Injection Technique for Exocleo (Exosome-HA-PDRN Skin Rejuvenation Product)
Critical Safety Warning
Intradermal injection of exosome products carries significant risk of serious complications including skin necrosis, leukocytoclastic vasculitis, and foreign-body granulomatous reactions, and should be avoided—topical application is the only currently safe and approved route for exosome-based aesthetic products. 1, 2, 3
Evidence-Based Concerns
Documented Complications with Injectable Exosomes
A 2024 case report documented severe skin necrosis following intradermal injection of lyophilized exosomes, presenting as painful, non-blanchable purplish papules and nodules with central crusted erosions within 3 days of injection 1
Histopathology from this case revealed necrotic keratinocytes, leukocytoclastic vasculitis, and eccrine necrosis—requiring 7 days of oral prednisolone treatment and leaving permanent post-inflammatory hyperpigmentation 1
Multiple foreign-body granulomatous reactions at injection sites have been reported with intradermal exosome products 1
Regulatory Status
In the United States, exosomes may only be topically applied and not injected into the skin at the time of current publications 3
Exosome products have only been approved for topical administration, with injection routes remaining unapproved due to lack of safety and efficacy data 1, 2
The safety, efficacy, potency, and dosages of exosomes remain to be determined via robust human clinical trials 2
If Proceeding Despite Risks (Following Local Regulations)
Given the serious safety concerns, if you are in a jurisdiction where this is permitted and choose to proceed, the following technique should be applied with extreme caution:
Pre-Injection Assessment
Inspect the injection site thoroughly for any signs of lipohypertrophy, inflammation, edema, infection, or ulceration—avoid injecting into any compromised areas 4
Avoid areas with scars, stretch marks, or tattoos as their impact on product delivery and absorption is unknown 4
Clean hands thoroughly before handling injection supplies 5, 6
Needle Selection
Use a 29-32 gauge needle or 25-27 gauge blunt-tip cannula to minimize pain and tissue trauma 7
For products containing HA and PDRN (similar to Profhilo-type products), consider using shorter needles (4-5mm) to target the appropriate tissue plane 4
Injection Technique (Based on Similar HA-Based Products)
Clean the injection site with an alcohol swab and allow it to dry completely before injecting 4, 6
Insert the needle at a shallow angle (10-15 degrees) with the bevel facing upward when targeting the deep dermis or superficial subcutaneous layer 7
Inject slowly and smoothly, avoiding jabbing motions, delivering small volumes (0.2 mL) per injection point 7
Pause for 5-10 seconds before withdrawing the needle to ensure complete product delivery 7
Use the BAP (Bio Aesthetic Points) technique with 5 points per facial side if following established protocols for similar products 7
Site Selection and Rotation
Rotate injection sites by at least 1 cm from previous injections to prevent tissue damage and ensure proper absorption 7
Avoid injecting into areas with lipohypertrophy, scars, or damaged tissue as absorption will be unpredictable 7
Post-Injection Monitoring
Monitor immediately for signs of vascular occlusion including blanching, severe pain, or skin mottling—though risk may be lower with non-cross-linked formulations 7
Watch for development of painful papules, nodules, or color changes in the days following injection 1
Have hyaluronidase immediately available if using HA-containing products 7
Safer Alternative: Topical Application
Topical application of platelet-derived exosome products has demonstrated statistically significant improvements in skin health scores, with reductions in redness, wrinkles, and melanin production at 6 weeks (P ≤ 0.0001) 8
Topical exosome products are safe, well-tolerated, and avoid the serious complications associated with injection 8
The topical route should be strongly preferred given the documented safety profile and lack of serious adverse events compared to injection. 2, 3, 8