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Despite an increasing surge of exosome use throughout the aesthetic arena, a paucity of published exosome-based literature exists. Exosomes are membrane-bound extracellular vesicles derived from various cell types, exerting effects via intercellular communication and regulation of several signaling pathways. The purpose of this review was to summarize published articles elucidating mechanisms and potential applications, report available products and clinical techniques, and prompt further investigation of this emerging treatment within the plastic surgery community., Methods: A literature review was performed using PubMed with keywords exosomes, secretomes, extracellular vesicles, plastic surgery, skin rejuvenation, scar revision, hair growth, body contouring, and breast augmentation. Publications from 2010 to 2021 were analyzed for relevance and level of evidence. A Google search identified exosome distributors, where manufacturing/procurement details, price, efficacy, and clinical indications for use were obtained by direct contact and summarized in table format., Results: Exosomes are currently derived from bone marrow, placental, adipose, and umbilical cord tissue. Laboratory-based exosome studies demonstrate enhanced outcomes in skin rejuvenation, scar revision, hair restoration, and fat graft survival on the macro and micro levels. Clinical studies are limited to anecdotal results. Prices vary considerably from $60 to nearly $5000 based on company, source tissue, and exosome concentration. No exosome-based products are currently Food and Drug Administration-approved., Conclusions: Administered alone or as an adjunct, current reports show promise in several areas of aesthetic plastic surgery. However, ongoing investigation is warranted to further delineate concentration, application, safety profile, and overall outcome efficacy., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Venous flaps are nonphysiologic flaps in which the venous system replaces the vascular circuit found in conventional flaps, serving as inflow as well as outflow. Although a main concern with venous flaps has been their reliability, this can be improved by manipulating their physiology using shunt restriction. The soft, pliable tissue provided by venous flaps coupled with the low donor site morbidity and ease of flap harvest make them ideal for coverage of moderate-sized facial defects, which may be too large for local options yet too small for conventional free flaps. We report the use of a large, 70 cm 2 arterialized venous free flap to reconstruct a complex forehead deficit after basal cell carcinoma resection. Furthermore, we present the first report of the successful use of valvulotomes in the case of a large, reverse flow arterialized venous flap where several in-series valves were found to prevent adequate perfusion of the flap. Upon removal of the valves, complete perfusion of the flap was achieved., Competing Interests: Disclosure: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)