Targeted Exosomal Cargo Delivery Versus Complex Growth Factor Profiles of Platelet-Rich Plasma Via Energy-Based Microchannels for Cutaneous Regeneration: A Systematic Review and Meta-Analysis

Introduction Exosome-based therapy and platelet-rich plasma (PRP) are competing regenerative modalities for cutaneous remodeling when delivered through energy-based microchannel devices, yet head-to-head comparative evidence across dermatologic indications remains fragmented. This systematic review and meta-analysis evaluated the relative efficacy of device-assisted exosome therapy versus device-assisted PRP versus energy-based device alone for atrophic acne scarring, facial photoaging, and pigmentary disorders. Method PubMed, EMBASE, Scopus, and Web of Science were searched from inception to 10 April 2026 following the PRISMA 2020 guideline. Randomized and non-randomized studies of adults receiving exosomes or PRP via fractional laser, radiofrequency microneedling, mechanical microneedling, or related devices were eligible. Study selection, extraction, and risk-of-bias appraisal (RoB 2; ROBINS-I) were performed independently and blindly. Random-effects meta-analyses with Hartung–Knapp–Sidik–Jonkman adjustment were conducted in R, with heterogeneity quantified by τ² and I². Results Thirteen studies (n = 354) were included. For atrophic acne scarring, the pooled standardized mean difference (SMD) was −0.28 (95% CI: −1.17 to 0.62; I² = 78.6%). For facial photoaging and rejuvenation, the pooled SMD favored treatment at 0.75 (95% CI: 0.45 to 1.05; I² = 0%; P = 0.0041). For pigmentation, the pooled SMD was 2.20 (95% CI: −1.91 to 6.32; I² = 93.9%). Overall risk of bias was low to moderate. Conclusion Device-assisted regenerative therapy consistently improves photoaging outcomes, whereas effects on acne scarring and pigmentation remain heterogeneous.