Exosome Therapy versus Platelet-Rich Plasma for Facial Skin Rejuvenation: A Randomized Controlled Trial in Fitzpatrick skin types IV–VI

Abstract

Background: Platelet-rich plasma (PRP) is a standard autologous treatment for facial skin rejuvenation, but exosome therapy offers a cell-free alternative with potentially superior signaling efficiency and tolerability. This randomized controlled trial compared the efficacy, safety, and patient-reported outcomes of exosome therapy versus PRP.

Methods: In this single-center, parallel-group RCT, 100 participants (50 per arm) with Fitzpatrick skin types IV–VI seeking facial rejuvenation were enrolled. Participants received either PRP therapy, administered via both intradermal injection and microneedling, or exosome therapy, which was delivered exclusively through microneedling at sessions 1, 3, and 6 months. Primary outcome: Global Aesthetic Improvement Scale (GAIS) rated by clinician and patient. Secondary outcomes: 5-point Likert scales for efficacy (A1–A10), safety/tolerability (B1–B7), satisfaction/consistency (C1–C8), and open-ended feedback.

Results: Mean age was 31.8 ± 10.9 years (88% female). Exosome therapy demonstrated superior clinician-rated GAIS (3.78 ± 0.61 vs PRP 3.55 ± 0.68; p=0.012) and patient-rated GAIS (3.71 ± 0.65 vs 3.48 ± 0.72; p=0.018). Moderate/significant improvement (GAIS ≥4) was higher with exosomes (clinician: 56% vs 48%, p=0.031; patient: 53% vs 45%, p=0.024). Overall efficacy scores (A1–A10) favored exosomes (3.51 ± 0.74 vs 3.28 ± 0.82; p=0.004). Tolerability was significantly better with exosomes (B1–B7: 4.12 ± 0.48 vs 3.85 ± 0.61; p=0.001), with lower rates of pain (12% vs 35%), redness (16% vs 28%), and swelling/bruising (9% vs 22%; all p<0.05). Satisfaction and recommendation rates were high in both arms. No serious adverse events occurred.

Conclusion: Exosome therapy is superior to PRP in efficacy, GAIS improvement, and tolerability for facial skin rejuvenation. It represents a promising non-autologous alternative.