Regenerative experts weigh in on anti-ageing options

At the recent Aesthetic Medicine and Surgery Conference 2025, a panel of four aesthetic specialists weighed in on exosomes and stem cells in anti-ageing procedures. The panel consisted of Dr Michael A. Pascuale, a leading surgeon and stem cell expert in Honolulu, US; aesthetic doctors Dr Audrey Lim Soo Yen and Dr Kelvin Tan Chee Ling, and Daniel Looi, a research scientist specialising in stem cells.  

Not all stem cells are equal
Pascuale discussed the future of cellular medicine and its potential to replace many surgical procedures. He highlighted the Hawaii Stem Cell Treatment Centre’s experience with over 1,000 cases since 2013. Stem cells act as repair cells, recognising and repairing injured tissues through growth signals and factors.

Pascuale explained the differences between embryonic and adult stem cells, emphasising adult stem cells’ therapeutic potential and preferred use in medical use. Embryonic stem cells are pluripotent and can become any type of cell, including tumour cells, making them less suitable for clinical use. Conversely, adult stem cells can renew themselves and differentiate into specific types of cells, such as muscle, blood, and liver cells.

He detailed the process of extracting and concentrating stem cells from fat using liposuction and enzymes, resulting in a stromal vascular fraction (SVF). Case studies showed significant improvements in facial aesthetics and scar treatment with stem cell injections, highlighting the effectiveness of stem cell therapy. Positive outcomes include reduced nasolabial folds, improved skin texture and reduced melasma. He also discussed the use of stem cells in treating scars, showing before and after images of a patient with significant improvements.
Pascale predicted that in 15-20 years, surgical procedures may become obsolete due to advancements in cellular medicine and envisioned a future where minor surgeries can be replaced by simple treatments like applying peptides to regrow tissues.

The power of exosomes

Tan, an aesthetic doctor with over 15 years of experience in hair restoration and regenerative medicine, discussed the use of exosomes in hair restoration. Exosomes are nano-sized extracellular vesicles secreted by various cell types, including mesothelial stem cells and adipocyte stem cells. Exosomes are important as their cargo, which includes microRNAs, mRNAs, and proteins, are shown to modulate recipient cell behaviour, promoting hair growth and suppressing inflammatory pathways.

He overviewed the hair follicle cycle and the role of various cells in maintaining hair growth. Hair loss is separated into androgenetic alopecia and non-androgenetic alopecia. Key signaling pathways and genetic markers responsible for hair loss include the Wnt, Sonic Hedgehog (Shh), TGF-beta, Notch, and Bone Morphogenetic (BMP) pathways. He then introduced exosomes as a therapeutic treatment for hair loss, with a focus on their intercellular communication.

Studies show that exosomes derived from fat stem cells and mesothelial stem cells improve hair density and scalp integrity. Additionally, combining exosomes with platelet-rich plasma (PRP), low-level laser therapy (LLLT), and oxidation boosts their efficacy. Interestingly, Tan alluded to plant-based exosome formulations that have shown promising results in increasing hair counts over 16 weeks. However, Tan cautioned that not everyone can use exosomes for therapy. Contraindications for exosome therapy include active scalp infections, pregnancy, breastfeeding, uncontrolled medical illnesses, and active malignancies.

Tan highlighted the criteria for safe exosome use, which include non-tumour-derived sources, proper purification methods, and standardised regulatory compliance. Also, to determine product purity and potency, a positive test for exosome markers such as CD63, CD81, TSG101, and CD100 should be done.

Lim, a family physician with expertise in aesthetic dermatology, discussed the clinical applications of exosomes in skin rejuvenation and immune-related skin conditions. Exosomes, ranging from 50 nm to 200 nm, play a crucial role in intercellular signalling, tissue homeostasis and cell regeneration. They act through growth factors and microRNA pathways, promoting tissue regeneration, inflammation control, and immune modulation with each of these playing different roles in various skin conditions.

The growth factor pathway mediates intercellular communication and promotes tissue regeneration. It also regulates the signal pathways for immune modulation, inflammation control, cellular proliferation, and tissue repair. Meanwhile, the microRNA pathway plays an important role in skin whitening, scar removal, hair growth, anti-ageing, and immune-related conditions.

Lim shared case studies demonstrating the efficacy of exosomes in treating conditions like dry skin, acne scars, and diabetic foot ulcers—all resulting in improvements in skin texture, hydration, and wound healing. She emphasised the importance of selecting high-quality exosomes for therapeutic applications.

The source matters

Looi, a research scientist specialising in stem cells, identified consistency as a major challenge in exosome treatment, with inconsistent results across different patients. The inconsistency can be attributed to the variability in stem cells and the different methods of isolating and preserving exosomes. Due to this problem, Looi emphasised the need for reliable exosome products, at the same time questioning the purity and concentration of exosomes available in the market.

Exosomes are usually extracted from cord blood. With this in mind, Looi alluded to the importance of understanding the location of the cells from which exosomes are isolated i.e., the foetal, middle, and maternal ends of the cord. An existing study shows that that stem cells from the foetal end grow faster and differentiate better than those from the maternal and middle ends. Beyond the source and origin of the exosomes, Looi also stressed the significance of using the right culture media and avoiding the use of animal-derived nutrients to maintain cell purity and functionality.

Currently, Looi is involved in a clinical case series being conducted in collaboration with a university involving 15 subjects monitored for over 6 months. The study includes parameters like pore size, wrinkle elasticity, and ultraviolet (UV) spots, with data still in the drafting stage. The research process involved patient screening, consultation, pre-treatment documentation, and monthly measurements using a Janis skin analyzer. The study aimed to measure the effectiveness of the treatment protocol, with significant reductions in UV spots observed over a 6-month period.

Stem cells and exosomes are becoming increasingly popular as regenerative tools in aesthetic medicine, with the potential of cutting the need for surgery. Nevertheless, the mainstreaming of these therapies is reliant upon overcoming of critical challenges such as quality control, sourcing, and standardisation.

Key takeaways:
1. Adult stem cells are preferred due to their therapeutic potential and lower risk of tumour formation compared to embryonic stem cells. Adult stem cells extracted from fat cells are being used to treat scars, melasma, skin texture issues, and facial ageing.

2. Exosomes promote hair growth by modulating cell behaviour and signalling pathways. They improve hair density, scalp integrity, and work well in combination with other therapies like PRP and LLLT. High quality exosomes must be non-tumour-derived, purified correctly, and tested for markers like CD63 and CD81.

3. Variability in exosome treatment results is due to differences in stem cell sources, isolation methods, and preservation techniques. Exosomes from the foetal end of cord blood stem cells perform better than those from maternal or middle ends.