Exosome therapy, or the use of extracellular vesicles, is an emerging and promising technology in regenerative medicine, particularly for skin and soft tissue repair. These nano-sized vesicles carry bioactive molecules that play crucial roles in cellular communication, potentially aiding in tissue regeneration. Preclinical studies, primarily involving animal models, have shown exosomes to be effective in promoting skin healing and restoration, and they hold potential for a variety of applications in plastic and reconstructive surgery. Exosome therapy offers the advantage of being cell-free and ready-to-use, which simplifies its adoption compared to traditional regenerative cell-based therapies. However, no exosome products have been approved by the US FDA yet, and more research is needed to establish clear guidelines for their use. The main considerations for practice utilization include variation in exosome purification, isolation, storage, scalability and reproducibility. In the field of regenerative aesthetics, exosomes are gaining attention for their potential in skin rejuvenation and hair restoration. As a minimally invasive option, exosomes offer a promising way to address the underlying causes of skin aging and promote tissue health. While the technology is still in its early stages, initial studies suggest that exosomes can improve skin rejuvenation by enhancing cellular communication and restoring tissue balance. Challenges remain in terms of exosome purification, storage, and reproducibility, and while current research shows safety in humans, there is a lack of consensus on long-term efficacy. Further clinical studies are required to determine which patients will benefit most from exosome therapy and to ensure regulatory compliance before widespread use in aesthetic medicine. Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York