Redefining Aesthetic Aging Through Cellular Medicine

Aesthetic medicine has historically addressed aging as a visual problem, but what if we treated it as a cellular condition? Aging is not merely the loss of collagen or volume; it is stem cell exhaustion, senescence, and disrupted signaling. It is a decay process, and like nuclear decay, it follows a predictable curve, unless we intervene.

My current approach to aesthetic treatment is guided by one overarching principle: cellular longevity. Whether I am performing a facelift or applying a bio-cream, my objective is to restore cellular function and slow the rate of tissue decay.

REPLACE, REGENERATE, RESET

Our earliest clinical observations confirmed that stem and regenerative cells (stromal vascular fraction) could be enzymatically separated from liposuctioned fat and could stimulate tissue repair and perfusion, even in cardiac patients. In aesthetics, I have adapted that principle into a layered protocol:

Structural Replacement: Fat is not just filler. It is biologically active. I graft fat to restore volume in facial compartments and address bone loss, creating a structural foundation for regeneration.

1. Intradermal Delivery: Using microneedling and techniques developed by colleagues such as Dr. Alex Verpaele in Belgium, I inject regenerative cells directly into the dermis.
2. Topical Bio-Cream: We have published on a bio-cream derived from autologous cells, which enhances post-laser outcomes and improves skin tone and texture.
3. Each component of this protocol contributes to a broader goal of reversing the cellular clock.

PATIENT OUTCOMES AND THE LONGEVITY CURVE

When we track patients longitudinally, we see something remarkable: a flattening, or even reversal, of the aging curve.

In patients under 55, who harbor fewer senescent cells, regenerative interventions produce a “rebound effect.” Over time, their skin and facial structure appear to improve, not merely maintain. For older patients, results are still durable, but less dramatic, which is likely due to a higher burden of exhausted cells.

We have seen this across many cases:

• A 47-year-old woman treated once with fat grafting and cellular therapy showed sustained improvement over 6.5 years.
• In facelift patients, combining regenerative techniques with structural repositioning has yielded 7- to 16-year improvements with no further volumizing interventions.

These outcomes are not due to fat survival alone. In many cases, the fat resorbs, leaving its structural matrix behind. Fat grafting today is not just augmentation, but a way of delivering stem cells and other molecular signals to regenerate aging tissue.

One of the most fascinating observations has been the secondary improvement in chronic skin conditions. Patients with rosacea or post-surgical skin changes have shown unexpected improvement after receiving nanofat or microneedled fat grafts. We are still uncovering the mechanisms, but it may relate to the anti-inflammatory and immunomodulatory properties of the stromal vascular fraction and associated exosomes.

AN ENGINEERED EXOSOME HYBRID

A major limitation of traditional exosomes is variability, both in content and performance. To address this, our team helped develop a hybrid involving membrane fusion of exosomes and liposomes that we call ASOMEs (advanced synthetic-organic messenger exosomes). This hybrid consists of autologous exosomes and secretomes concentrated from platelet-rich plasma (PRP). Its structure allows us to:

• Load targeted molecules (eg, vitamins, amino acids, peptides, growth factors, etc)
• Achieve deeper dermal penetration
• Improve stability and cellular uptake

In comparative studies, ASOMEs outperformed adipose-derived stem cells in wound healing, regeneration, and telomerase enzyme activation—a direct marker of cellular rejuvenation.¹

We also conducted a double-blind, split-face study in more than 100 patients comparing ASOME topicals to retinol. ASOME was superior in improving texture, tone, and collagen density.²

IN-OFFICE AUTOLOGOUS EXOSOME THERAPY

One of the most exciting recent developments has been a device (ExoCube, London Regenerative Institute) that is cleared by the US Food and Drug Administration (FDA) to help clinicians isolate exosomes and secretomes from a patient’s own PRP. The device activates platelets to release exosomes, filters out the platelets, and then concentrates the exosomes with the secretomes (growth factors, cytokines, etc).

In about 20 minutes, we can produce 1 billion exosomes per milliliter of blood, which can be injected, applied topically, or thermally modified into a bio-based alternative to synthetic fillers. Early results from Brazil, where the device was approved in April 2024, have shown impressive improvements in the areas of hair growth, melasma, inflammatory conditions, tear troughs, cheeks, and hands, and enhanced wound healing compared to PRP and other regenerative treatments. 

This could circumvent many of the regulatory and safety concerns associated with donor-derived exosomes.

A NEW MODEL OF REGENERATIVE AESTHETICS

We are no longer just chasing symmetry or smoothing wrinkles in aesthetic medicine. We are working to alter the trajectory of aging.

Through fat grafting, stem cell–enriched therapies, exosome engineering, and autologous biologics, we now have tools to not just restore what was lost but to reprogram how we age.

The science is still maturing. We have more to learn about dosing, patient selection, and long-term outcomes. But we are entering a new phase in dermatologic and aesthetic care in which we do not just make patients look younger—we help their cells become younger.

Welcome to the new biology of beauty. 

Editor’s note: This article is based on a presentation delivered at the 2025 Genesis: Innovations in Aesthetic Regenerative Medicine Meeting.