{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:49:33Z","timestamp":1790833773942,"version":"4.1.0"},"reference-count":45,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T00:00:00Z","timestamp":1680048000000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Exosome research continues to flourish. Subsequent knowledge surrounding indications, dose\u2013response, safety, efficacy, and the ability to combine exosome treatment as a \u201cskin primer\u201d\u2014for biostimulation modalities such as calcium hydroxylapatite (CaHA), platelet\u2010rich plasma (PRP), and platelet\u2010rich fibrin matrix (PRFM) is growing rapidly. The objective of this study was to develop safe, reproducible methods of improving topical exosome absorption to enhance the quality of skin either by themselves, or in combination with injectable CaHA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Under IRB Approval (International Cell Surgical Society: ICSS\u20102022\u2010007), 40 patients were enrolled in this study. Twenty patients underwent facial biostimulatory dermal infusion alone, to determine if this method allowed adequate exosome absorption. Five patients underwent facial biostimulatory infusion followed immediately by Dilute CaHA injection (1:1 dilution) to the face. Five patients underwent exosome biostimulatory dermal infusion followed immediately by hyperdilute CaHA (dilution 1:4) injection to the neck. Five patients underwent Facial Dilute CaHA injection (1:1 dilution) alone, without dermal infusion. Five patients underwent neck hyperdilute CaHA injection (1:4 dilution) alone, without dermal infusion. All patients had pretreatment Quantificare 3\u2010D photo\u2010documentation and skin analysis (Quantificare, France). In all patients, the skin was first cleansed with a gentle glycolic acid facial wash (Gregory MD). To induce a \u201choming inflammatory environment\u201d for the exosomes, sea salt exfoliation was performed (SaltFacial\u00ae, SaltMed, Cardiff, CA). A nitric oxide\u2014generating serum (N101 Pneuma Nitric Oxide, Austin, TX) was then applied to act as an enhanced vehicle for absorption. A 3\u00a0MHz ultrasound (SaltFacial\u00ae, SaltMed, Cardiff, CA) was then utilized to further deepen the absorption of the nitric oxide serum. A topical emulsion containing equal volumes (1.0\u00a0cc containing 1 million) of exosomes (Kimera Labs, Miramar, FL), 25\u2009units of botulinum toxin (Xeomin, Merz Aesthetics, Raleigh, NC) and hyaluronic acid (Belatero, Merz Aesthetics, Raleigh, NC) was mixed via back\u2010and\u2010forth propulsion in a 3\u2010cc syringe. When adequately mixed, the emulsion was then applied to the treatment areas. The cavitating ultrasound was then used to aid in the absorption of the emulsion. The patients were then treated with high\u2010intensity LED therapy (SaltFacial\u00ae, SaltMed, Cardiff, CA), utilizing the collagen restoration preset program of combination red (660\u2009nm) near\u2010infrared (930\u2009nm) wavelength for 20\u2009min. Post\u2010treatment Quantificare analysis was performed at 15 and 30\u2009days after treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Without exception, all dermal infusion alone and CaHA injection alone patients showed an improvement in the tone, quality, and texture of their skin. Quantificare results showed consistent improvement in wrinkles, pores, skin evenness, improved vascularity, and a reduction in oiliness and unwanted pigment. When employed as a skin primer prior to injections (CaHA), enhanced and more rapid results were seen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Biostimulatory dermal infusion can be achieved utilizing topical placental mesenchymal stem cell\u2010derived exosomes. These exosomes can be used alone, or mixed with ancillary ingredients such as botulinum toxin, hyaluronic acid dermal filler, and CaHA to customize and personalize treatments based upon individual patient needs. Topical absorption is enhanced with sea salt exfoliation, a topical nitric oxide\u2010generating serum, and 3\u00a0MHz cavitating ultrasound. Post\u2010absorption activity is enhanced with high\u2010intensity LED treatment. The addition of CaHA injections after the topical exosome \u201cpriming of the skin\u201d yielded enhanced skin quality faster than exosomes or CaHA alone.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.15695","type":"journal-article","created":{"date-parts":[[2023,3,29]],"date-time":"2023-03-29T14:59:16Z","timestamp":1680101956000},"page":"15-27","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Combining topical dermal infused exosomes with injected calcium hydroxylapatite for enhanced tissue biostimulation"],"prefix":"10.1111","volume":"22","author":[{"given":"Greg","family":"Chernoff","sequence":"first","affiliation":[{"name":"Department of Surgery Ascension Hospital  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-816053-4.00010-9"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0748806817691152"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0094-1298(20)32764-4"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2018.06.009"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.29011\/2575-9760.001388"},{"key":"e_1_2_9_7_1","first-page":"1482","article-title":"The utilization of human placental, fetal mesenchymal stem CellDerived\u2010exosomes in treating keloid scars","volume":"7","author":"Chernoff G","year":"2022","journal-title":"J Dermatol Surg"},{"key":"e_1_2_9_8_1","first-page":"123","article-title":"Paracine mechanisms of mesenchymal stem cells in tissue repair methods","volume":"1416","author":"Gnecchi M","year":"2016","journal-title":"Mol Biol"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcb.20886"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms18030538"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.12230"},{"key":"e_1_2_9_12_1","first-page":"996","article-title":"Calcium hydroxylapatite filler: an overview of safety and tolerability","volume":"12","author":"Pavicic T","year":"2013","journal-title":"J Drugs Dermatol"},{"key":"e_1_2_9_13_1","first-page":"39","article-title":"Calcium hydroxylapatite: over a decade of clinical experience","volume":"8","author":"Van Loghem J","year":"2015","journal-title":"J Clin Aesthet Dermatol"},{"key":"e_1_2_9_14_1","first-page":"1047","article-title":"A randomized, split\u2010face, histomorphologic study comparing a volumetric calcium hydroxlapatie and a hyaluronic acid\u2010based dermal filler","volume":"13","author":"Yutskovskaya Y","year":"2014","journal-title":"J Drugs Dermato"},{"key":"e_1_2_9_15_1","first-page":"267","article-title":"Body vectoring technique with Radiesse for tightening of the abdomen, thighs, and brachial zone. 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