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Objectives: Open-label split face clinical trial assessing the safety and efficacy of Adipose Stem Cell Derived Exosomes vs PRP post RF microneedling in the cosmetic improvement of facial photoaged skin Introduction: Exosomes and PRP are increasingly used in aesthetic medicine Materials / method: 15 subjects FP I-IV between ages 44-68 years old were treated. Subjects received 3 RF microneedling treatments to the full face spaced at 4-week intervals. Post treatment, PRP was applied to the right side and exosomes to the left side of the face. All subjects Followed for 6 months post final treatment. 4 biopsies to the right & left infra-auricular area at: Baseline; After the final treatment (Tx 3); at 3-month follow-up and : 6-month follow-up Investigator and subject assessments were undertaken regarding overall skin appearance, wrinkling, dyschromia, erythema, and textural quality. Results: Exosomes and PRP indicated comparable histological results.  Exosomes showed slightly better results than PRP in Investigator visual assessments Conclusion: Exosomes are less invasive as they do not require blood draw. Exosomes can result in equal or improved efficacy than PRP.  PRP is harvested from the patient's own blood, reflecting their age, whereas exosomes are harvested from healthy donors aged 18 to 25 years, potentially offering more robust regenerative properties