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Exosomes in Plastic Surgery

We recently had a series of inquiries from prospective patients who wanted to have ‘exosome’ cosmetic treatment. Given this recent trend (as of late 2020), we decided to post on our blog here to shed a little light on the whole concept of exosome treatment in plastic surgery.

What Are Exosomes?

So what are exosomes? They are microscopic particles that get released from a cell and, simply put, signal surrounding cells to change their biological behavior. Think of exosomes as basically messengers that influence the behavior of cells in the region where they are present by signaling some sort of response. Exosomes include agents like proteins, growth factors, mRNA, cytokines, enzymes, etc. Once released into the surrounding area, exosomes can influence the biological behavior and activity of the surrounding cells – thus they have huge potential in terms of cell repair, rejuvenation and healing.

Exosomes have become increasingly popular as of late because they are a buzzword in the world of ‘regenerative’ medicine – especially in the arena of cosmetic regenerative medicine. Regenerative medicine refers to any number of varied cosmetic treatments that are purported or intended to help biologically turn back the clock – literally. These include cosmetic interventions that have the potential to regenerate certain cells in an attempt to reverse the aging process or optimize wound healing. So, for example, exosomes are touted as a great option to place on open wounds (such as after a laser skin resurfacing procedure) to help speed up healing and/or make the healing process more ideal.

What About Stem Cells?

So what about stem cells and how do they relate? Exosomes are basically the messengers that get released from stem cells to signal change in other cells. Think of the exosomes as being a more specific type of cell-to-cell targeting while stem cells are more non-specific and generic in their remodeling capabilities.

Stem cells are all the rave right now in plastic surgery (and other fields) because of their potential to help regenerate tissue and reverse aging. But isolating true stem cells is a laboratory process that currently is not feasible to do in your average clinical setting. For example, when fat is taken out of the body there are two main components – (1) the actual fat cells, or adipocytes and (2) what is called the stromal vascular fracture, or SVF. The stem cells are largely contained in the SVF, which has to be isolated away from the adipocytes to generate the stem cells.

So, if you are reading online that a particular plastic surgery clinic is using ‘stem cells’ to treat certain conditions, it is in all likelihood not exactly true. In most instances, the surgeon is harvesting fat from one area of the body and placing it in another – called fat transfer. Now fat contain a number of stem cells and stem cell attractants, which can help in the healing process. These are sometimes referred to as adipose (fat) derived mesenchymal stem cells. However, when this procedure is being performed, the surgeon is not injecting a concentrated, isolated solution of stem cells – they are just one component of what is being injected or transferred.

Most scientific studies looking at the potential of stem cells to regenerate tissue utilize a concentrated batch of stem cells. And this process requires an elaborate series of steps – usually done in a laboratory – to isolate the actual stem cells. Although fat transfer does contain stem cells, they are not isolated and concentrated as you would find in the laboratory process of deriving stem cells. Therefore, it is very challenging – and inaccurate – to say that undergoing fat transfer stem cell treatment is the same as true stem cell treatment.

Legality of Exosomes

Unfortunately, although the potential for exosome treatment for cosmetic surgery patients has been scientifically proven, the reality is that we still do not have the ability to do this in a predictable – and legal – manner. The use of exosomes does fall under the umbrella of the FDA – which, as of this blog date, has not approved their use. So anything that you read online right now regarding treatments with exosomes to act regeneratively as a cosmetic enhancement is, quite frankly, illegal.

Some plastic surgery clinics and medical spas have skirted this FDA issue by stating that topical use of exosomes – to accelerate healing or to improve skin wrinkle formation – is more or less equivalent to using a cosmetic skincare product. However, the FDA clearly states that this is not the case and that exosomes – and their biological potential to affect skin and soft tissue – have more serious potential implications than a simple cosmeceutical agent.

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