I got my first zit in elementary school. It popped up one morning right in the middle of my nose, shiny and painful. I said it was a spider bite, but knew it was a zit because my mom had adult acne and I’d been bombarded by Clearasil commercials since I was 4. Several years later, I would start getting acne in earnest. During puberty, little pink spots bloomed across my jaw, and I spent my teens slathering foundation over the huge, hard lumps that grew on my cheeks and forehead. I tried everything — oral antibiotics, prescription creams, birth control, DIY face masks. None of it helped. In my early 20s, I found a good dermatologist who put me on Accutane without asking too many questions. It was annoying and took six months, but my skin finally cleared and I was, for the first time in years, acne-free.
But one thing I’ve never been able to get rid of is the scarring. Ten-plus years of acne, much of it cystic, left pitting and discoloration across my cheeks. I use powerful prescription creams that improve the texture of my skin, and it looks good, but I figured I’d always have the marks. When I complained about this to my aesthetician, he mentioned exosomes. It wasn’t the first time I’d heard of them. When I was in Tokyo last year, a group of my girlfriends took a flight to Seoul to get exosome facials, and my mother-in-law, a barely-lined 60-year-old Japanese woman, told me she gets an exosome treatment once every six months. But exosomes have only caught on in the States in the last few years: Last year, Elle said they might be “bigger than Botox,” Allure recommended them to people who wanted skin rejuvenation with no downtime, and a Coveteur writer said microneedling with exosomes made her skin appear years younger. Here’s what happened when I tried them.
What are exosomes?
Exosomes are the tiniest part of a stem cell. The ones I used came from Resilielle, which extracts them from stem cells derived from umbilical-cord tissue collected by a tissue bank from donors right after a healthy birth. You can think of exosomes as “little packages filled with various materials like nucleic acids, growth factors, proteins, lipids, and other cell signals to help repair the tissue as fast as possible,” says Dr. Anna Avaliani, who started using exosomes in her Upper East Side dermatology practice on patients’ hair and skin two years ago.
When applied to skin, exosomes are used in conjunction with other treatments to speed up downtime and improve results. Avaliani explains that exosomes alone don’t do anything. They only come into play after being activated, which is why treatments usually involve “creating controlled injury like microneedling or lasering.” They don’t generate collagen on their own, but once healing begins on the injury, exosomes speed up and buoy the collagen-production process. My provider, Akis Ntonos, explained that the size of exosomes are part of why they’re so effective: “They’re about a thousand times smaller than a grain of sand — they can easily diffuse into tissues and impact healing more effectively.” For people past their mid-20s (when collagen production slows down and the skin can’t repair itself as quickly or effectively), exosomes can make the skin act younger. The idea, explains Dr. Jennifer Levine, a New York–based plastic surgeon who has also been using exosomes on patients for several years, is to “restore the skin to factory settings, so you go back to a time where you did it better.”
What is exosome therapy like?
I tried exosomes in combination with microneedling, which involves perforating the skin with a superfine needle. I had three sessions over the course of six months, and each lasted about an hour. First, my skin was wiped clean, then lidocaine cream was applied to numb the face (if you’ve never experienced this before, be warned — the sensation of having no nose is peculiar, but the effects only last about two hours.) Once I was completely numb, about 30 minutes later, my skin was cleaned again and then microneedled. Ntonos used the SkinPen, an FDA-approved device that created thousands of tiny puncture wounds on the surface of my skin. It took about two minutes, and since I was properly numbed, it didn’t hurt — I just felt a bit of pressure around sensitive, bony areas, like my cheekbones. Afterwards, Ntonos used a dropper to apply the exosomes directly to my skin. They come in a clear, cool saline solution, and feel a little slimy, like hyaluronic acid.
And then I was done. I was pink for about six hours after the treatment, but my face looked totally normal the next morning (in contrast, microneedling without exosomes once left me beet-red for three days).
How were the results?
After one session, I didn’t notice much. After the second, the pitting on my cheeks, where I have the worst scarring, seemed to lighten and fill. I’m now two months past my third treatment, and my scarring has continued to improve; there’s still some hyperpigmentation, but it’s less noticeable. The changes weren’t drastic, but of the many facials I’ve had over the years, it seems to have improved scarring the most, and I’d probably get it again.
That said, be wary of claims that exosomes are the fountain of youth: They are not FDA-approved, and the potential effects are still being researched. If you’re interested in trying them, you should first consult with your dermatologist and ask where your exosomes come from. Some exosomes on the market are derived from plants and animals, which are cheaper and less effective than human-derived exosomes. Human-derived exosomes also vary in quality and can be extracted from many sources, including bone marrow and placental tissues. Dr. Michael Heke, a longtime stem-cell researcher and chief scientific officer of Resilielle, says that exosomes obtained from umbilical-cord secretions are considered the gold standard since they have “‘just finished building a human, and are the youngest, freshest, and most potent” cells available, though Avaliani has seen excellent results with placental cells. You should also ask how your exosomes are tested — for example, the ones I used were tested by a CLIA-certified lab, a federal designation that ensures quality testing. And you should pay attention to prices — in New York, microneedling with exosomes starts north of $800, and anything less than that might be a red flag.
My skin has been acting differently in the months since the treatments. It seems to be purging more frequently; every few weeks in the shower, I have to slough off a layer of dead skin. Afterwards, my face feels tender and I look like I’ve been peeling from a sunburn. This could be due to a lot of things — cold weather, a recent laser treatment — but it might also be the exosomes, which, after all, are kind of a science experiment on my face. And take it from someone who has been fighting with their skin for 15 years: At the end of the day, nothing is as effective as sunscreen, lotion, and eight hours of sleep.
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