Clinical Outcomes of Exosome-Augmented Microneedling and Laser Therapies in Full-Face Skin Rejuvenation: A Split-Face Observational Study

Objective: To compare clinical outcomes of full-face rejuvenation using microneedling, fractional CO 2 laser, and picosecond laser—each with and without exosomes—and to assess exosome delivery efficacy. Methods: Nine women (aged 30–50) received split-face treatments: one side with an energy-based modality plus exosomes (Sihler X, Sihler Inc., Seoul, Korea), the other with the modality alone. Standardized 3D imaging, Global Aesthetic Improvement Scale (GAIS), and Patient Satisfaction Scores were recorded at 30, 90, and 180 days. Treatment settings were consistent. Results: All patients completed follow-up without serious adverse events. Exosome-treated sides showed greater improvements in texture, hydration, elasticity, and pigmentation. The most notable gains occurred with microneedling + exosomes and CO 2 laser + exosomes. In the picosecond laser group, dermal density and satisfaction improved on both sides, though differences between exosome-treated and untreated areas were smaller—possibly due to pinpoint bleeding reducing exosome absorption. At 180 days, GAIS scores were highest for picosecond laser (mean 4.2), followed by CO 2 laser (4.0) and microneedling (3.5). Conclusions: Exosomes enhanced skin rejuvenation with microneedling and CO 2 laser. Picosecond laser showed strong results overall, though exosome benefit was less distinct. Larger studies are warranted to optimize delivery and confirm long-term regenerative effects.