising role in accelerated healing following deep skin resurfacing procedures. Level of Evidence: 4