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Objectives: This study aims to evaluate the combined effects of botulinum toxin and exosome therapy on hair loss over one year, utilizing data from twelve cases across four countries following a unified protocol. Additionally, the study explores the results among different races and age groups. Introduction: Hair loss is a global concern, prompting the exploration of innovative treatments. Botulinum toxin and exosome therapy offer distinct mechanisms of action and show promise in addressing this issue. This study investigates the synergistic effects of combining these therapies, drawing on data from twelve cases spanning four countries. Results among different racial and age groups are also examined Materials / method: Twelve cases meeting predefined criteria from four countries were enrolled in this study. Participants received combined botulinum toxin and exosome therapy according to a unified protocol. Hair shedding, density, and thickness were evaluated as primary outcomes over a six-month period using standardized criteria Results: Significant improvements in hair shedding, density, and thickness were observed among participants following the combined therapy. Statistical analysis supported the efficacy of this approach, indicating its potential as a promising treatment for hair loss. Younger patients demonstrated better outcomes, and Caucasians experienced quicker effects compared to Asians. Additionally, positive results were noted among black individuals with curly hair Conclusion: The findings suggest that combining botulinum toxin and exosome therapy holds promise in addressing hair loss. Integration of this approach into existing treatment regimens may improve outcomes. However, further research, including larger trials and mechanistic studies, is necessary to fully understand its potential and optimize its clinical application.