Choosing an exosome provider starts with the license, before the product: the FDA tells patients to ask whether it has reviewed what is offered and to request the facts, and a 2023 secret-shopper survey reported that a supervising physician was not on site at 81.1 percent of 127 Chicago-area med spas [1, 6]. The FDA states that no exosome product is FDA approved, so a sound practice answers with a named licensed practitioner, a state license you can look up, and lot documents for the material it uses [1].
A license lookup takes a few minutes, and the supervision surveys show why it is worth doing. The sections that follow cover the lookup, the supervising practitioner question, the nine documents a sound practice can show, the limits the reviews state, and a directory of the city and state guides on this site; every decision about a procedure belongs to you and your licensed provider.
Regulatory status
The FDA stated in its 2019 public safety notification that there are currently no FDA-approved exosome products, and its consumer alert, current as of 2024, repeats that statement [1, 2]. ExaVeyra Sciences supplies exosome material for topical aesthetic use by licensed practitioners, and for laboratory research and clinical research conducted under an IND, described by its available formats. ExaVeyra holds no state practice license and operates no clinic; whether a procedure suits you is a decision for you and your licensed practitioner.
State license lookups establish who is responsible for the service
State licensing boards keep public license records: Soares and colleagues drew the license and certification data for their 2025 Florida survey from the state Department of Health and medical board databases, and a patient can check a provider’s name, license type and status the same way before an appointment [5]. Malik and colleagues reviewed state statutes, administrative codes, case law and board guidance in 2025 and reported significant variability between states in med spa ownership rules, the role of the supervising physician and the scope of practice of nonphysician providers [4].
That variability is why the lookup matters more than a website’s wording. Choudhry and colleagues interviewed 31 state medical boards and reported in 2012 that 20 allowed all minimally invasive cosmetic procedures to be delegated at the physician’s discretion to at least one category of nonphysician, 14 required general supervision and 13 required some form of on-site supervision [7].
A practice that passes this first check can name the supervising practitioner, the license under which the service is offered, and the person who will perform each step. The state guides linked at the end of this article summarize the practice-act questions for the states where most readers search, and the boards remain the authority.
Supervision surveys explain why the on-site question is asked directly
Hogan and colleagues telephoned 127 med spas in the Chicago area as prospective patients in 2023 and reported that a supervising physician was not on site at 81.1 percent of them, and that callers were told so at 64.6 percent [6]. Soares and colleagues surveyed the 1,038 independent med spas they identified in Florida and reported in 2025 that nonphysician practitioners made up 84 percent of providers, that core specialty medical director supervision was present at 22 percent of facilities, and that 25 percent appeared to disregard state directorship guidelines [5].
Outcomes track that picture. Rossi and colleagues surveyed consumers and physicians in 2019 and reported more burns and discoloration among consumers seen by nonphysicians, more often in a spa setting, with improper technique the most cited reason [8]. Valiga and colleagues described in 2022 how med spas outnumber physician-based cosmetic practices in 73 percent of major US cities and rely on operators with variable training [9].
None of this means a nonphysician provider is the wrong choice; it means the question "who supervises, and are they here today" deserves a direct answer. The FDA microneedling page gives the same advice for the device most exosome add-ons follow: select a trained provider and ask about training and experience [17].
Nine checks a sound practice answers with documents
Each check below has a paper answer. A practice working from documentation can produce it in the consultation, and the table names the source behind each one.
| Check | What to ask | What a documented answer looks like | Source |
|---|---|---|---|
| 1. License | Under whose license is this service offered, and may I look it up? | A name and license number you can verify on the state board site | Malik 2025 [4] |
| 2. Supervision | Who supervises, and are they on site today? | A named supervising practitioner and the supervision level the state requires | Hogan 2023 [6]; Choudhry 2012 [7] |
| 3. Who performs each step | Who performs the procedure and who applies the material? | A delegation that matches the state practice act | Soares 2025 [5] |
| 4. Product identity | What is the material, who manufactured it, and what tissue does it come from? | A named manufacturer, product line and source | Knauer 2026 [11]; Rahman 2025 [10] |
| 5. Lot number | May I see the lot number on the vial? | A lot number that also appears in your chart | MISEV2023 [15] |
| 6. Certificate of analysis | Is there a certificate of analysis for this lot? | A certificate carrying the same lot number, with sterility and serology results | Practice lot record |
| 7. Characterization | How was the material characterized? | A panel with particle size, concentration and marker proteins, readable against MISEV2023 | MISEV2023 [15] |
| 8. Cold chain | How was it shipped and stored, and when was it thawed? | A temperature record from manufacturer to clinic and a freezer log | Görgens 2022 [16] |
| 9. Route and approval | Is it applied to the skin surface, and is any exosome product FDA approved? | Topical labeling, and a plain statement that no exosome product is FDA approved | FDA 2019 [1]; Wang 2026 [13] |
The FDA notification adds one more question for anyone offered an exosome product as part of a study: the FDA-issued IND number and the agency letter acknowledging it [1]. The 2021 patient information page states that a listing on clinicaltrials.gov does not by itself mean a product is legally marketed [3].
Lot documentation shows what the material is
Products sold as exosomes vary widely, and the documentation is how one lot distinguishes itself. Knauer and colleagues surveyed 20 commercial topical exosome products in 2026 and reported that they carried minimal information on isolation, processing or shelf life [11]. Rahman and colleagues evaluated 18 manufacturers and 70 product formulations in 2025, rated 18 percent of the manufacturers highly transparent, and rated 27 percent of social media claims misleading [10].
The International Society for Extracellular Vesicles publishes MISEV2023, the reporting guideline for describing vesicle material by its source, how it was separated and how it was characterized [15]. A characterization panel that reports particle size and concentration and marker proteins can be read against those headings, and a certificate of analysis tied to the lot number on the vial shows the testing applies to the material in front of you [15].
Storage is part of identity. Görgens and colleagues tested storage conditions for up to two years in 2022 and reported that vesicle recovery depended on buffer and temperature, with losses in phosphate-buffered saline (PBS) and better preservation at minus 80 degrees Celsius in a buffer with albumin and trehalose [16]. A practice that keeps a freezer log and can show the shipping record has answered the cold-chain question.
A sound practice answers with a license you can look up, a supervising practitioner you can name, and lot documents you can read.
Understanding what the evidence does not yet show
A provider who describes the research accurately will describe it as early. The points below are the limits the reviews themselves state, and a claim that runs past them is a reason to ask for the source.
- Certainty is low: Gaebe 2026 reviewed 16 facial studies with 503 participants, found no serious adverse events, and rated the evidence low or very low with a short-term safety signal [12].
- Products are not interchangeable: the studies used different sources and preparations, and Knauer 2026 found minimal processing information on commercial products [11].
- Long-term safety is unmeasured: follow-up in the controlled studies runs to weeks or months [12].
- Supervision has not been studied as a variable: no located study compares outcomes by practice setting or level of oversight; the surveys describe the setting, not the result [5, 6].
- Serious harms followed injection: Wang 2026 lists granulomas, necrosis and allergic reactions after injection, and Park KY 2025 described four women injured in nonclinical settings [13, 14].
- Claims outrun evidence online: Rahman 2025 rated 27 percent of social media claims misleading [10].
Injection outside a study is the pattern behind the reported harms
The route a provider proposes belongs on the checklist because the published harms share one. Wang, Bajwa and Rivers mapped 17 human studies in 2026 and reported that the granulomas, necrosis and allergic reactions they found followed injection [13]. Park KY described four women in 2025 with persistent nodules and scarring after intradermal injection, in nonclinical settings, of products that had been sold for topical use [14].
The FDA’s 2021 patient page states that a product offered outside a clinical trial under FDA oversight is likely offered illegally, and lists infections and unwanted inflammatory responses among the harms reported to it [3]. The agency’s cosmetics page explains that whether a product is a cosmetic or a drug is determined by its intended use, so a provider’s claims can be read against the product’s labeling [18].
Exosome material from ExaVeyra is supplied for topical aesthetic use by licensed practitioners, applied to the skin surface, and the FDA microneedling page states that the devices used before many topical add-ons are not approved for delivering products into the skin [17]. A practice that describes the service in those terms, and names MedWatch as the place a problem would be reported, has answered the ninth check [19].
City and state guides describe local practice rules
A "near me" search is a local question, and the rules that decide who may offer a service are set by the state. The table lists every city guide on this site with its state, and the links that follow lead to the city pages, the regional index and the state guides, where the local supervision and delegation questions are summarized.
| City guide | State | Page |
|---|---|---|
| Aspen | Colorado | /exosomes/regions/aspen |
| Atlanta and Buckhead | Georgia | /exosomes/regions/atlanta |
| Austin | Texas | /exosomes/regions/austin |
| Beverly Hills | California | /exosomes/regions/beverly-hills |
| Boca Raton | Florida | /exosomes/regions/boca-raton |
| Boston and Wellesley | Massachusetts | /exosomes/regions/boston |
| Calabasas | California | /exosomes/regions/calabasas |
| Chicago and the North Shore | Illinois | /exosomes/regions/chicago |
| Coral Gables | Florida | /exosomes/regions/coral-gables |
| Dallas and Highland Park | Texas | /exosomes/regions/dallas |
| Denver and Cherry Hills | Colorado | /exosomes/regions/denver |
| Fort Lauderdale | Florida | /exosomes/regions/fort-lauderdale |
| Houston and River Oaks | Texas | /exosomes/regions/houston |
| Las Vegas and Summerlin | Nevada | /exosomes/regions/las-vegas |
| Los Angeles | California | /exosomes/regions/los-angeles |
| Malibu | California | /exosomes/regions/malibu |
| Manhattan | New York | /exosomes/regions/manhattan |
| Miami Beach | Florida | /exosomes/regions/miami-beach |
| Mountain View | California | /exosomes/regions/mountain-view |
| Naples | Florida | /exosomes/regions/naples |
| Nashville | Tennessee | /exosomes/regions/nashville |
| Newport Beach | California | /exosomes/regions/newport-beach |
| Orlando and Winter Park | Florida | /exosomes/regions/orlando |
| Palm Beach and West Palm Beach | Florida | /exosomes/regions/palm-beach |
| Palo Alto and Atherton | California | /exosomes/regions/palo-alto |
| Philadelphia and the Main Line | Pennsylvania | /exosomes/regions/philadelphia |
| Phoenix | Arizona | /exosomes/regions/phoenix |
| Reno and Lake Tahoe | Nevada | /exosomes/regions/reno-lake-tahoe |
| Salt Lake City | Utah | /exosomes/regions/salt-lake-city |
| San Diego and La Jolla | California | /exosomes/regions/san-diego |
| San Francisco and Marin | California | /exosomes/regions/san-francisco |
| San Jose | California | /exosomes/regions/san-jose |
| Santa Clara | California | /exosomes/regions/santa-clara |
| Scottsdale | Arizona | /exosomes/regions/scottsdale |
| Seattle | Washington | /exosomes/regions/seattle |
| South Lake Tahoe and Truckee | California | /exosomes/regions/south-lake-tahoe |
| Tampa | Florida | /exosomes/regions/tampa |
Readers looking for a provider can also start with the practitioner directory on this site, which lists practices that order documented material through a verified account. The directory ranks no one, and the nine checks above apply to every practice on it.
Documented supply is how a practice answers these questions
Every check in this guide has a paper answer, and ExaVeyra Sciences builds its exosome supply around those answers. Every vial carries its lot number, a certificate of analysis with serology exists for every lot, and the certificate, characterization panel and cold-chain records are available on request, so a practice that carries the material can show a patient the documents this guide asks about.
Practices that want to carry documented material can apply for a verified account; anyone may apply or ask our scientific team a question without an NPI, and NPI verification, completed in one to three business days, gives access to the practitioner portal, product documentation and pricing. Patients who ask clear questions and practices that keep clear records raise the standard together, and the city and state guides above are the place to start locally.
Educational Disclaimer: This article is for educational purposes only and does not constitute medical or legal advice. It does not identify any material, compound, device setting or protocol as safe, effective or appropriate for any patient, and it is not intended to diagnose, treat, cure, or prevent any disease. Questions about a treatment belong with the reader’s own licensed provider. Exosome material is supplied for topical aesthetic use by licensed practitioners. No exosome product is FDA-approved for any use, and ExaVeyra Sciences makes no statement about administration, route, or outcome. Compounded medications are not FDA-approved. They are prepared by a 503A compounding pharmacy licensed by the Texas State Board of Pharmacy for an individual patient against that patient’s prescription, and are available to NPI-verified licensed practitioners only, in the states where the pharmacy is licensed. Product, device and brand names mentioned are trademarks of their respective owners and are used only to identify the products discussed. Their mention is not an endorsement, and those owners have not reviewed or endorsed this article. ExaVeyra Sciences is a supplier and takes no part in any diagnosis, treatment decision, or plan of care. Findings described are attributed to the peer-reviewed literature, trial registries and agencies cited. The content of these guides is provided for general informational purposes only. It does not constitute legal, medical, or regulatory advice, and does not establish that any particular product or practice is compliant. Regulatory requirements vary by state and depend on the circumstances of each practice. Each practitioner should consult their own legal counsel and the applicable state licensing boards before acting on anything stated here.
References
- 1.U.S. Food and Drug Administration. Public Safety Notification on Exosome Products. December 6, 2019 (content current as of 12/06/2019; verified 4 November 2026). https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/public-safety-notification-exosome-productsAgency safety notification (CBER). Carries in this article: the statement that there are currently no FDA-approved exosome products, the report of serious adverse events in Nebraska after unapproved products marketed as containing exosomes, and the agency’s advice to patients to ask whether the FDA has reviewed what is offered, to request the facts, and to ask questions when something is unclear.
- 2.U.S. Food and Drug Administration. Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. Issued July 22, 2020; content current as of 04/09/2024; verified 4 November 2026. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/consumer-alert-regenerative-medicine-products-including-stem-cells-and-exosomesAgency consumer alert (CBER). Carries in this article: the FDA has authority over exosome products, there is misleading online information about the conditions these products can address, there are currently no FDA-approved exosome products, and the agency invites patients to call or email it with questions about a product before deciding.
- 3.U.S. Food and Drug Administration. Important Patient and Consumer Information About Regenerative Medicine Therapies. June 3, 2021; content current as of 04/08/2024; verified 4 November 2026. https://www.fda.gov/vaccines-blood-biologics/consumers-biologics/important-patient-and-consumer-information-about-regenerative-medicine-therapiesAgency patient information page (CBER). Carries in this article: a listing on clinicaltrials.gov or a firm’s registration with the FDA does not mean a product is legally marketed, a product offered for a fee outside a clinical trial under FDA oversight is likely offered illegally, and the agency’s list of reported harms including infections and unwanted inflammatory responses.
- 4.Malik AM, Ferrante AM, Booker BM, Council ML, Michalski-McNeely BM. Medical Spa Legislation, Regulations, and Guidelines in the United States. Dermatol Surg. 2025;51(8):785-790. PMID 40304398. doi:10.1097/DSS.0000000000004648Legal review of state statutes, administrative codes, case law and professional board guidance, with a stakeholder toolkit; no participants. Carries in this article: significant state variability in med spa ownership rules, the role of the supervising physician and nonphysician scope of practice, the reason a provider check starts with the state. Disclosure: academic dermatology and law school authors; no funding statement in the PubMed record.
- 5.Soares DJ, Bowhay A, Fakhre F, Hynes SD, Lee A, Yi CH. The Shifting Face of Aesthetic Care: A Systematic Survey of Independent Medical Spa Directorship and Practitioner Trends in Florida. Plast Reconstr Surg. 2025;155(1):66e-74e. PMID 38722589. doi:10.1097/PRS.0000000000011511Statewide cross-sectional survey of independent med spas in Florida using business, corporate and Department of Health licensing records; 1,038 med spas. Carries in this article: nonphysician practitioners made up 84 percent of providers, core specialty medical director supervision was present at 22 percent of facilities, and 25 percent appeared to disregard state directorship guidelines. Disclosure: none stated in the PubMed record.
- 6.Hogan S, Wood E, Mishra V. Who Is Holding the Syringe? A Survey of Truth in Advertising Among Medical Spas. Dermatol Surg. 2023;49(11):1001-1005. PMID 37774041. doi:10.1097/DSS.0000000000003929Descriptive secret-shopper telephone survey of med spas in Chicago and its suburbs; 127 med spas. Carries in this article: a supervising physician was not on site at 81.1 percent of the facilities, and callers were told so at 64.6 percent, the reason the on-site question is asked directly. Disclosure: none stated in the PubMed record.
- 7.Choudhry S, Kim NA, Gillum J, Ambavaram S, Williamson E, Yoo S, et al. State medical board regulation of minimally invasive cosmetic procedures. J Am Acad Dermatol. 2012;66(1):86-91. PMID 21798624. doi:10.1016/j.jaad.2011.01.009Structured interviews with officials of US allopathic state medical boards; 31 of 50 boards took part. Carries in this article: 20 boards reported that all minimally invasive cosmetic procedures could be delegated at the physician’s discretion to at least one category of nonphysician, 14 required general supervision and 13 some form of on-site supervision, the reason who may perform a procedure differs by state. Disclosure: non-US government research support listed in the PubMed record.
- 8.Rossi AM, Wilson B, Hibler BP, Drake LA. Nonphysician Practice of Cosmetic Dermatology: A Patient and Physician Perspective of Outcomes and Adverse Events. Dermatol Surg. 2019;45(4):588-597. PMID 30946699. PMC6450566. doi:10.1097/DSS.0000000000001829Internet surveys of consumers and of American Society for Dermatologic Surgery physician members; 2,116 consumers began the survey, 401 had had a cosmetic procedure, and 50 adverse events were reported. Carries in this article: more burns and discoloration in the group seen by nonphysicians, more often in a spa setting, with improper technique the most cited reason; recall bias noted by the authors. Disclosure: NIH extramural support listed in the PubMed record.
- 9.Valiga A, Albornoz CA, Chitsazzadeh V, Wang JV, Saedi N, Geronemus RG, et al. Medical spa facilities and nonphysician operators in aesthetics. Clin Dermatol. 2022;40(3):239-243. PMID 34838654. doi:10.1016/j.clindermatol.2021.11.007Narrative review. Carries in this article: med spas outnumber physician-based cosmetic practices in 73 percent of major US cities and rely on nonphysician operators with variable training, a lack of uniform oversight the authors wrote may contribute to adverse events. Disclosure: authors are practicing dermatologists; no funding statement in the PubMed record.
- 10.Rahman E, Sayed K, Rao P, Abu-Farsakh H, Sadeghi-Esfahlani S, Garcia PE, et al. Exosome Revolution or Marketing Mirage? AI-Based Multi-domain Evaluation of Claims, Scientific Evidence, Transparency, Public Sentiment, and Media Narratives. Aesthetic Plast Surg. 2025;49(12):3454-3479. PMID 40055226. doi:10.1007/s00266-025-04712-3Cross-sectional, AI-assisted analysis of 18 manufacturers, 70 product formulations, about 2.7 million social media posts and 37,437 consumer reviews. Carries in this article: 18 percent of manufacturers rated high on transparency and 27 percent of social media claims were rated misleading, the reason a provider’s product documentation is asked for rather than assumed. Disclosure: the authors declared no conflicts of interest.
- 11.Knauer G, Chang A, Gupta A, Brownstone N, Mejia N, Bauman S, et al. Clinical Evidence and Commercial Landscape of Topical Exosomes for Skin Rejuvenation: A Scoping Review. Aesthet Surg J. 2026;46(11):NP148-NP157. PMID 42411735. doi:10.1093/asj/sjag141Scoping review of 18 human studies plus a survey of the first 20 commercial topical exosome products in an online shopping search. Carries in this article: the products carried minimal information on isolation, processing or shelf life, the gap a lot-specific certificate of analysis and characterization panel fill. Disclosure: academic authors (USA); no COI statement in the PubMed record.
- 12.Gaebe K, Lowe K, Bosnalie D, Khoury S, Villemure Poliquin N, Nichols A. Effectiveness and Safety of Extracellular Vesicle-Based Therapies for Nonsurgical Facial Rejuvenation: A Systematic Review. Facial Plast Surg Aesthet Med. 2026. Published online ahead of print. PMID 42487416. doi:10.1177/26893614261457879PRISMA systematic review with risk-of-bias and GRADE assessment, searches to June 2025; 16 studies and 503 participants. Carries in this article: no serious adverse events were reported across the facial studies, certainty was low or very low, and the authors described the safety signal as short term, the reason a provider who promises results beyond that is asked for the source. Disclosure: academic authors (Canada); no COI statement in the PubMed record.
- 13.Wang OJE, Bajwa BB, Rivers JK. Exosome-Based Therapies in Dermatology: A Scoping Review. J Drugs Dermatol. 2026;25(4):368-376. PMID 41931695. doi:10.36849/jdd.9610Scoping review (PRISMA-ScR) including US and EU trial registries and grey literature; 17 human studies from 2020 to 2025. Carries in this article: adverse events were uncommon, and the granulomas, necrosis and allergic reactions it lists followed injection, the reason the route a provider proposes is a question on the checklist. Disclosure: no COI statement in the PubMed record.
- 14.Park KY. Adverse Reactions Following Intradermal Injection of Exosome-Based Formulations: A Case Series. J Cosmet Dermatol. 2025;24(10):e70520. PMID 41097876. PMC12528963. doi:10.1111/jocd.70520Case series (South Korea); four adult women after intradermal injection of exosome-containing cosmetic products sold for topical use, given in nonclinical settings. Carries in this article: persistent erythema, nodules, granulomatous inflammation and scarring when a product was injected in a setting without clinical oversight, the pattern a licensed, supervised practice is checked against. Disclosure: the author declared no conflicts of interest.
- 15.Welsh JA, Goberdhan DCI, O'Driscoll L, Buzas EI, Blenkiron C, Bussolati B, et al; MISEV Consortium; Théry C, Witwer KW. Minimal information for studies of extracellular vesicles (MISEV2023): From basic to advanced approaches. J Extracell Vesicles. 2024;13(2):e12404. PMID 38326288. PMC10850029. doi:10.1002/jev2.12404International Society for Extracellular Vesicles reporting guideline, compiled with ISEV task forces and more than 1,000 researchers. Carries in this article: the reporting headings (source, separation, particle size and concentration, marker proteins, morphology) a characterization panel can be read against when a practice shows one. Disclosure: many consortium authors list EV company affiliations, declared in full in the article.
- 16.Görgens A, Corso G, Hagey DW, Jawad Wiklander R, Gustafsson MO, Felldin U, et al. Identification of storage conditions stabilizing extracellular vesicles preparations. J Extracell Vesicles. 2022;11(6):e12238. PMID 35716060. PMC9206228. doi:10.1002/jev2.12238In vitro stability study over up to two years across buffers and temperatures, vesicles from several cell sources. Carries in this article: vesicle recovery depended on buffer and temperature, with losses in plain phosphate-buffered saline and better preservation at minus 80 degrees Celsius in a buffer with human albumin and trehalose, the reason the cold-chain record is on the checklist. Disclosure: several authors list affiliation with an EV therapeutics company.
- 17.U.S. Food and Drug Administration. Microneedling Devices. Content current as of 10/15/2025; verified 4 November 2026. https://www.fda.gov/medical-devices/aesthetic-cosmetic-devices/microneedling-devicesAgency device information page (CDRH). Carries in this article: the agency advises patients to select a trained provider, to ask about the provider’s training and experience, to ask how the device is cleaned and whether a new cartridge is used for each patient, and states that the devices are not approved for delivery of cosmetics, topical medications, drugs or blood products into the skin.
- 18.U.S. Food and Drug Administration. Is It a Cosmetic, a Drug, or Both? (Or Is It Soap?). Content current as of 09/11/2024; verified 4 November 2026. https://www.fda.gov/cosmetics/cosmetics-laws-regulations/it-cosmetic-drug-or-both-or-it-soapAgency guidance page on the FD&C Act definitions. Carries in this article: whether a product is a cosmetic or a drug is determined by its intended use, and firms sometimes violate the law by marketing a cosmetic with a drug claim, the reason a provider’s claims are read against the product’s labeling.
- 19.U.S. Food and Drug Administration. MedWatch: The FDA Safety Information and Adverse Event Reporting Program. Content current as of 11/03/2026; verified 4 November 2026. https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-programAgency reporting program page. Carries in this article: the voluntary reporting route for patients, consumers and health professionals that both FDA exosome notices point to, and the route a practice names when asked how it would report a problem.