In 2022, the global beauty market – defined as skincare, fragrances, makeup and haircare – generated around $430 billion in revenue, according to McKinsey & Company.1 By 2027, the overall beauty market is expected to reach $580 billion, with the fastest growth occurring in the premium skincare market.
Used as stand-alone therapy, and incorporated before, during and after device-based treatments, the well-established synergistic relationship between topical skincare and cosmetic procedures continue to evolve and expand. One of the most talked-about new entrants to the U.S. market – exosome-based topicals – join an array of newer preparations featuring growth factors, stem cells and even polydioxanone (PDO).
“As new product categories such as regenerative medicine-based approaches are introduced into topical skincare, it is important to recognize their independent mode of action,” explained Saranya Wyles, MD, PhD, dermatologist and assistant professor of dermatology and regenerative medicine at the Mayo Clinic* (Rochester, Minn.). “It could disrupt the dogma that a multi-step regimen is needed. Perhaps the same purposes can be achieved with fewer products, or one “holy grail” product,” she continued.
Exosomes & Growth Factors
Along with time-honored ingredients such as retinoids, Dr. Wyles said, newer regenerative products such as extracellular vesicles or regenerative nanotechnology, also called exosomes, may perform multiple skincare functions. However, she noted, product effects vary considerably based on their sources.
Popular exosome sources for cosmetics include platelets, mesenchymal stem cells and plant based. “Platelet-based technology contributes to ideal regeneration, as platelets play a key role in skin rejuvenation, wound healing and other mechanisms,” Dr. Wyles reported.
In a study conducted at her practice, patients aged 40 to 80 years old who used ( plated ) INTENSE Serum, a platelet-based exosome skincare line by Rion Aesthetics, Inc. (Rochester, Minn.) ,for six weeks experienced significant improvement in clinical signs of photo-aging, as did a younger cohort that used ( plated ) DAILY Serum.2 Both products can be used alone, mentioned Dr. Wyles, but can also enhance post-procedure results. In a pilot study, patients who used ( plated ) CALM after CO2 facial resurfacing experienced significantly less crusting and downtime, with brighter and younger-looking skin, than patients who used silicone gel.3
AnteAGE MDX® Exosome Solution by AnteAGE (Irvine, Calif.) can be used in combination with microneedling, radiofrequency (RF), laser and other ablative treatments. This first-of-its-kind hybrid exosome solution is derived from multiple types of human-derived stem cells – bone marrow mesenchymal stem cells and umbilical cord mesenchymal stem cells. Packed with 10 billion viable exosomes per vial, AnteAGE MDX delivers a powerful, potent, ultra-pure exosome treatment solution.
Desmer Destang, DDS, MSc, medical director of Dermalogics Aesthetic Dermatology in St. Lucia, Caribbean, said that she swears by Exosome Regenerative Complex from BENEV (Mission Viejo, Calif.) because it is a cutting-edge product with scientific data showing that it provides skin rejuvenation.4,5 The product comprises powdered exosomes that one mixes into a solution containing hyaluronic acid and peptides. “Once placed topically on the skin, the exosomes speed up the healing process and reduce complication rates,” she noted. “The product also complements many other treatments that Dr. Destang offers. “We love to do anti-inflammatory red light-emitting diode as well.
With the exosomes, patients see faster results in terms of improvement in their skin quality. Within a week of treatment, 90% of patients are thrilled with the results.” According to Dr. Destang, the product also reduces incidence of reactionary hyperpigmentation on patients with darker skin.
The ELEVAI E-Series™ products, empower and enfinity by ELEVAI Labs (Newport Beach, Calif.), provide both post-treatment skin support and ongoing daily aftercare. Both products contain exosomes; ultrasmall, nanoparticle compartments packed with growth factors known to support skin health.
“I have used other exosomes; however, I have settled on routinely using ELEVAI products as an adjunct not only post-laser skin resurfacing but for all procedures that break the skin barrier, such as microneedling and lasers,” said Kristine Romine, MD, a dermatologist in Scottsdale, Ariz. ELEVAI’s science leads the exosome space, she said, because the exosomes come from age zero stem cells without the use of any animal components or animal testing. Most exosomes on the market are sourced from individuals of unknown age or health, use animal products in their manufacture, or come in a format that is not well designed for topical cosmetic use — the only way that adheres to FDA guidelines, she expressed.
“Presently, the only exosome-based products available in the U.S. are intended to improve the skin’s appearance and should only be applied to intact skin. Nevertheless, some U.S. physicians are already injecting exosomes offlabel,” said Shino Bay Aguilera, DO, a dermatologist in Fort Lauderdale, Fla.
Trials for specific FDA-sanctioned medical indications are ongoing, Dr. Wyles emphasized.
EGF Fortify + Regenerate Ampoule by Martinni Beauty (Richmond, Calif.) is a potent skin-saving aftercare ampoule that helps to improve skin density, smooth creases and strengthen the skin barrier. This ampoule contains plant stem cells and sea fennel extract, which together target lines, wrinkles, hyperpigmentation and devitalized complexions. Results include a replenished youthful radiance. Epidermal Growth Factor promotes cell growth and regeneration. It can help to reduce the appearance of wrinkles, fine lines and age spots, as well as improve the overall texture and tone of the skin. Plant stem cells help promote cell regeneration. This can help to reduce the appearance of wrinkles and fine lines. Sea fennel extract is a natural antioxidant that can help to protect the skin from damage caused by free radicals. This can help to prevent premature aging and keep the skin looking youthful.
Pro-Max Age Renewal from PCA Skin (Phoenix, Ariz.) is an advanced anti-aging serum clinically proven to lift and firm the appearance of skin by 60%*. While conventional growth factors sit on the surface of skin, the patentpending micro growth factor (MGF) technology penetrates 10x deeper than conventional growth factors** to support collagen production and reduce the appearance of sagging, loss of volume, lack of firmness and wrinkles with clinical results starting in one week.
Treating Skin of Color
“For darker skin, I tend to avoid glycolic acid products, Dr. Destang shared. “Glycolic acid has a tiny molecular size, which burns through the skin.” For example, if a patient with acne applies glycolic acid, followed by benzoyl peroxide, “we found that often, especially in a region or area that has a very high UV index, these patients develop hyperpigmentation in the area where they used the combination treatments.” Conversely, she said that salicylic acid, lactic acid and mandelic acid are gentler on darker skin.
Dr. Aguilera added that A-luminate Brightening Serum by Alastin (Carlsbad, Calif.) is safe and effective for skin of color because it has been shown to outperform 4% hydroquinone.6
Skin Biome Fortification
“The current health of your skin determines what kind of treatment results you are going to see,” said Doris Day, MD, a dermatologist in New York City, N.Y. “I am huge on combining SkinPen microneedling from Crown Aesthetics (Dallas, Texas) with skin-biome safe skincare like the newly launched BIOJUVE,” she continued. “SkinPen works by penetrating the surface of the skin to stimulate collagen production, while BIOJUVE will support a healthy skin microbiome to enable healing and maintain your results.” The Cutibacterium acnes defendens (C. acnes defendens) featured in BIOJUVE supports a healthy skin environment, helps with skin hydration, decreases redness, regulates sebum production and reduces the appearance of fine lines and sun damage – all in about eight weeks.7
Collagen and Elastin Boosters
Act O’ Feel by MedResults (Glendale, Calif.) is a CE-approved anti-aging serum that helps gradually renew damaged and lost collagen for results that can last up to 24 months. MedResults has discovered high-end skin protocols capable of driving real biostimulation (Act O’ Firm).
Activating the CD44 receptors provides skin cells with the necessary ingredients to build collagen, elastin and glycosaminoglycans. MedResults also offers an advanced formula for biorestoration of very mature and wrinkled skin with the Act O’ Reverse product. The products’ sterility makes them ideal for use during or after treatments such as Plexr, fractional lasers and microneedling, facilitating the delivery of benefits deep into the skin, said Robert Fischer, MD, medical director of Finesse MediSpa in Fair Lawn, N.J. “Over 95% of our patients report more satisfaction when I use Act O’ Feel in their procedures. I recognized faster recovery in my laser-based or Plexr treatments as well.”
FF3 Biointensive GF by Vivant (Miami Lakes, Fla.) uses green fluorescent protein (GFP) Complex to promote neocollagenesis, organize collagen fibers and regulate cell turnover, leaving estrogen-depleted skin feeling plumper. GFP Complex joins retinoid and growth factor technology with select amino acids and alpha hydroxy acids to repair the skin’s support matrix at the cellular level. In 90 days, users have experienced significant improvement in skin elasticity and visible improvement in skin texture.8
FF3 can be used safely around the mouth, neck, decolletage, and under the eyes, where many other products often cause burning and peeling, said Ana Lamas, MD, an allergist in Miami, Fla. “The moisture seeps into the layers deep into the skin so that the skin becomes plump and fresh. The sallow, dull appearance of older skin gives way to a smoother, fresher and healthier appearance. Saggy, thin skin tightens as it plumps, helping diminish jowls, indistinct jawlines, fine lines and deep wrinkles.”
PDO AfterGlo™ by PDO Max (Liverpool, N.Y.) is the first polydioxanone (PDO) topical serum skin booster, designed for patients with skin laxity and texture issues, and who could use a boost of collagen. “PDO AfterGlo is my top choice to combine with medical microneedling, RF microneedling and lasers because it is safe for every Fitzpatrick skin type.
If I can improve every concern possible with this ‘magic potion’ as opposed to addressing hydration, wrinkles or pigmentation, separately the choice is obvious,” said Hulnara Castellon, FNP, MSN, founder of Uplifted Aesthetics in Redondo Beach, Calif.
PDO AfterGlo is a hydrating skin booster made of PDO in powder form and hyaluronic acid (HA). PDO threads, which are composed of the same biodegradable polymer as this new serum, and aid in the production of collagen, have been safely used in various surgeries for more than 30 years. HA can smooth rough surfaces and provide a protective layer to help skin retain moisture. It also strengthens skin to improve elasticity and resilience. Ms. Castellon reported an improved appearance of fine lines, wrinkles, dark circles and skin complexion after use.
Pretreatment Prep
To prepare patients’ skin before procedures, Dr. Aguilera recommends Alastin Regenerating Skin Nectar. “Alastin Nectar cleans the debris on the extracellular matrix to create room for new collagen formulation.” In fact, he said, using this product for two weeks to prime skin for energy-based and microneedling procedures has become the gold standard for most U.S.- based aesthetic physicians. He also recommends it before biocollagen stimulators such as poly-L-lactic acid.
*Disclaimer: Dr. Wyles’ comments reflect her own views, not those of Mayo Clinic
References:
1. McKinsey & Company. The state of fashion: beauty. https:// www.mckinsey.com/industries/retail/our-insights/the-beautymarket-in-2023-a-special-state-of-fashion-report. May 2023. Accessed July 23, 2023.
2. Wyles SP, Proffer SL, Paradise CR, et al. Efficacy and tolerability of topical platelet exosomes for skin rejuvenation: six-week results. Aesthet Surg J. 2022;42(10):1185-1193. doi: 10.1093/asj/sjac149. PMID: 35689936.
3. Dayan S, Gandhi N, Wilson J, et al. Safety and efficacy of human platelet extract in skin recovery after fractional CO2 laser resurfacing of the face: a randomized, controlled, evaluator-blinded pilot study [published online ahead of print, 2023 Jul 7]. J Cosmet Dermatol. 2023;10.1111/jocd.15914. doi:10.1111/jocd.15914
4. Ha DH, Kim HK, Lee J, et al. Mesenchymal stem/stromal cell-derived exosomes for immunomodulatory therapeutics and skin regeneration. Cells. 2020;9(5):1157. Published 2020 May 7. doi:10.3390/cells9051157
5. Cho BS, Lee J, Won Y, et al. Skin brightening efficacy of exosomes derived from human adipose tissue-derived stem/stromal cells: a prospective, split-face, randomized placebocontrolled study. Cosmetics. 2020; 7(4):90. https://doi.org/10.3390/cosmetics7040090
6. Wang J, Fabi S, Robinson D, et al. A multi-center, randomized, blinded clinical study evaluating the efficacy and safety of a novel topical product for facial dyschromia. J Drugs Dermatol. 2023;22(4):333-338. doi:10.36849/ JDD.7340
7. Rhee MS, Alqam ML, Jones BC, Phadungpojna S, Day D, Hitchcock TM. Characterization of a live Cutibacterium acnes subspecies defendens strain XYCM42 and clinical assessment as a topical regimen for general skin health and cosmesis. J Cosmet Dermatol. 2023;22(3):1031-1045. doi:10.1111/ jocd.15510
8. FF3 Technology. Vivant. https://www. vivantskincare.com/pages/about-ff3. Accessed July 23, 2023.
