Exosomes vs PRP Therapy: What's the Difference?

In these past few years, PRP (platelet-rich plasma) and exosomes have been hot topics among researchers and doctors. However, these forms of treatments are often mixed up and are confusing for most average consumers. 

As of January 2024, there are more than 29,000 studies published related to exosome and more than 14,000 studies related to PRP on PubMed (US NIH Library of Medicine Database). 

Nevertheless, PRP and exosome-related therapies are not yet established as standard treatments, given their relatively recent emergence.

Regenerative medicine is also becoming a buzzword in the medical community. Why? Because the human body is specially equipped to heal itself, and regenerative therapies tap into this powerful ability.

Regenerative medicine includes treatments like stem cell therapy, exosome therapy and platelet-rich plasma (PRP) therapy. Research around these therapies is expanding every day and it's not easy to keep updated.

In this article, we will cover the essentials, differences and explain about each of these biologics below.

What is Exosome?

An exosome is a small vesicle produced by a cell that can tell other cells what to do. Exosomes are how cells talk to each other (R).

Put more simply, exosomes are how cells communicate. For example, we can communicate by writing small notes to each other electronically, otherwise known as email. Exosomes are a way for one cell to email another. The message may be how to behave or what’s happening in the local area.

Meletios Verras/Shutterstock

Intercellular communication through exosomes appears to have a role in the causes of a variety of diseases, including cancer, neurodegeneration, and inflammatory diseases.

There are at least a few hundred different types of exosomes that can all do different things (R). The main challenge is that no one is absolutely clear on how to isolate specific exosomes that code for specific actions like fixing your skin, cartilage, ligaments, tendons, muscles, or nerves. 

Note: The FDA first allowed the study of botulinum toxin’s effect on health conditions more than 50 years ago. Decades later, it was studied, then approved, as a treatment for wrinkles; today, Botox is possibly the most popular aesthetic procedure worldwide. It takes significant time to understand what innovative treatments are capable of and even longer to get them regulated and approved as an actual therapy. So when the FDA issued a warning letter against exosome treatment—one of today’s buzziest procedures—many aesthetic providers took it with a grain of salt. 

What is PRP? 

PRP is an abbreviation for Platelet Rich Plasma. It is a substance that’s thought to promote healing when injected. Plasma is a component of your blood that contains special “factors,” or proteins, that help your blood to clot. It also contains proteins that support cell growth. Researchers have produced PRP by isolating plasma from blood and concentrating it.

PRP is performed by drawing a patient’s blood, then placing it in a centrifuge to separate the red and white blood cells from the nutrient-packed plasma. In addition to featuring things like proteins and sugars, plasma contains platelet cells, which are rich in growth factors and help heal wounds.

The idea is that injecting PRP into damaged tissues will stimulate your body to grow new, healthy cells and promote healing. Because the tissue growth factors are more concentrated in the prepared growth injections, researchers think the body’s tissues may heal faster. Famous athletes like Tiger Woods and tennis star Rafael Nadal have been known to use these injections to help heal injuries.

How do exosomes work in cosmetic treatments?

Though exosomes are very small, they cannot penetrate and will not be effective when administered to intact skin. They must be applied to skin that has been injured in some way. 

Dr. Marina Peredo, a board-certified dermatologist in New York City often uses exosomes after Clear + Brilliant or RF microneedling. “[After treatment], the skin is normally red and burning,” she says. She then applies the exosomes, which must be refrigerated (more on this shortly); this instantly cools the skin down and causes redness to subside, expediting the healing process.

Brittany Blancato, a medical aesthetician working for New York City-based board-certified facial plastic surgeon Dr. Yael Halaas, has performed exosome treatments on many clients’ skin, including a scar on someone’s chin. “I did microneedling twice, with exosomes topically afterward, and the results were amazing,” she says. “The discoloration is pretty much gone.” Dr. Jennifer Levine, a board-certified facial plastic surgeon in New York City, recounts one patient who had a travel-related injury that wouldn’t heal after six weeks. “I gave her the exosomes, and when I saw her again four days later, it was almost healed,” she says. “They really work.”

It’s the combination of three different factors that seems to be behind the efficacy of exosomes. Though more research is needed, a study from 2021 shows that they stimulate collagen synthesis, reduce inflammation, and promote angiogenesis, the formation of new blood vessels. These characteristics make exosomes an exciting option for treating not just skin health but hair loss too. “I see more hair growth with a single session of exosome therapy than with PRP,” says Dr. Cheung. Similarly, Dr. Halaas’s patients have impressive results, with one showing significant regrowth three months after just one injectable treatment with exosomes.

It’s worth noting that exosomes are also being used intravenously for pain management. Considering that the FDA has not approved any use of exosomes, let alone this therapeutic or drug-like use, this is especially controversial.

What are the differences between all the exosome products available?

There are a lot of exosome brands on the market, including Kimeravive, Benev, Exocel Bio, and Rion. Hydrafacial even also announced in September 2022 that the company plans on releasing an exosome booster sometime this year. The primary differences between these manufacturers’ exosomes are the concentration (or number) of exosomes in the end product and the source of the exosomes themselves.

When used intravenously, there can be several hundred billion exosomes in a single milliliter of product. Injected forms of the treatment use fewer, and topically applied formulas require even fewer to be effective. This is a good thing, as the higher the concentration, the more expensive the treatment. “For topical use, the concentration would be anywhere from 5–25 billion exosomes per mL,” says Dr. Peredo. “If you’re just treating the face, you use one to two mLs; if you do face, neck, and chest, then you probably use five.”

Perhaps obviously, all exosomes are derived from human sources. One common source is mesenchymal stem cells, cells that are capable of self-renewal. “Mesenchymal stem cells are [often] derived from the umbilical cords or amniotic fluid from healthy donor pregnancies,” says Dr. Cheung. They’re also taken from placenta. “Normally, the placenta is discarded,” points out Dr. Peredo. “When you take PRP from someone in their 60s and 70s, the growth factors and platelets are old. When you use exosomes, you inject something that’s very young, like placental cells from a 20-year-old.” However, Dr. Batra notes that the benefits of PRP aren’t often related to age. “Younger patients with younger platelets didn’t always have the best result,” he says. “Remember, a platelet only lives for about seven days, so your body is constantly making new platelets.”

Platelets are another common source of exosomes; platelet-derived exosomes are used by Rion, which in addition to distributing exosomes for clinical use also offers an at-home skin-care collection, ( plated ) Skin Science. These products are formulated with what the brand refers to as platelet extract. This differs from true exosomes—that’s because exosomes are from live cells. “Exosomes are very difficult to keep viable at room temperature, so the products we have either require storage in a special deep freezer and need to be defrosted before use or need to be kept refrigerated and then reconstituted before use,” explains Dr. Cheung.

Anything with true exosomes will not be very shelf stable and will have a short lifespan. Dr. Levine actually whips up exosome-infused Aquaphor for her patients, especially those who have received ablative laser treatment. “We’ve given it to people to heal after procedures, and it works really, really well,” she says. “We tell them to keep it in the refrigerator, keeping it for no more than two weeks.”

Dr. Batra explains that ( plated ) Skin Science formulas are platelet-derived exosomal products for topical use. “It’s what the exosomes release, the payload of what is in the exosomes—proteins and growth factors,” he says. “These proteins are dead. I hate to say it that way, but they still may have a biological effect or improve the appearance of fine lines and wrinkles.” (If you’re familiar with SkinMedica TNS Advanced+ Serum, which use growth factors, it’s a similar concept.)

Are exosomes safe?

The short answer is yes, with the longer answer being that the scientific community isn’t so sure yet, due to limited information. “The real workhorse in regenerative medicine is exosomes,” says Dr. Batra. “They can affect intercellular communication in a really special way. I think it’s very promising. There’s tremendous excitement in the hair world and dermatology.”

It’s worth considering some of the common potential fears of being treated with exosomes. One such concern is that your body could reject them. That’s why, when you get PRP, it has to be sourced from your own body—if a foreign cell is incompatible with your body, your immune system will attack it. Remember though: exosomes are not cells, which is why these little messengers can be extracted from various sources and used by anyone to treat a broad range of concerns.

Another concern is the health or safety of the sourced material—what if the exosomes are pulled from someone with a serious medical condition? That shouldn’t be a worry either. “The manufacturing process essentially purifies the product,” says Dr. Batra. “I don’t worry about taking someone’s blood product—it’s sort of like vodka. When you start distilling vodka, it ends up being very pure. “You want products with detectable RNA and clinical studies, and you need to consider the tissue source,” says Dr. Cheung.

The real question with exosome safety has to do with your own health. “Exosomes are ways that the cells communicate with each other—if information is telling them to make the body do good things, that’s great,” says Dr. Levine. “But what if there’s a bad cell in your body? In someone who might be predisposed to having a disease, can this magnify it? That’s the flip side of the coin.” While there’s no data to show that exosomes do this, the FDA is saying that the knowledge just isn’t there yet—hence the aforementioned warning letter.

But plenty of experimental and well-regarded aesthetic treatments are not cleared by the FDA—including PRP. “The FDA doesn’t govern the practice of medicine, so a physician can give treatments that are considered off label,” says Dr. Batra. Currently, the FDA has approved the use of PRP only in wound care; using it for facials or hair growth is off label. It takes hundreds of millions of dollars, in-depth studies, and often, decades to achieve FDA approval. In the meantime though, providers are going to continue to treat their patients with cutting-edge exosomes—whether you’re excited to join the experiment is up to you.

Exosomes vs PRP for Cosmetic Treatments

Exosome vs PRP, what's the difference? Are they the same in terms of effectiveness and safety?

PRP are not necessarily as potent as exosomes. “Exosomes are vesicles that cells use for communication,” explains Dr. Marina Peredo, a board-certified dermatologist in New York City. “They’re not cells but tiny little bags with all the ‘goodies.’” Platelet cells are actually a common source for the exosomes used in aesthetics treatments, as are placenta and stem cells, but all cells have exosomes—they’re essential messengers that tell cells what to do. “Until about 15 years ago, people thought that exosomes were kind of like the sewer system of the cell, a way to get rid of waste material,” explains scientist Dr. Sanjay Batra, founder of WeThrivv and a former adjunct professor at the Wake Forest Institute for Regenerative Medicine. “No one had any idea that these exosomes are chockfull of pixie dust and magical materials, including growth factors, mRNA, RNA, and things that could influence cell-to-cell communication.”

You may find providers using exosomes as a replacement for—or in conjunction with—PRP. “They have more regenerative potential than PRP, which contains 8 to 10 growth factors. Exosomes contain over 100 different growth factors,” says Dr. Jessie Cheung, a board-certified dermatologist in Chicago who specializes in regenerative medicine. Because they aren’t tied to any specific type of cell, they will send signals to cells in the treatment area to kick things into high gear. “They will wake up cells, keratinocytes and melanocytes and promote new collagen production,” to name a few, explains Dr. Peredo.

Exosomes vs PRP for Joint Injuries and Osteoarthritis

For peripheral mild to moderate tendon injuries (partial shoulder rotator cuff tears, shoulder labral tears, tennis/golfer’s elbow, carpal tunnel syndrome, mild hip osteoarthritis, hip labral tears, gluteal or hamstring tears, trochanteric bursitis, mild knee osteoarthritis, mild meniscal tears, ankle ligament sprain, plantar fasciitis and others), platelet-rich plasma is usually a good alternative of treatment. 

Exosomes are the result of a purification process of stem cells. The result is a concentration of proteins, messenger RNA (mRNA) and growth factors, without any of the original cell’s DNA. The lack of DNA makes rejection of these cells impossible so it lowers the risk of their use.

For an older patient with moderate osteoarthritis, a combination of patient’s own PRP and commercially available exosomes might be a viable and balanced option.

Can the exosomes found in PRP repair cartilage by themselves? Researchers in Asia (R) made PRP and then also isolated the exosomes from PRP. They exposed both mixes to cartilage cells and looked at things like cell growth, the ability to close a tear or gap, helping cartilage cells deal with bad inflammation, and resisting apoptosis (cell death). The PRP and the PRP-derived exosomes without platelets performed similarly. Interestingly, the exosomes did better in some tasks, but that result should be taken with a grain of salt as the exosomes were more concentrated than those found in the PRP sample. 

Exosomes vs PRP in Chronic Wounds

The exosomes derived from PRP (PRP-Exos) have been proven to encapsulate principal growth factors from platelets. According to a study, these exosomes may have the same function as PRP. PRP-Exos can promote angiogenesis and re-epithelialization in chronic wounds by causing endothelial cells and fibroblasts to proliferate and migrate.

A study observed the cutaneous healing process in chronic wounds treated with PRP-Exos in a diabetic rat model. They provide evidence of the probable molecular mechanisms underlying the PRP effect on healing of chronic ulcers and describe a promising resource of growth factors from exosomes without species restriction.

Take Home Messages

It is beyond the scope of this article to describe exactly which treatment is better for which condition. Each patient should be treated like an individual and each treatment should be personalized. The choice of regenerative cells and regenerative products is highly individualized based on age and health of the patient and the extent of injury or degeneration. 

Ultimately, nothing can substitute a thorough evaluation, history, physical examination and a diagnostic work-up. We hope that you keep these things in mind when you seek regenerative treatments anywhere.