XOXO Exosomes: What’s To Love About Them?

Dr. Furnas (00:12):
XO, XO, exosomes. Everyone's talking about these tiny little packages like blobs of toothpaste that are cells extrude. They're blobs that contain little signals. I'm Heather Furnas. Welcome to Skintuition.

Dr. Korman (00:30):
And I'm Josh Korman. As two plastic surgeons, we lay aside our scalpels and explore the non-surgical world to bring you what's new, what's safe, and what to look for when you're ready to hit refresh.

Dr. Furnas (00:43):
XO, XO exosomes, what's to love about them?

Dr. Korman (00:48):
Well, it sounds like there's a lot to love about them, but I think we gotta figure out what they really are in the first place. It took a lot for me to kind of listen to things and read about things. So I think we gotta figure out what really they are. But I think they're these like little magic bullets that get shoved around the body and, and cause their messengers. Like in Romeo and Juliet, if that messenger had actually gotten to him, maybe he would've, the world would've been different. For Romeo and Juliet, it's really, they're these little secret messengers that do a lot of amazing things, but we gotta figure out where they come from and how do we get there. So what are they? We gotta love them, but we gotta know what they are. So what are they?

Dr. Furnas (01:29):
Well, you know, our cells contain these magical things. They contain little short peptides are called little chains, little growth factors, little, you know, all kinds of things that go out in the world and tell other cells to produce collagen or heal a wound. But the thing is, is in order to get out into the rest of the body, they have to be packaged. And so they're, they're packaged in this little container and they're kind of pushed out of the cell. But it sounds actually, you know, they're extruded. That's a little disgusting.

Dr. Korman (02:05):
So it sounds like they go in luggage, like they're these really good little signals, but they kind of need each other. And so it's like a cake. Like if you just have the flour in a cake, it's not really the whole cake. So I think it's all the components of the cake, the flour, the chocolate, the fruit, the baking soda, or a baking powder. And it all gets put in a suitcase now. A cake in a suitcase. Now that's not sounds so good, but I think you get what I mean. So you have all these little ingredients that need each other, and they go in this suitcase and then the, like in Superman, where the world is exploding and they have to send everything out, all the parts that are important with the little boy. So here is, it's in the suitcase and it gets shoved out, out of the cell and moves on. So where does it move?

Dr. Furnas (02:59):
Well, you know, it's, it's interesting 'cause it, it'll, even if it just goes just outside the cell, it will communicate with cells right next to it. You know, a little bit like you sit in a theater and you can talk to the person next to you, but it can also send long distance signals. So it's, uh, a little bit like a telephone, you know, like what we're doing right now can send signals over a distance and the signals can be all different kinds of things. Most of the cells in our body, extrude exosomes and the old,

Dr. Korman (03:36):
So they make 'em?

Dr. Furnas (03:37):
Yes, they have all the, the ingredients of the cake and then they create a suitcase and they send it out into the world. So the reason we're talking about this is because there are now products that are these exosomes. So we get these little suitcases in a bottle.

Dr. Korman (04:00):
So I just wanna go back a little bit. Okay, I, I get it. Here's the suitcase and it's got all these cool things and it goes out maybe to the cell next door or goes in the bloodstream and goes to find a cell somewhere else. I mean, every organ is made with so many different kinds of cells. There are gazillion cells in animals, including humans. And so it seems like the body probably has a, a finely tuned way to help live and help get better and, and respond to illness or injury. But one of the things that I think isn't relevant is that, you know, as we get older, our cells kind of go a little more senescence. That's sort of a scientific word, but,

Dr. Furnas (04:43):
Senescence. Boy, that's like senile.

Dr. Korman (04:46):
Yeah, hmmm, well nice to think about. But the part is that, so these cells make it wrinkles, and creases, and why diseases may be more common as we age. So obviously we know that, that our bodies age. So the question is, do the exosomes as they, we know what they do when everything is working fine. So does this, if we get products, does that help move the signals faster? Do the signals make things work over time? If you have enough vitamin D then you get a lot of good things. If you don't have enough vitamin D, you need more vitamin D. But if, if the body has enough vitamin D, do you need more vitamin D? So if the body's making exosomes, why do we need more exosomes?

Dr. Furnas (05:39):
Well, as we age, our cells kind of shut down and, and you know, it's like the factory just slows down and so they kind of go to sleep, they stop making collagen, they stop making or as much collagen they stop making as elastin as far as the skin. 'cause that's our focus, you know, exosomes are found in most cells. But we're looking at the skin and as we age, our skin thins it produces less collagen, less elastin. The elastin is all broken up and that contributes to old, dry, thin, wrinkled skin. And so exosomes from outside the body, like in a cream or you know, it's usually carried in something like, uh, hyaluronic acid can then penetrate the skin, wake up those cells and get those cells to start producing more collagen and elastin. So it's not like they, they just automatically put in collagen, elastin. It's indirect. 'cause they're just messengers. They're saying wake up cells start producing.

Dr. Korman (06:54):
Okay, well that sounds pretty cool. I think the thing is, it's also good to figure out like what actually is in the luggage, what's in the suitcase? So I don't think it has flour and baking powder <laugh>. So what does it have? I know it has growth factors. That's the buzzword people talk about all the time. But, and you mentioned peptides in which a lot of these things are are proteins, but what else does it have?

Dr. Furnas (07:18):
It's got lipids. It's even got genetic material like mRNA messenger, RNA which we all heard about in the media because that was, uh, how these covid vaccines were developed. And now it's a, you know, it's sort of a new industry, different types of future.

Dr. Korman (07:34):
So messenger, I get it, it's a messenger. RNA is a messenger. So it, it seems like it gets right to the whole root of how our bodies work. And we probably don't know a lot yet, but I I was interested to read that actually exosomes were sort of discovered at least in the current iteration, like even in, in the sixties, but science sort of had to catch up.

Dr. Furnas (07:57):
Exactly. Yeah. And so people have been looking at the individual things like growth factors and, and peptides. Now peptide is a short chain of amino acids and it can act as a messenger itself by telling cells to start producing. Like I said, you know, uh, we've been mentioning collagen and elastin and the exosomes will contain lipids, they contain a lot of different things that are, I don't think we actually understand everything about them, but we do understand that messenger rule.

Dr. Korman (08:36):
So let's focus a little bit on skin and how exosomes can help the skin. 'cause we talked about that it's good for skin or it can be good for skin, but skin, I, I think we, we talked about that, you know, they're these chemical communicators and they can nudge these inactive skin cells to become more active. Again, collagen, we all talk about collagen. Every product you see on the market says it, it improves collagen. Well collagen's made by so many cells and so many things. It's kind of a continual breakdown and buildup of, and, and the question is, and I've always tried to understand this, is that okay, you can see things on like a, a microscope that is not visible to the human eye, but how does that actually help our skin look to our own humans looking at humans? Can you see a difference? So I think some people use exosomes topically meaning on the skin and sometimes they're even injecting them. But can we talk about a little bit about like what are the results? Like you put some exosomes on the skin, what's supposed to happen to that skin?

Dr. Furnas (09:44):
Well, you, you increase the collagen and elastin production, which we talked about. They're also anti-inflammatories. And so it helps with redness and people with rosacea really do in our own practice. Uh, we've seen some really nice results with, uh, patients using their home exosomes and their redness has really gone down. And so all of this plumps the skin up, it smooths it out, and so it looks firmer and brighter. It reduces fine lines and it reduces, as I said, redness. So all of this is rejuvenating for the skin.

Dr. Korman (10:28):
So I, I've been using exosomes in my practice for probably a couple years now. And what I find is that it works best is that when we do things like microneedling or radio frequency with microneedling or laser or anything that actually makes the skin kind of hot and red, the recovery is much faster by putting on either in gel form or in liquid form or in slurry form. These things that are these exosomes, which really helps the swelling really helps the inflammation as you mentioned. And I found that has been quite dramatic in improving the injury and inflammation that comes from a treatment.

Dr. Furnas (11:12):
Exactly. I've had it after my microneedling myself and the nurse who did it missed one little spot and you could see it was much redder than everything else looked very calm. And so it hastens healing. And it's also because the microneedling itself is sort of kick-starting collagen production. You add the exosomes on top of that, their kick-starting collagen production. And so it's uh, that combination, they're just a natural pair. They go hand in hand together.

Dr. Korman (11:48):
So I know there's some companies now that actually think that their products can, you can use it like a home product. Like it's actually something that you, like a cream, which is really kind of amazing to me. 'cause the skin has this outer layer called the corneum layer, and that's what is a protective layer for the skin. The skin is actually the biggest organ in the body and in a lot of ways one of the least understood, which is so interesting. Like the old days when you sit a little kid and say, okay, your epidermis is showing, and people are like, what is that <laugh>? What is that? But it sounds like that at least one company's and neither of us have any financial interest in these exosome companies. So it's, it's not like we're trying to promote anything. But it, it sounds like that there's a way that some of these folks have figured out to make a, a skincare product that actually delivers exosomes to the skin that somehow gets through that corneal layer without having to create the openings that happens when you laser or microneedling.

Dr. Furnas (12:58):
Yeah. It's interesting because a lot of places you read that exosomes can't penetrate that stratum cornea, that literally it means a horn layer, which is kind of a, you know, sort of a reptilian term, but it's that protective outer layer of the skin. And um, this one company, Ryan Aesthetics does have a home product and they say that it penetrates, they actually have electron microscopy, you  know these photographs taken with an electron microscope that show penetration. You know, I've seen the images and they show the collagen actually thicker and, and more robust after just, you know, four to six weeks. So they do have some backing to show that even though other companies are saying that exosomes cannot penetrate the stratum corneum, they say that the exosomes themselves are so small, they get their exosomes from platelets, which actually makes total sense because platelets are what go to wounds to heal. And a lot of what we're looking for in re rejuvenation is really that same reaction to produce collagen, produce elastin and healing. So, you know, all of this is still early on and we'll see where this company goes and where other companies go. Some companies do say that you need to keep your, the product frozen and this Ryan Aesthetic says that it's shelf stable. It's very different.

Dr. Korman (14:32):
So I think we'd be remiss to not talk about that buzzword stem cells, because we've all heard stem cells being used for a long time. Do they work, do they not work? And is exosomes related or exosomes not related to a stem cell? I mean, an exosome is not a cell, whereas a stem cell is a cell that can go on to become a lot of different kinds of cells. So I think we need to kind of, sort of sort this out because I, I know that some stem cells actually, or maybe most of 'em, maybe all of them actually have exosomes. So Heather, do you think that the secret ingredient in stem cells, or at least one of them are exosomes?

Dr. Furnas (15:16):
Well, I think you've just put your finger on the pulse there. I think it's exactly the exosomes that are really the magic ingredient. And the stem cells a cell, it's got a nucleus and so you're more likely to have a, an immune reaction, uh, if you get a stem cell, it doesn't match your body. And the exosomes within the stem cell are really what we're after when we're looking for the magic of stem cells.

Dr. Korman (15:46):
So for us as consumers, as practitioners, where do we go from here with exosomes? It seems like there's a little bit of a path that we know when there's a defined injury, there's certainly as a way to heal faster. But how would you want to use it if you could use it anyway, like you had a, somebody delivered to you, this magic packet, this messenger to Romeo. Like what is it that you would like it to do besides when having a winning lottery ticket inside <laugh>? What would you like it to do?

Dr. Furnas (16:24):
Uh, good question. Well, a couple things. You know, if I'm young, I wanna prevent all this aging. And then as the older I get, I wanna maintain that youthful look. And so I don't want my cells to start shutting down. I don't want my dermis to thin. And if it is going that way, then I want those exosomes to help sort of thicken my dermis and increase cell turnover and, and fight with antioxidants, fight some of the damage from the sun. How about you Josh? What, what are you looking for?

Dr. Korman (16:58):
Well, you know, if I like, pretend that I'm young, if I had acne, I certainly would want it to help my acne. I think, you know, the reason we talk about from pimples to wrinkles is because pimples afflict a lot of humans at a time when it's, you know, trying to figure out a lot of things out in their lives. And I would really like to be able to hand it to me if I was, you know, younger or to other people and have it really help create a either, I don't know, it'd be a hard to say magic to make it all better, but in conjunction with anything else, I think it could be really good. And then, sure, we all want something in a bottle that's gonna make it fantastic. So, I mean, can always hope, but I still have a feeling that it will probably be more effective when you can enter the skin past that corneal layer. I think that corneal layer protects us, but I think it also prevents us from doing things.

Dr. Furnas (17:57):
Exactly. I think once we get that sorted out and it's predictable, I must say that the, the home product that, uh, Ryan Aesthetics makes is the one thing that you need to do is after you apply, use your cleanser and then you apply it and then you have to wait like five minutes. And that's the hardest thing for me to wait five minutes before putting anything else on. And the company recommends using it twice a day. I don't have personal experience with any other exosomes and as Josh said, neither of us has any personal connection with these companies. And other than I do carry this one product in, in our practice. But it really, you know, I think there's, there's a lot of research that needs to be done. There are not a lot of studies and we need some good studies that, that look at these different effects. 'cause it's, they're talking about how this is the disruptor in skincare.

Dr. Korman (19:01):
So one last thing we should talk a little bit is safety. So obviously there are some studies, but not a lot of studies. Do you think they could be dangerous?

Dr. Furnas (19:12):
From what I've read, what I know, what I've heard, it's, uh, a pretty doggone safe product, uh, without a lot of reactions or allergies, but that's obviously gonna be a potential risk. But I think as products go, it's very low risk. Um, people don't get sort of the, like the redness that say you can get with Retin A, which is just a, a sensitivity to the reaction. How about you Josh? What would you say?

Dr. Korman (19:43):
Well, I think these products are made by taking something either an organ, like some from placental tissue, or in this case with platelets, which is platelets are a blood product and they make sure there's no antigenicity, meaning there's not viruses that could be part of this. It's not in the same kind of language. But I think that when you, you're talking safety and you're getting things together and what they do, I think in general, skincare things that you put on the skin are, in general, I think the safety issue comes with an allergic reaction. And it seems like, as you said, it's really, there seems to be a lot of evidence that there's not a lot of of allergic responses. So in that way I think it's good. I think as they get more known and popularized and more products come out, I think that probably the exosome delivery process is really what the key to a lot of these things are.

(20:51)
I think in general they're probably safe because, you know, they take a, a sample and then they grow it in the laboratory so they multiply 'em. So that's how a product is made. It's not like it's reaching out to millions of people to try to get these products. It is mostly done in a laboratory. So I'm generally optimistic with these and I'm all for, for learning, uh, new things. And I think skin and skincare is really crucial. We live in a world where our bodies are aging, the sun affects us and we do need to work on how to, we're a visual species, how to make ourselves feel better and I in a safe way that's effective. And, and one thing I think that is true is that people are pretty tired of so many skincare products doing the same thing. Many times not that much. And people are hungry for something that's new and different. And I would say one thing that's exciting about exosomes, especially as they become part of products that consumers can, can easily access, is that here is something essentially new or it's being packaged newer so that the availability's increasing. So I'm actually quite excited about it and look forward to trying it and using more of it and learning more of it.

Dr. Furnas (22:12):
And one other thing that we should cover is cost. For the home products, you're going to see a range of $250 to $300 for a, uh, container, a jar. And so the price point is high. On the other hand, if it's effective then and it saves you from a lot of other costs, then the price point then becomes a lot lower. Now some people feel that because it does, it contains so many things and does so much that contains antioxidants and increases cell turnover, that it may mean that you don't need to use some of the other products that you're also paying for. That remains to be seen. And it's also often an add-on as, as Josh was saying, with microneedling, it can be an add-on with, uh, ablative lasers. We've talked about different types of lasers, but lasers that take a little bit of the top layer of the skin off and that also will, the exosomes can be used to enhance the healing. So that add-on typically runs from my research, brief research about $300 to maybe $500 beyond the cost of the treatment.

Dr. Korman (23:28):
So one thing is like, it all depends on how long it lasts too. I mean, if something costs $150 but lasts a lot longer than, than something that costs a hundred dollars, it might be worth it too. So I think it a lot depends on how I, I think people, I, I find this in my own office, even when it comes to numbing cream before a procedure. Some people think you're supposed to apply it on like, like thick layers when you only need to put a little bit on. So I think that's another thing that's important. I think we all could use a lot more instruction on exactly how much of a product we should put on at any given time. Obviously companies want consumers to go through the product so they will buy more, but as a consumer, I'm not sure that a dollop is the same as a gallon. You don't need the whole luggage putting on there and using the product.

Dr. Furnas (24:19):
Thank you for listening to this episode of Skintuition. Join us every two weeks as we tackle topics from hair loss to hormones and pimples to wrinkles, discovering new ways to feel better about ourselves. I'm Heather Furnas.

Dr. Korman (24:35):
And I'm Josh Korman. We'll see you next time.