ABSTRACT Background Deoxycholic acid (DCA) injection is an established minimally invasive treatment for localized submental fat (SMF) reduction. Although clinical trials and systematic reviews support its efficacy, submental fullness is anatomically heterogeneous and may not always represent targetable fat. Aims This narrative review summarizes evidence on DCA injection, emphasizing anatomy‐based patient selection and safety planning for submental treatment and cautious off‐label use. Methods This structured narrative review was guided by the Scale for the Assessment of Narrative Review Articles. PubMed/MEDLINE was searched in August 2026 for evidence on DCA efficacy, mechanism, anatomy, imaging, injection technique, safety, and non‐submental applications. Relevant reference lists were also examined. The literature was organized by mechanism, clinical evidence, anatomy, imaging, patient selection, off‐label applications, and safety. Results DCA produces adipocyte membrane disruption followed by inflammatory clearance and tissue remodeling. The strongest evidence supports SMF reduction in patients with localized superficial subcutaneous fat, particularly preplatysmal fat. Similar fullness may result from deep fat, laxity, platysmal banding, glandular or muscular prominence, soft‐tissue ptosis, skeletal deficiency, or regional atrophy; these contributors require different strategies. High‐frequency ultrasound may assist when clinical examination does not clearly identify the dominant contributor or intended tissue plane, but it is an adjunct rather than a stand‐alone test of candidacy or safety. Evidence for non‐submental applications remains limited. Conclusions DCA should be regarded as an anatomy‐dependent adipocytolytic procedure rather than a general “fat‐dissolving” injection. Careful selection, precise placement, and realistic counseling may improve outcomes, reduce avoidable complications, and support cautious, individualized off‐label use.
ABSTRACT Facial rejuvenation has progressively shifted from volumetric correction toward biologically driven regenerative therapies. Autologous fat grafting has gained prominence due to its ability to restore both volume and tissue quality. Among its various forms, nano fat grafting has emerged as a purely regenerative technique, characterized by a high concentration of stromal vascular fraction and adipose‐derived stem cells with minimal viable adipocytes. This article review discusses the biological basis, preparation techniques, clinical indications, and outcomes of nano fat grafting in facial rejuvenation. A comparison has been done between nano Fat grafting and injectable, hyaluronic, skin, boosters, and also emphasis has been taken on the importance of optimal donor [1–4].
ABSTRACT Background Sunlight exposure presents a dual challenge in dermatology: it is the primary modifiable risk factor for skin cancer, yet it provides essential systemic health benefits, including vitamin D synthesis and potential mental health advantages. Controlled “microdosing” of sunlight may help balance these risks and benefits. Objective This review highlights the physical and mental health benefits of limited sun exposure and evaluates practical frameworks for safe, personalized sun exposure. Methods A narrative review was conducted examining sub‐erythemal ultraviolet‐B (UVB) doses required for maintaining endogenous vitamin D levels. Key frameworks analyzed include the ¼ minimum erythema dose (MED) rule and the standardized erythema dose (SED) approach based on the UV Index (UVI). Factors influencing safe exposure (skin type, season, geographic location, and prior skin disease history) were considered. Results Sub‐erythemal UVB doses vary significantly by individual and environmental factors. The ¼ MED rule offers a practical estimate but remains influenced by personal variability and conditions. The SED/UVI‐based method provides a more standardized alternative, independent of many patient‐specific variables. The combined use of the MED and SED frameworks supports individualized sun exposure guidance. Conclusion MED and SED‐based approaches together offer a balanced framework for personalized sun exposure that minimizes skin cancer risk while preserving systemic health benefits. These strategies can guide public health recommendations and clinical practice.
ABSTRACT Background The recommendation of cosmetic products in dermatological practice has become increasingly common, driven by the evolution of formulations and active ingredients that sometimes mirror pharmacological effects. This convergence has blurred the boundaries between cosmetics and medications, creating uncertainty among professionals regarding product efficacy and classification. Additionally, dermatologists face challenges interpreting label information, which is often technical, fragmented, or lacks standardization, undermining clarity and clinical confidence. Objective This study aimed to evaluate dermatologists' understanding of the labeling information on cosmetic products they prescribe or recommend. Methods Structured interviews were conducted with 118 Brazilian dermatologists using a 29‐question instrument (multiple‐choice, open‐ended, and scaled formats). Descriptive analysis was performed using specific statistical software 1 . Results Most participants regularly prescribe cosmetics or dermocosmetics and value labeling information. However, they report difficulties interpreting data and defining terms such as “claim” and “natural product.” Industry communication, particularly via medical detailing (industry representatives) and congresses, strongly influences prescribing decisions. There is a clear demand for objective information on composition, active concentration, safe use, and scientific evidence of efficacy. Conclusion Participants suggested improving communication between the cosmetics industry and dermatologists by providing clear, standardized information on ingredients, concentrations, usage guidelines, efficacy, adverse effects, and safety during pregnancy. These findings reinforce the need for tools that support informed clinical practice.
ABSTRACT Background Exosome‐based skin boosters are increasingly recognized in aesthetic dermatology, yet consolidated evidence on their safety and effectiveness remains limited. This scoping review aimed to synthesize available evidence on the clinical safety, efficacy, and practical application of exosome‐based skin boosters for facial rejuvenation in aesthetic medicine settings. Methods A systematic search of PubMed, Scopus, and Embase (2015–2025) was conducted following PRISMA‐ScR guidelines. Inclusion criteria focused on clinical trials or observational studies evaluating exosome‐based products for facial skin rejuvenation. Primary outcomes assessed were adverse events and clinical efficacy measures (skin texture, wrinkles, pigmentation, and global aesthetic improvement). Results Eight studies ( n = 20–60 participants per study, predominantly female, age range 18–80 years) met inclusion criteria. Exosomes from platelets, stem cells, adipose tissue, and bovine milk were delivered topically, via microneedling, or with laser assistance. All products demonstrated favorable tolerability; mild, transient adverse effects (erythema, dryness, petechiae) resolved within 2–14 days without serious complications. Efficacy improvements were reported across studies: skin texture enhancement (76.8%–90.9%), wrinkle reduction (5‐85.5% improvement), and melasma clearance (up to 99% melanin index reduction). Conclusion Exosome‐based skin boosters appear safe and effective for facial rejuvenation with minimal adverse effects. However, heterogeneous study designs, small sample sizes, and short follow‐up periods necessitate larger, standardized clinical trials with extended monitoring to validate long‐term safety and establish treatment protocols for broader clinical application.
ABSTRACT Background Anogenital papular mucinosis (APM) is a rare localized cutaneous mucinosis characterized by dermal mucin deposition presenting as flesh‐colored papules in the anogenital region. Its rarity and clinical resemblance to common infectious and inflammatory dermatoses contribute to frequent misdiagnosis. Objectives To summarize the clinical presentation, histopathology, differential diagnosis, and proposed pathogenesis of APM, with emphasis on cases occurring in patients with chronic anal fissures. Methods Narrative review of published reports and clinicopathologic literature addressing anogenital presentations of papular mucinosis, histologic diagnostic features, and proposed mechanisms including fibroblast dysregulation and trauma‐related cytokine signaling. Results Across reported cases, APM typically presents as asymptomatic or mildly pruritic dome‐shaped papules. Biopsy demonstrates abundant superficial‐to‐mid‐dermal mucin highlighted by Alcian blue staining, with sparse fibroblasts and minimal inflammation—features that distinguish APM from condyloma, molluscum contagiosum, lichen planus, and lichen nitidus. Emerging evidence supports a trauma‐associated framework in which chronic fissuring and microinjury may stimulate fibroblasts and extracellular matrix remodeling, leading to localized mucin accumulation. Conclusions APM may be best interpreted as a benign, localized mucinous reaction pattern within the spectrum of lichen myxedematosus rather than a distinct clinicopathologic entity. Recognition prevents unnecessary treatment and stigma and, in perianal cases, should prompt attention to fissure management and reduction of mechanical trauma.
ABSTRACT Background Regenerative medicine has expanded rapidly over the past decade, with continued exponential growth across both clinical and aesthetic applications. Objective Understand the use of GHK‐Cu (copper peptide), a peptide that has emerged as one of the most widely recognized and clinically relevant peptides due to its versatility in administration, favorable safety profile, and broad therapeutic potential. Methods and Materials This review article will explore the rise of GHK‐Cu within regenerative aesthetics and review the evidence supporting its benefits in skin health, repair, and rejuvenation. Results and Conclusion Peptides—administered via injectable, topical, intravenous, and intranasal routes—have become a central component of modern regenerative therapies and integrative aesthetic practice.
ABSTRACT Background Vitiligo is the most common acquired depigmentary disorder, affecting approximately 0.5%–2% of the global population. Although traditionally considered an autoimmune disease leading to melanocyte destruction, accumulating evidence indicates a multifactorial pathogenesis involving oxidative stress, immune dysregulation, metabolic abnormalities, and impaired regenerative capacity of melanocyte stem cells within the follicular niche. Conventional medical therapies often fail to achieve stable and durable repigmentation in resistant or long‐standing lesions. Regenerative medicine has therefore emerged as a promising therapeutic paradigm aimed at restoring melanocyte populations and re‐establishing a supportive cutaneous microenvironment. Methods A narrative review of the literature was conducted to summarize current regenerative approaches for vitiligo. The review focuses on cellular and non‐cellular replacement therapies, microenvironment‐modulating strategies, and hybrid multimodal interventions, with emphasis on the rationale and the clinical outcomes reported in recent studies. Results Regenerative therapies can be broadly categorized into cell‐based and cell‐free approaches. Cell‐based modalities include established modalities like cultured melanocyte transplantation, non‐cultured epidermal cell suspension (NCES), follicular melanocyte transplantation, and emerging stem cell‐based therapies. Cell‐free strategies aim to restore the melanocyte niche through both established and experimental modalities like platelet‐rich plasma, mesenchymal stromal stem cell‐derived products, exosomes, and cytokine‐modulating agents, including Janus kinase inhibitors. However, variability in treatment protocols and limited high‐quality randomized controlled trials remain important limitations. Conclusion Regenerative medicine represents a promising therapeutic frontier in vitiligo by integrating melanocyte replacement, microenvironment restoration, and immune modulation. Advances in stem cell biology, bioengineering, and precision dermatology may further refine these strategies and enable more durable repigmentation outcomes.
ABSTRACT Background Exosome and stem cell–derived products have rapidly gained popularity in dermatology, particularly in elective settings. Despite their expanding clinical and commercial use, exosome‐based therapies have yet to receive regulatory approval for dermatologic indications, and long‐term safety data remains limited. Objective To review the biological background, global regulatory frameworks, safety considerations, and ethical challenges associated with exosome‐based therapies in dermatology, with an emphasis on clinical decision‐making in elective settings. Methods A narrative review of current regulatory guidance, published clinical and preclinical literature, and ethical frameworks relevant to exosome and stem cell–derived products was conducted. Results Exosome‐based therapies do demonstrate potential regenerative applications in areas such as skin rejuvenation, wound healing, and hair restoration. However, substantial variability in cell sourcing, manufacturing processes, and product characterization makes standardization and regulation complicated. No exosome‐based products have received U.S. Food and Drug Administration (FDA) approval for dermatologic use. Reported adverse reactions, limited longitudinal follow‐up, and variability in international regulatory oversight highlight persistent translational and safety gaps. Conclusion While exosome‐based therapies represent an evolving frontier in dermatology, their integration into clinical practice should proceed with caution. Regulatory literacy, transparent informed consent, structured product evaluation, and evidence‐based clinical restraint are essential to ensure patient safety.
ABSTRACT Background Hybrid resurfacing lasers have emerged as a novel modality to deliver ablative and non‐ablative emissions simultaneously with reduced downtime and improved tolerability compared to traditional single‐wavelength technologies. Despite increasing clinical use, their efficacy and safety has not been comprehensively reviewed. Objectives To evaluate published clinical evidence on hybrid fractional laser systems combining ablative and non‐ablative wavelengths for dermatological applications. Methods A systematic search of PubMed was performed for English‐language clinical studies published from 1992 to 2025 assessing hybrid fractional ablative/non‐ablative lasers for cutaneous applications. Eligible study types included clinical trials, prospective or retrospective observational studies. Exclusion criteria included use of adjunctive procedures, non‐cutaneous treatment areas, preclinical studies, conference abstracts, case reports, and small case series (< 10 patients). Data was extracted on study design, device parameters, clinical outcomes, adverse events and patient satisfaction. Results Ten studies ( n = 344 patients; Fitzpatrick skin types I‐V) met inclusion criteria. Six studies addressed photoaging and four studies treated acne, traumatic, surgical or striae distensae scars. All studies demonstrated clinical improvements across validated aesthetic scales. Mean downtime was < 7 days in nearly all cohorts. The overall adverse event rate was 7.9% (23/291), predominantly transient post‐inflammatory hyperpigmentation. Patient satisfaction was consistently high and hybrid treatments were preferred over fractional ablative‐only resurfacing in comparative studies due to reduced discomfort, faster recovery, and similar or superior outcomes. Conclusions Current evidence supports hybrid fractional lasers as effective and well‐tolerated treatments for photoaging and scarring. Larger controlled trials with standardized parameters are needed to refine treatment algorithms and optimize ablative‐to‐non‐ablative emission ratios.
ABSTRACT Background Prebiotics, probiotics, postbiotics, and synbiotics have been increasingly investigated and incorporated into cosmetic formulations to preserve or restore skin health, function, and esthetics. Objective To review biotics applications in cosmetology, discussing their concepts, general characteristics, and potential benefits and limitations in modulating the skin microbiome and improving skin health. Methodology Literature searches were conducted on the PubMed, Web of Science, and Scopus databases to identify studies evaluating the role of biotics in skin health and dermatological applications. No language restrictions were applied, and studies published up to April 2025 were considered. Full‐text in vitro, in vivo, and clinical studies investigating topical prebiotics, probiotics, postbiotics, or synbiotics were included. Abstracts, reviews, editorials, letters, meta‐analyses, and conference proceedings were excluded. Analysis covered biotic category, study design, and microbiological and tissue‐related outcomes. Results The review sample included 60 studies. In vitro and in vivo evidence indicates that prebiotics, postbiotics, and synbiotics can reduce potentially pathogenic microorganisms, including Staphylococcus aureus , Cutibacterium acnes , and Corynebacterium spp., without negatively affecting—or in some cases promoting—the growth of commensal bacteria such as Staphylococcus epidermidis . Most studies reported antioxidant, anti‐inflammatory, and antimelanogenic effects, in addition to improvements in skin hydration and anti‐aging parameters. However, clinical evidence supporting the efficacy and safety of these compounds, particularly in disease‐related conditions, remains limited. Conclusion Further research, especially well‐designed in vivo and clinical studies, is needed to elucidate the long‐term effects, benefits, and limitations of biotics application on the skin and its microbiome. Despite their widespread use in cosmetic products, an evidence‐based approach is essential to ensure the efficacy and safety of biotic‐based formulations.
ABSTRACT Background Secondary intention healing (SIH) after Mohs micrographic surgery (MMS) is often limited by delayed closure, infection risk, and infrequent follow‐up. Traditional surface‐area assessments overlook wound depth. Re‐volumization, wound depth restoration, may better indicate healing progress. A novel, patient‐administered collagen–Mānuka honey–hydroxyapatite dressing (CHD) has demonstrated benefits in reducing pain and progressing healing. Objective Evaluate efficacy, safety, and satisfaction of CHD in at‐home SIH after MMS, emphasizing re‐volumization. Methods and Materials In this IRB‐approved prospective study, 10 adults with full‐thickness post‐MMS wounds applied CHD daily for 2 months via a durable medical equipment (DME) model. Wounds assessed by area, volume, photography, scar scales, and satisfaction. Safety monitored via adverse events. Results Baseline wound area and volume averaged 2.99 cm² and 2.35 cm³. Wound area decreased linearly; volume decreased exponentially, with 50% achieving full re‐volumization within 1 month and 90% achieving > 90% by 2 months. Investigators rated healing speed 8.0/10; patients rated 8.67/10. Pain was minimal, scar appearance favorable, and satisfaction high (8.25/10). Dressing was simple to use, empowering independent at‐home healing. One withdrew due to secondary adhesive irritation; no serious adverse events. Conclusion CHD is a suitable, affordable, patient‐administered option for SIH after MMS, demonstrating rapid re‐volumization, minimal pain, and high satisfaction.
ABSTRACT Background Androgenetic alopecia (AGA) is a great burden for patients. Treatments are limited to minoxidil, androgen blockers, platelet rich plasma, low level light or transplantation. These treatments are limiting due to side effects, and unpredictability. Recent studies display successful topical delivery and hair growth topicals with non‐invasive technologies such as ultrasound and radiofrequency. Aims Identifying safety and efficacy of plant‐based derived secretory factor (CFa1) hair serum scalp delivery by either ultrasound or radiofrequency microneedling (RFMN). Subjects The study included 20 subjects, ages 23–79 with Fitzpatrick I‐VI skin types experiencing AGA. Demographics included 45% male and 55% female subjects with 45% Caucasian, 35% Hispanic/Latino, and 20% Asian. Methods 10 subjects received radiofrequency microneedling (RF) before scalp product placement and 10 subjects received ultrasound after scalp product placement. The subjects received three in‐office treatments of the secretory factor hair serum spaced 4 weeks apart. Afterwards, all subjects applied the plant derived hair serum two times a day at home. Subjects were then asked to rate their improvement on a scale of 1‐ 5 at 3 and 6 months following treatment. Assessments included patient ratings, blind investigator analysis, quantitative image analysis, and histological analysis from biopsies taken before and after treatment. Results Both treatments resulted in improvement. Ultrasound displayed a more pronounced improvement in overall hair appearance, reduced shedding, hair density, thickness and color. Conclusions Secretory factor hair serum delivered by both RFMN and ultrasound, lead to improvements in hair and scalp health. This study suggests that US delivery may lead to greater improvement.
ABSTRACT Background Whenever multiple specimens are sent to a pathology lab for processing and interpretation, there are multiple potential points of error in the entire process. Every dermatologist has likely experienced receiving a pathology report in which, at some point, the specimens were misidentified. Mohs and “Slow Mohs” (Staged excision with permanent section margin control) offer precise tumor removal and a tissue‐sparing approach, but often require interpretation of several specimens from the same patient. Meticulous attention to mapping is absolutely necessary to maintain exact specimen orientation and identification. Sending specimens out for permanent section processing introduces more potential points in handling for error in specimen tracking and orientation, from mislabeling of bottles to mishandling or mix‐up of specimens once received by the processing lab. We present a variable tissue‐marking protocol to enhance patient safety and specimen identification, significantly reducing any potential for mapping or orientation error. Methods In our protocol, the surgeon intentionally alters the ink color combination for every section submitted. The surgeon inks the specimens immediately in the clinic room to maintain precise orientation and records these unique patterns in the patient's record and Mohs map. For example, if a Mohs‐type layer is sectioned into quadrants, the 12 o'clock cut is inked one color, the 3 o'clock another, and so forth. This results in four uniquely identifiable specimens that can no longer be misidentified or misoriented, eliminating a potential for error between practices. In our practice, for example, the inking is as follows: 12 o'clock blue, 3 o'clock green, 6 o'clock black, and 9 o'clock red. The first quadrant, 12–3 o'clock, is the only specimen with blue and green; the second quadrant, 3–6 o'clock, is the only quadrant inked green and black, and so forth. The specimens could all be mixed up or mislabeled, and the pathologist would still be able to interpret the mapping accurately. This ensures that each quadrant is accurately identified and mapped. Results This variable marking serves as a secondary unique identifier that provides a safety stop‐check for slide interpretation. By assigning distinct color sets to each specimen, the potential for mapping errors or patient‐specimen mismatches is essentially eliminated. Conclusion Utilization of unique color coding significantly enhances laboratory accuracy and patient safety. This simple protocol ensures the correct interpretation is accurately mapped to the correct location in staged excision specimen processing.
ABSTRACT Background Injectable poly‐D, l ‐lactic acid (PDLLA; AestheFill®) is a collagen‐stimulating biostimulator increasingly used for facial rejuvenation and skin‐quality improvement. AestheFill® consists of porous PDLLA microspheres suspended in sodium carboxymethylcellulose (CMC), a formulation that influences handling, early volumization, and tissue integration. Objective To summarize the composition, mechanisms, reconstitution/dilution methods, clinical efficacy and safety, complication prevention/management, and practical comparisons relevant to AestheFill®. Methods Narrative review of preclinical studies, clinical trials, case reports, and consensus/guideline publications addressing AestheFill® properties, in vivo tissue responses, clinical outcomes, and adverse‐event management, informed by structured database searching and reference‐list screening, with emphasis on clinically actionable preparation and injection protocols. Results Preclinical evidence shows localized persistence of PDLLA microspheres at the intended plane with progressive cellular infiltration and type I collagen deposition, supporting a scaffold‐to‐tissue replacement mechanism. Randomized evaluator‐blinded comparative trials in South Korea and China demonstrate noninferior nasolabial fold correction versus hyaluronic acid comparators with favorable short‐ and long‐term safety. Outcomes are technique‐dependent: initial reconstitution should use sterile water for injection to ensure complete CMC hydration; suspension thickness should be selected according to injection plane; and injections should be delivered as small, evenly distributed aliquots to reduce maldistribution‐related nodules. Accelerated reconstitution techniques (back‐and‐forth and vacuum‐assisted hydration variants) improve workflow and suspension homogeneity. Recent guidance emphasizes ultrasonography‐assisted diagnosis and staged management for AestheFill® nodules. Rarely, vascular occlusion may cause severe ocular or neurologic sequelae. Conclusions Available evidence supports injectable PDLLA as a collagen‐stimulating filler when reconstitution and anatomy‐driven technique are standardized; further comparative trials and standardized outcomes are needed.
ABSTRACT Background Growing regulatory and safety limitations of established tyrosinase inhibitors create an unmet need for safer, mechanistically distinct depigmenting agents. Glucuronyl Glucosyloleanolate (GGO), a natural saponin, was identified through an AI‐enabled discovery platform integrating public compound databases with in silico physicochemical and toxicity predictions. Methods GGO was evaluated in normal human epidermal melanocyte (NHEM) models for melanin inhibition and tyrosinase activity. Ex vivo activity was assessed in UV‐stimulated NativeSkin human skin explants. Safety was evaluated by semi‐occlusive patch test ( n = 12) and a validated GARDskin assay (OECD 442E). Clinical efficacy was assessed in a randomized, single‐blind, placebo‐controlled trial ( n = 60; 84 days; 0.01% twice‐daily application), stratified by Fitzpatrick phototype. Results GGO inhibited melanin production by up to 86% at 2 µg/mL in NHEMs, outperforming hydroquinone, kojic acid, niacinamide, and tranexamic acid. GGO did not directly inhibit tyrosinase, indicating a distinct mechanism. In UV‐stimulated explants, melanin content decreased 45% and tyrosinase expression by 2.4‐fold. No irritation (mean irritation index 0.00) or sensitization potential was detected. Clinically, GGO produced statistically significant increases in Individual Typology Angle (ITA°) from Day 21: 11% in phototype III, 14% in phototype IV, and 24% in phototype V at Day 84. Conclusions GGO is a safe and effective depigmenting ingredient with a differentiated, multi‐target mechanism of action. These data support its use as a clinically validated cosmetic active for skin brightening and hyperpigmentation management.
ABSTRACT Background Exosomes are nanosized extracellular vesicles of endosomal origin that mediate intercellular communication through the transfer of proteins, lipids, nucleic acids, metabolites, and other bioactive cargo. Their ability to regulate immune responses, tissue repair, angiogenesis, extracellular matrix remodeling, and cellular homeostasis has generated substantial interest in their diagnostic and therapeutic applications. Objectives To provide a comprehensive overview of exosome biology, molecular cargo, cellular sources, isolation and characterization methodologies, dermatologic applications, and emerging translational strategies relevant to regenerative medicine and dermatology. Methods A narrative review of contemporary literature was performed to summarize current evidence regarding exosome biogenesis, cargo sorting, cellular sources, isolation and characterization techniques, storage considerations, engineered therapeutic approaches, and clinical applications in dermatology. Results Exosomes are generated through the endosomal pathway and contain selectively packaged proteins, lipids, DNA, messenger RNAs, microRNAs, and other regulatory molecules that reflect the biological state of the parent cell. Mesenchymal stem cells, adipose‐derived stem cells, umbilical cord‐derived mesenchymal stem cells, platelets, fibroblasts, and keratinocytes have emerged as important exosome sources for regenerative applications. Advances in isolation technologies, including ultracentrifugation, size‐exclusion chromatography, immunoaffinity capture, and microfluidic platforms, have improved extracellular vesicle characterization and translational research. In dermatology, exosomes have demonstrated promising applications in wound healing, skin rejuvenation, hair regeneration, scar modulation, pigmentary disorders, inflammatory dermatoses, and cutaneous oncology. Furthermore, bioengineering approaches have enabled the development of exosome‐based drug delivery systems, targeted therapeutics, and hydrogel‐assisted delivery platforms. Conclusions Exosomes represent a rapidly evolving platform for precision diagnostics, regenerative medicine, and targeted therapeutics. Their unique biological properties, favorable safety profile, and cell‐free therapeutic potential position them as promising candidates for future dermatologic applications. However, challenges related to standardization, large‐scale manufacturing, characterization, regulatory approval, and long‐term safety must be addressed before routine clinical implementation can be achieved.
ABSTRACT Background Aesthetic dermatology is increasingly framed within a skin longevity paradigm that emphasizes sustained skin quality and functional preservation rather than short‐term cosmetic change alone. This review looks at evidence relevant to skin longevity, integrating biologic mechanisms of skin aging, approaches to outcome measurement, exosomes and lifestyle contributors, as well as key safety and regulatory considerations. Most outcomes discussed reflect surrogate, short‐term, or cosmetic measures rather than validated indicators of long‐term skin health, and this limitation is discussed explicitly. Methods This is a narrative (non‐systematic) review; a targeted PubMed/MEDLINE search (January 2015–May 2026) and a validated evidence‐grading framework (GRADE) were used, as detailed in the Methods. Extracellular matrix remodeling and collagen depletion, oxidative stress, chronic low‐grade inflammation, cellular senescence, and reduced reparative capacity consistently link to clinical dyspigmentation, photodamage, textural change, laxity, and dermal thinning and/or volume loss. Skin healthspan is measured across studies, using approaches that include photoaging scales, standardized photography, patient and investigator assessments, and objective measures such as hydration, transepidermal water loss, and elasticity. Results Interventions are reviewed, including prevention, topical therapies, energy‐based devices, injectables, and emerging regenerative or biologic approaches, with the most consistent evidence supporting prevention and well‐studied topicals. Procedural and regenerative modalities show greater variability in durability, safety, and evidentiary maturity. Conclusion Based on the integrated literature, a phenotype‐guided approach may help operationalize skin longevity in clinical practice. Patients can be stratified according to dominant aging patterns, including photodamage, texture change, laxity, or volume loss, with interventions selected to address both upstream drivers and downstream structural consequences.
