Microneedling Combined with Photothermal-Biomodulated Autologous PRP to Enhance Exosome Release in Refractory Melasma: A Case Report

Luciana Leite Crivelin,1,* Gabriela Tomasi-Batiston2,* 1Aesthetics Department, Crivelin Medical Center, Saint Joseph of Rio Preto, Sao Paulo, Brazil; 2Department of Dermatology, Base Hospital, Saint Joseph of Rio Preto School of Medicine, Saint Joseph of Rio Preto, São Paulo, Brazil*These authors contributed equally to this workCorrespondence: Luciana Leite Crivelin, Aesthetics Department, Crivelin Medical Center, Saint Joseph of Rio Preto, Sao Paulo, Brazil, Tel +55 17 99657-7575, Email [email protected]: Melasma is a challenging condition to treat, requiring multiple therapeutic approaches. Exosomes have been used as regenerative therapies in diverse contexts, including dermatological disorders. A 35-year-old male patient with Fitzpatrick skin phototype II and a longstanding diagnosis of facial melasma, who had undergone multiple prior treatments — including topical agents and laser therapy — with little to no improvement was treated with three monthly sessions of robotic microneedling without radiofrequency on the melasma-affected areas, followed by the injection of preconditioned autologous platelet-rich plasma. The preconditioning consisted of photothermal biomodulation using the Meta Cell Technology technique, applying blue light (467 nm), 1 J/cm2, while maintaining the sample at 37°C for 10 minutes. Intradermal injections of 0.25 mL of the autologous product were administered at each demarcated point (1 × 1 cm). After treatment, the patient showed significant improvement in refractory melasma, with lightening of the malar and temporal regions and improved vascularization in the treated areas. This case suggests that intradermal administration of photothermal-biomodulated platelet-rich plasma combined with microneedling may represent a well-tolerated therapeutic alternative for selected patients with resistant melasma.Keywords: exosomes, skin, regeneration, platelets, autologous platelet-rich plasma, skin regeneration