The Efficacy of Combined Exosome (Exodew) and Microneedling Treatment for Facial Pore Reduction and Skin Texture Improvement

Abstract

Background:

Enlarged facial pores are a common aesthetic concern that worsens with age due to increased sebum production, reduced skin elasticity, and photoaging. Although microneedling is known to stimulate collagen production, the combined use of stem cell–derived exosome therapy for pore reduction has not been thoroughly investigated.

Methods:

A case series was conducted at a private aesthetic clinic between January and June 2024. Three patients (1 man and 2 women; 32–55 y of age; Fitzpatrick skin type IV) underwent 3 sessions of microneedling combined with topical exosome application (Exodew, Hyundae Meditech) at 4-week intervals. Standardized photographs were obtained at baseline and posttreatment. Clinical outcomes were evaluated using the Global Aesthetic Improvement Scale by 2 independent dermatologists and patient satisfaction scores at 12 and 22 weeks.

Results:

All patients exhibited visible reductions in pore size and improvements in skin texture and overall appearance. Global Aesthetic Improvement Scale scores ranged from 4 to 5, indicating “very much improved” outcomes. Patient satisfaction was high at both 12- and 22-week follow-ups. No adverse events were reported, and improvements were sustained through week 22.

Conclusions:

Microneedling combined with stem cell–derived exosome therapy seems to be a safe and effective treatment for facial pore reduction and skin texture enhancement. Larger, controlled studies are needed to confirm these preliminary results.

Takeaways

Question: Can microneedling combined with stem cell–derived exosome therapy effectively reduce pore size and improve skin texture in patients with enlarged pores?

Findings: This case series of 3 patients demonstrated significant improvements in pore size, skin texture, and overall appearance using a combination of microneedling and exosome therapy, with high satisfaction rates and no severe adverse events. Results were durable for at least 22 weeks posttreatment.

Meaning: Combining microneedling with exosome therapy is a promising, minimally invasive approach for improving pore size and skin texture, offering safe and long-lasting results in aesthetic dermatology.

INTRODUCTION

Enlarged pores are a prevalent aesthetic concern that often worsens with age, driven by increased sebum production, reduced skin elasticity, and photoaging. Although not a medical condition, large pores significantly affect skin texture and appearance, leading many to seek treatments to reduce their visibility.¹ Current options, such as chemical peels, lasers, and topical agents, offer some improvement, yet patients often prefer minimally invasive treatments with longer-lasting effects.²

Microneedling is a well-established technique that creates controlled microinjuries to stimulate collagen production and enhance the absorption of topical agents.³ Recently, exosome-based therapies have emerged as a promising option for skin rejuvenation due to their antiaging, anti-inflammatory, and collagen-stimulating properties.⁴ Combining microneedling with exosome therapy has shown potential to enhance skin rejuvenation by enabling deeper exosome penetration through microchannels created during the procedure. However, its specific effects on pore reduction remain underexplored.⁵ This case series presents three patients treated with microneedling and exosome therapy for pore reduction on the nose and cheeks.

MATERIALS AND METHODS

This case series was conducted at a private aesthetic clinic in Seoul, Korea, between January and June 2024. Patients of 30–60 years of age with Fitzpatrick skin type IV who expressed concerns about enlarged pores on the nose or cheeks were included. Exclusion criteria comprised active dermatologic conditions, a history of keloid formation, recent use of oral or topical retinoids, pregnancy or lactation, and any prior aesthetic treatments targeting pores within the past 6 months. A total of 3 patients (1 man and 2 women, 32–55 y of age) met the inclusion criteria and provided informed consent before treatment. This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

MICRONEEDLING AND EXOSOME APPLICATION

A microneedle therapy system with sterile, single-use cartridges was used to create microinjuries in the targeted areas (nose and cheeks). The procedure involved a single pass across the entire face, with an additional focus on areas with prominent pores where necessary. A 0.5-mm needle length was used for this procedure. Immediately following microneedling, a topical application of stem cell-derived exosomes (Exodew, Hyundae Meditech Co., Ltd, Wonju, Korea and EXOP, Sihler Inc., Seoul, Korea) was administered to the treated areas. The exosome formulation consisted of 2 main components: (1) lyophilized powder containing exosomes 0.5% and hyaluronic acid 0.2%, and (2) an activating solution (3 mL per vial) comprising polydeoxyribonucleotide 1%, hyaluronic acid 1%, and glutathione 1%. Exodew, developed by Hyundae Meditech, is an exosome-based therapy distinguished by its regenerative efficacy and safety. Its exosomes are derived from pharyngeal stem cells collected noninvasively during early childhood, offering high differentiation potential. The formulation combines lyophilized exosomes with an activating solution containing polydeoxyribonucleotide, glutathione, and amino acids to support tissue repair and antioxidant defense. The treatment was conducted at 4-week intervals, with each patient receiving three sessions. Posttreatment care included strict sun protection and the use of hydrating moisturizers.

PHOTOGRAPHIC DOCUMENTATION

Standard digital photographs were captured at baseline and after the final treatment session using a Canon EOS 5D Mark IV camera under standardized conditions, including fixed distance, angle, and lighting to ensure comparability between pre- and posttreatment images. Frontal and lateral views of the nose and right cheek were obtained to ensure comparability between pre- and posttreatment images.

OUTCOME MEASURES

The primary outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS),⁶ evaluated by 2 independent dermatologists who were blinded to the study details. GAIS scores ranged from 1 (worse) to 5 (very much improved). Patient satisfaction was self-assessed using a 4-point scale at 12 and 22 weeks after the final treatment, with higher scores indicating greater satisfaction (0: not satisfied; 1: slightly satisfied; 2: satisfied; 3: very satisfied). Adverse events were recorded throughout the study.

CASE PRESENTATIONS

All patients showed positive improvements in pore size, skin texture, and overall appearance. Table 1 summarizes the GAIS assessments by 2 independent dermatologists, as well as the patient self-assessment scores at both 12 and 22 weeks after the final treatment.

Table 1.

Patient Demographics, GAIS Scores, and Satisfaction Ratings at 12 and 22 Weeks Posttreatment

Participant	Age (y)	Sex	Fitzpatrick Skin Type	GAIS Dermatologist 1 (12 wk)	GAIS Dermatologist 1 (22 wk)	GAIS Dermatologist 2 (12 wk)	GAIS Dermatologist 2 (22 wk)	Patient Satisfaction (12 wk)	Patient Satisfaction (22 wk)
Case 1	32	Female	IV	4	4	4	4	3	3
Case 2	40	Male	IV	4	4	4	4	2	3
Case 3	55	Female	IV	4	5	4	5	3	3

Case 1

A 32-year-old woman presented with concerns about enlarged pores on her nose. Following 3 sessions of microneedling and exosome therapy (Exodew, Hyundae Meditech), she demonstrated significant improvement, with GAIS scores of 4 from both independent dermatologists at 12 and 22 weeks posttreatment. She rated her satisfaction as 3 (very satisfied) at both follow-up points. Photographs revealed a reduction in pore size and smoother skin texture, with no reported adverse effects (Fig. 1).

Fig. 1.

Before and after images of case 1 (32-y-old woman), demonstrating significant improvement in pore size and skin texture on the nose. Images were taken at baseline (A) and 12 weeks after the final treatment (B).

Case 2

A 40-year-old man concerned with enlarged pores on his nose underwent the same treatment protocol. His GAIS scores were 4 at both follow-up points, reflecting substantial improvement. He rated his satisfaction as 2 (satisfied) at 12 weeks and 3 (very satisfied) at 22 weeks. Photographs showed a marked reduction in pore size and improved skin texture (Fig. 2).

Fig. 2.

Before and after photographs of case 2 (40-y-old man) showing notable reduction in pore size on the nose. Images were taken at baseline (A) and 12 weeks after the final treatment session (B).

Case 3

A 55-year-old woman with concerns about large pores on her cheeks completed the 3-session treatment. GAIS scores were 4 at 12 weeks and 5 at 22 weeks, indicating continued improvement. Her satisfaction score was 3 (very satisfied) at both follow-up assessments. Photographs demonstrated a significant reduction in pore size and a smoother appearance of the skin (Fig. 3).

Fig. 3.

Photographs of case 3 (55-y-old woman) showing a marked reduction in pore size and improved skin texture on the cheeks. Images depict the condition at baseline (A) and 12 weeks after the final treatment (B).

DISCUSSION

This pilot study demonstrates the potential of combining microneedling with stem cell-derived exosomes to reduce pore size and improve overall skin texture. All patients experienced significant improvements, evidenced by GAIS scores from independent, blinded dermatologists and high patient satisfaction ratings. The synergistic effect likely arises from microneedling-created microchannels, which facilitate deeper exosome delivery. Stem cell–derived exosomes contain growth factors, cytokines, and microRNAs essential for collagen synthesis, inflammation reduction, and cellular turnover, processes crucial in addressing enlarged pores and skin irregularities.⁴

The treatment was well-tolerated across all patients, with mild, transient side effects such as erythema, edema, and minor bleeding that resolved within 24–72 hours posttreatment. These mild reactions, alongside the absence of severe adverse events, underscore the preliminary safety findings of this approach. Additionally, the improvements were durable, with both GAIS scores and patient-reported outcomes remaining consistent at 12 and 22 weeks, suggesting sustained regenerative benefits from the exosomes.

Although microneedling alone has been shown to improve skin texture and pore appearance, studies suggest that exosomes may enhance these effects through prolonged collagen stimulation and tissue regeneration. Although studies on microneedling alone have shown varying durations of improvement, our results demonstrated continued benefits up to 22 weeks, suggesting a potential role for exosomes in sustaining skin rejuvenation. This extended duration of improvement may indicate a role for exosomes in maintaining skin rejuvenation. Future studies with controlled comparisons of microneedling alone versus microneedling with exosomes are needed to validate this hypothesis.^7–9

Despite its increasing clinical use, particularly in Asia, there remains a gap in the literature regarding the combined efficacy of microneedling and exosomes for pore reduction. Limited research explores both their synergistic effects and the patient experience regarding enlarged pores.^10,11 In clinical practice, many patients express concerns about pore visibility and seek effective treatments. This pilot study contributes by providing initial insights into patient outcomes and satisfaction.

It is important to clearly acknowledge that this study has significant limitations that affect the interpretation and applicability of the results. The extremely small sample size (3 patients) and the absence of a control group substantially limit the internal validity of our findings. Without a control group receiving either no treatment or microneedling alone, we cannot definitively attribute the observed improvements to the combination therapy rather than to microneedling alone or natural skin changes over time. This work should be viewed as a proof of concept that demonstrates the feasibility of the approach rather than evidence of efficacy. The subjective nature of the assessments, despite blinding efforts, also presents a limitation. Validated objective measures of pore size and skin texture would strengthen future investigations.

Scaling this pilot study into a full clinical trial presents several challenges that must be addressed. Patient recruitment will be critical; identifying a larger cohort of patients with comparable pore concerns and willingness to participate in multiple treatment sessions will require multicenter collaboration. Control group design represents another challenge, as determining appropriate control interventions (eg, microneedling alone, sham treatment, or alternative pore reduction methods) is essential for isolating the specific contribution of exosomes. Implementing standardized objective measurements through techniques such as 3-dimensional imaging or skin profilometry would provide more objective outcome measures than the subjective assessments used in this pilot. Establishing protocols for extended follow-up periods will be necessary to determine the sustainability of results beyond the 22-week mark observed in this pilot study. Finally, ensuring consistency in exosome preparation and application across larger patient cohorts will be essential to maintain treatment standardization in future research.

CONCLUSIONS

This pilot study suggests that combining microneedling with stem cell–derived exosomes may reduce pore size and improve skin texture, with minimal adverse effects, indicating preliminary feasibility and safety. However, the small sample size and lack of a control group limit the generalizability and strength of these findings. These results should be seen as a foundation for future research rather than definitive evidence. Larger randomized controlled trials with objective measurements are needed to confirm efficacy, assess long-term outcomes, optimize protocols, and determine if the combination offers significant advantages over microneedling alone.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

Informed consent was obtained from all participants, with full disclosure of the study’s purpose, risks, and confidentiality.

DECLARATION OF HELSINKI

This study was conducted in compliance with the principles set forth in the Declaration of Helsinki.