Exosomes are small extracellular vesicles secreted by various cell types that have caught significant attention in recent years for their potential roles in intercellular communication and as carriers of biomolecules such as proteins, lipids and RNA. These properties make exosomes promising candidates in the field of anti-aging research. This article explores the multifaceted roles of exosomes in aging processes and their potential applications in cosmetology for anti-aging effects. Exosomes are involved in modulating inflammation, promoting tissue regeneration and facilitating the removal of cellular waste, all of which are critical factors in aging and longevity. Furthermore, their ability to transfer bioactive molecules between cells makes them an effective tool for rejuvenating aging tissues and reversing cellular dysfunction. In this chapter, we discuss recent advancements in exosome-based therapies, including their use in stem cell-based regenerative medicine, anti-inflammatory treatments and the modulation of senescence-associated pathways.

BackgroundThe United Kingdom aesthetic botulinum toxin industry operates with limited regulatory oversight despite being a prescription-only medication. Following recent public scrutiny, regulatory reforms are imminent, warranting comprehensive analysis to inform evidence-based policy.ObjectivesThe aim of the study was to characterize practitioner profiles, pricing patterns, premises types, and socioeconomic gradients in the provision of aesthetic botulinum toxin across the United Kingdom.MethodsCross-sectional analysis was conducted of practitioners administering aesthetic botulinum toxin and fillers across the UK (January–July 2025). Data were collected from publicly available websites and social media platforms. Geographic analysis used deprivation indices to examine socioeconomic patterns. Statistical methods included descriptive analysis, χ2 tests, and multivariable regression modeling.ResultsA total of 19,701 practitioners across 5589 clinics were identified, representing a 437% increase over 2 years. Doctors comprised 28.4% of practitioners, while the proportion of nonmedical aestheticians doubled from 12% to 24.8%. Practitioner density showed a 6.7-fold increase from the least (9.4 per 100,000) to the most deprived areas (63.2 per 100,000). Doctor representation declined from 34.4% in affluent areas to 27.0% in deprived areas, while odds of nonclinical botulinum toxin administering beauty salon exposure peaked in moderately deprived areas (odds ratio [OR] = 2.18). Specialist access (dermatologists/plastic surgeons) declined significantly in Quintiles 3 to 5 (ORs 0.70-0.77). Regression analysis identified practitioner profession as the strongest pricing determinant: doctors charged 32% to 38% more than aestheticians, dentists 28% to 33% more, and nurses 2% to 4% more (all P < .001). Geographic context exerted modest effects, with higher-income and denser areas associated with 1% to 5% higher prices.ConclusionsThe UK aesthetic medicine market has expanded rapidly, with significant differences in practitioner qualifications and treatment settings across socioeconomic groups. These findings provide key evidence to guide upcoming regulatory reforms and highlight the need for stronger safety oversight of prescription-only aesthetic procedures.Level of Evidence: 5 (Therapeutic)

Polynucleotides purified through High Purification Technology (PN HPT), combined with hyaluronic acid (HA), represent a novel injectable strategy to improve skin quality in aesthetic medicine. This real-world data collection aimed to evaluate the safety and performance of PN HPT-based treatments across multiple facial and body areas. Data were collected through a post-market clinical follow-up survey, analysing 218 questionnaires completed after 654 intradermal infiltrations performed on the face (e.g., forehead, perioral lines, crow’s feet), neck, hands, and décolleté. Aesthetic outcomes were assessed using clinician- and patient-reported Global Aesthetic Improvement Scale and Global Clinical Improvement Scale scores. Safety and satisfaction were evaluated through adverse event reporting and a patient-completed Likert scale. Across all treated areas, consistent improvement was observed. For the face, 39% of cases achieved “marked improvement” or “excellent result” on the GCI-S, with 48% rated as “much improved” or “very much improved” on the GAIS. Similar outcomes were reported for the neck (41% and 57%), hands (31% and 41%), and décolleté (43% and 55%). Patient satisfaction was high, with over 90% expressing general satisfaction and willingness to repeat the treatment. No serious or unexpected adverse events occurred. These findings suggest that PN HPT and HA injectables may offer a high level of patient satisfaction, observable improvements in skin quality, and a favorable safety profile in the modern aesthetic practice.

Stem cell-derived and plant-derived exosomes: Promising therapeutics for skin healing and regeneration.

Reframing Hyaluronidase in Aesthetic Medicine: From "Dissolving Filler" to "Modifying Filler".

Skin quality is an aggregate term encompassing a broad range of skin attributes that convey its overall look, feel, and health. To assess consistency in definitions and treatment outcomes for various skin quality attributes. We searched PubMed, MEDLINE, and Embase to perform 2 systematic reviews. The initial search identified published articles (January 1, 2000-October 13, 2021) and abstracts (January 1, 2019-October 13, 2021) that used an objective or subjective instrument to assess skin quality at ≥2 timepoints. A supplemental search of meta-analyses published from 2010 to May 2024 was conducted to evaluate treatment outcomes for each skin quality attribute. The initial search included 903 studies comprising 4,668 individual observations. Subjective end points comprised 87% of observations. Substantial inconsistencies were identified in the definition of individual skin quality attributes across studies, with multiple definitions in use in the literature for each attribute (range, 7-17) and no clear consensus. This extensive review of the current state of the aesthetic medicine literature revealed an absence of consensus definitions for skin quality attributes, which poses a barrier to comparative evaluation of treatment options and could affect physician recommendations, potentially with downstream effects on patient outcomes.

Background: Hyaluronic acid (HA) injections have become a cornerstone of minimally invasive aesthetic medicine. While the demand for these procedures continues to grow globally, large-scale longitudinal analyses of patient demographics and specific injection site trends remain limited, particularly in Asian populations. Existing data in Japan are largely confined to aggregate procedure numbers. This study aimed to elucidate the transition in patient demographics and site-specific treatment trends using a nationwide big-data approach. Methods: This retrospective study analyzed 299,413 treatment sessions (417,590 injection sites) from patients who underwent facial HA injections at 110 clinics across Japan between October 2020 and December 2024. Data were analyzed by year, patient age, and injection site to evaluate demographic shifts and treatment patterns. Results: The annual number of treatment sessions increased steadily during the study period. A significant demographic shift was observed: while patients in their 20s were predominant in 2020-2022, the proportion of patients aged ≥ 40 years increased markedly from 2023 onward, accounting for more than half of all cases (63.7% in 2024). Treatment preferences varied distinctly by age; younger patients favored localized contouring (e.g., pretarsal fullness, chin), whereas older patients required multi-site rejuvenation. By 2024, the orbital rim became the most frequently treated site (22.6%). Statistical analysis confirmed that age was a significant predictor for multi-site treatments (p < 0.001). Conclusions: This large-scale analysis reveals a clear transition in the Japanese aesthetic market from contour enhancement in younger demographics to anatomy-based rejuvenation in middle-aged and older populations.

Abstract Botulinum toxin type A (BoNT-A) is widely used in aesthetic and therapeutic medicine and is considered safe. Nonetheless, rare adverse reactions can occur, even in patients with no prior allergic history. We report the case of a 50-year-old woman who developed a localized inflammatory reaction characterized by erythema, edema, vesicles, burning, and pruritus following injections in the upper face. A reactivity test with another formulation in the subcutaneous tissue of the arm produced an even more severe response, suggesting greater immune reactivity in subcutaneous tissue compared to muscle. Considering the known differences among commercial formulations, including accessory proteins and stabilizers, the test excluded the hypothesis of an allergy specific to a single brand. Standard therapies with corticosteroids and antibiotics failed to produce improvement, while ozone therapy led to significant recovery. This case emphasizes the importance of individualized follow-up and highlights the need for further studies to elucidate the immunopathological mechanisms underlying such rare hypersensitivity reactions.

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings.

The evolving field of regenerative aesthetic medicine continues to seek minimally invasive methodologies that provide natural, durable outcomes in body contouring. This article elucidates the scientific rationale and clinical efficacy of autologous fat grafting, specifically through the technique of microfat harvesting and processing, augmented with the concentrated release of endogenous growth factors derived from activated platelet-rich plasma (PRP) or platelet-rich fibrin (PRF). We posit that this synergistic combination transcends the conventional model of mere volume restoration, advancing into a holistic paradigm of in situ tissue regeneration. The core mechanism hinges on the bioactive interplay between the adipose-derived stem cells (ASCs) and endothelial progenitor cells within the stromal vascular fraction (SVF) of the micrografts and the potent cytokine cocktail—including platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β)—released from the platelets. Current evidence underscores that this microenvironment significantly enhances graft viability by promoting early angiogenesis, mitigating apoptotic cell death, and fostering adipocyte progenitor differentiation. Furthermore, we review contemporary high-level clinical studies and systematic analyses that demonstrate superior volumetric retention, improved cutaneous quality, and reduced postoperative resorption rates compared to traditional lipofilling. This manuscript provides a comprehensive synthesis of the current biological understanding, technical protocols for optimized bio-activation, and clinical applications, positioning growth factor-enriched adipose micrografts as a cornerstone in the pursuit of natural, structural body remodeling.

Introduction: Several factors influence the quality and appearance of the skin, including age, lifestyle, sun exposure, and certain conditions. These elements can have a significant negative impact on some individuals. As aresult, esthetic medicine is increasingly sought after as a solution to counteract these effects, enhancing bothappearance and self-esteem. The objective of the research was to observe the clinical and histological changesin the skin of five women with photoaging, hyperpigmentation, rhytidosis, or acne scars after a single applicationof recombinant enzymes.Methods: This longitudinal descriptive study was conducted on 5 women aged 47-65, randomly selected.Photographic records and biopsies were taken before and after the treatment.Results: Clinical results revealed a significant improvement in skin quality and texture, with reduced skin laxityand skin repositioning, as well as a decrease in hyperpigmented lesions and acne scars. Histologically, there was areduction in hyperkeratosis and collagen basophilia, along with regeneration of elastic and collagen fibers, showingan increase in their integrity.Conclusion: A single dose of recombinant enzymes demonstrated improvement in skin quality both clinically andhistologically in 100% of the patients, proving to be a safe, reliable, and easy-to-apply treatment. It achieved highlevels of patient satisfaction, suggesting its potential to replace more invasive procedures.

Aesthetic medicine is undergoing asubstantial shift toward more objective, algorithm- and data-driven decision-making, with artificial intelligence (AI)-supported facial analysis playing apivotal role. Modern systems such as CAARISMA™ capture the face holistically using anatomical landmarks, integrate these into the evaluation of different aesthetic dimensions, and translate them into easily interpretable scores such as Facial Aesthetic Index (FAI), Facial Youthfulness Index (FYI), and the Skin Quality Index (SQI). These indices enable standardized and reproducible aesthetic diagnostics, free from subjective, practitioner-specific influences. Clinically, they lead to more structured consultations, individualized treatment plans, and improved communication between physician and patient. At the same time, AI-based, data-driven aesthetic diagnostics and treatment planning can enhance efficiency and treatment quality in daily practice and allow for long-term monitoring of outcomes. Challenges at the interface between AI and aesthetics lie in the areas of bias, transparency, and data protection, all of which must be addressed to ensure responsible use of these technologies.

In recent years, there has been rapid growth in aesthetic medicine and an increase in the number of minimally invasive procedures aimed at improving appearance. With the increasing number of procedures performed, the incidence of post-operative complications is also rising, and high-frequency ultrasound (HFUS) is increasingly being used to assess these complications. The article presents the case of a 52-year-old woman who reported for an HFUS examination several months after non-surgical nose correction with hyaluronic acid (HA) and implantation of polydioxanone (PDO) lifting threads. The patient experienced post-treatment complications in the form of erythema, oedema and pain, followed by blanching and bruising of the skin. Hyaluronidase and prednisone were used for treatment. Four months after the procedure, the patient returned for another HFUS examination because, despite the disappearance of most symptoms, uneven purple-blue discoloration of the skin on the nose and a subjective feeling of cold persisted. At the time of the HFUS examination, the discoloration was barely visible. The grey-scale HFUS examination revealed foci corresponding to HA deposits and PDO threads located in close proximity to the dorsal artery of the nose. A Doppler examination revealed blood flow disturbances in this artery, which may indicate compression by the threads and be the likely cause of the patient’s complaints. High-frequency ultrasound has proven to be a useful diagnostic method for assessing such complications. Due to its safety, non-invasiveness and high reliability, HFUS has the potential to become a common diagnostic tool in aesthetic medicine practice.

Background: The regenerative field of aesthetic medicine has placed a growing emphasis on using biologically derived, minimally invasive techniques through which tissue function and quality can be restored. Autologous (patient’s own) therapies such as platelet-rich plasma (PRP), stem-cell-derived products, and fat-derived grafts have become common treatments for a variety of indications including facial rejuvenation, scar treatment, and hair restoration. Most of these treatments are currently performed with the aid of landmark-based methods for injecting, which can lead to inconsistent results and increased risks during procedures. Rationale and Purpose: Interventional radiology offers the opportunity to use a more precise image-guided technique with the use of real-time imaging (i.e., ultrasound) to view vascular structures and soft-tissue planes as they are placed within the body. This allows for better needle placement and allows for the accurate delivery of biologic agents with significantly less risk of intravascular injections. The purpose of this narrative review is to describe the current body of literature regarding the use of imaging guidance to aid in the delivery of regenerative aesthetic medical procedures. It will address the following components: clinical efficacy, safety, regulatory aspects, and standardization of the imaging technique. Methods and Results: A structured search of the literature was completed using PubMed, Embase, and the Cochrane Database from 2020 to July 2025.Based on the available studies, image-guided delivery of biologic medications does demonstrate an increase in procedural accuracy, improves the distribution of grafts within tissues, and leads to improved patient-reported outcomes when compared to traditional methods of injection. However, much variation exists in the methods of biologic preparation, methods to assess the outcomes, and length of time patients are followed the procedure. Conclusion: Recent evidence has shown that imaging guidance can help increase both safety and reproducibility in various areas of the patient care continuum. However, there continues to be a lack of high-quality randomized trials demonstrating the benefits associated with imaging guidance and comprehensive standardized protocols for the utilisation of imaging guidance, which ultimately hampers the development of clinically significant evidence-based treatment algorithms. A need for additional multi-disciplinary studies is present to create valid and scientifically based guidelines for incorporating the use of interventional radiology within regenerative aesthetic practices. Keywords: Platelet-rich plasma; stem-cell therapy; fat grafting; regenerative aesthetics; interventional radiology; ultrasound-guided injection; imaging guidance.

Genioplasty and chin-augmentation are well-established procedures aimed at enhancing lower facial aesthetics. Traditionally, aesthetic outcomes have been assessed subjectively through expert opinions and patient-reported measures. The integration of artificial intelligence (AI) offers an objective approach to evaluating surgical results. This study utilizes the ICA Aesthetic Navigation AI Research Metrics Model (ICAAN® ARMM) to analyze postoperative changes in facial attractiveness, youthfulness, and skin quality following genioplasty. Pre- and postoperative full-frontal images of 50 patients undergoing osseous genioplasty were analyzed using the ICAAN® ARMM. Therefore, an array of three aesthetic scores, the Facial Aesthetic Index (FAI), Facial Youthfulness Index (FYI), and Skin Quality Index (SQI), were measured before and after surgery, with subgroup analyses by age, sex, and ethnicity. Minimally clinically important differences (MCIDs) were estimated. All three aesthetic scores demonstrated improvement postoperatively, with FAI showing the greatest increase (82 (73-89) to 85 (75-92); p = 0.296), without showing statistical significance. Older patients (≥ 35 years) exhibited greater improvements in FAI scores compared to younger individuals (4 (1-10) vs. 1 (- 3-5); p = 0.028). Sex-related trends were observed, while lacking statistical significance. Ethnic subgroup analysis revealed no differences in score changes, suggesting cross-cultural applicability. Observed improvements did not exceed estimated MCIDs. AI-assisted aesthetic analysis offers a novel, contemporary, and objective method for assessing genioplasty outcomes. While our study suggests general aesthetic improvements following surgery, further research incorporating larger data collections and subjective patient-reported measures is necessary. AI tools hold promise as a complementary tool in aesthetic medicine, supporting both clinicians and patients in surgical decision-making. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction:Modern aesthetic dentistry increasingly integrates techniques from aesthetic medicine to improve the appearance and function of the oral cavity. Growing patient expectations concerning not only health but also the aesthetics of teeth and perioral tissues have led to the development of interdisciplinary treatment methods. Materials and Methods:This article reviews current techniques used in aesthetic medicine, such as botulinum toxin, tissue fillers, and mesotherapy, and their adaptation in dental practice. The use of platelet-rich plasma (PRP) for aesthetic treatment of the face and perioral structures is also discussed. Results and Discussion:Aesthetic dentistry now includes procedures that enhance both teeth and facial soft tissue aesthetics. Botulinum toxin is used to treat gummy smile, bruxism, and muscular asymmetry. Dermal fillers help in contouring facial structures and enhancing lip volume. Mesotherapy and PRP support tissue regeneration and skin quality, also aiding healing after dental procedures.

The aesthetics industry is undergoing a paradigm shift toward regenerative and biologically based therapies. This article critically compares polynucleotides (PNs) and exosomes, two innovative modalities demonstrating significant potential in aesthetic and dermatologic applications. Polynucleotides, composed of nucleotide polymers, promote fibroblast proliferation, collagen synthesis, and cutaneous hydration, contributing to skin repair and rejuvenation. Exosomes, nanoscale extracellular vesicles derived from stem cells, facilitate intercellular communication and deliver bioactive molecules that enhance tissue regeneration, immune modulation, and wound healing. While both therapies exhibit promising clinical outcomes, exosomes provide a broader regenerative mechanism but face greater regulatory and ethical scrutiny due to their origin and production methods. The article underscores the necessity for evidence-based practice, safety evaluation, and standardised protocols in advancing these emerging biotechnologies within aesthetic medicine.

Polynucleotides (PNs) and polydeoxyribonucleotides (PDRNs) have gained immense traction in aesthetic medicine due to their regenerative properties. These biostimulator agents act at a cellular level to promote fibroblast proliferation, angiogenesis, extracellular matrix remodelling, and DNA repair – enhancing skin elasticity, hydration and overall tissue quality. Clinically, PNs have been used in multiple different indications, including facial rejuvenation (periorbital, perioral, midface), neck and décolletage laxity, hand revitalisation, hair restoration, acne scarring and post-inflammatory pigmentation. Although current evidence is limited to small-scale studies of low-moderate methodological quality, outcomes consistently report skin texture enhancement, wrinkle reduction, improved dermal hydration, and high patient satisfaction, with only mild and transient side effects observed. This review analyses available literature, positioning PNs as a safe, effective and distinctly regenerative option distinguishing them from traditional skin boosters and other biostimulators.

Kate Monteith-Ross discusses why so many practitioners choose to leave the aesthetics industry within their first year of practice

In this regular feature, Aesthetic Nurse Claudia McGloin presents a brief synopsis of a range of recently published articles on medical aesthetics. Research roundup aims to provide an overview, rather than a detailed summary and critique, of the papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided at the end of each study summary