Exosome therapy is emerging as a promising treatment in dermatology and aesthetic medicine due to its potential to promote skin regeneration, reduce inflammation, and improve wound healing. Exosomes are small extracellular vesicles secreted by cells, particularly stem cells, containing biological molecules such as proteins, lipids, and RNAs, which can be transferred to other cells to influence various physiological processes. This review explores the molecular mechanisms of exosome function, their clinical applications in skin rejuvenation, inflammatory skin diseases, wound healing, and hair loss treatments, as well as their potential use in cosmetic and clinical medicine. The article also discusses methods for exosome extraction, highlighting both chemical and physical techniques, and evaluates the advantages and limitations of exosome therapy, including the need for further clinical studies. Ultimately, exosome-based therapies hold great promise for non-invasive methods in dermatology and aesthetics, though further research is needed to optimize their use. Despite the exciting expectations surrounding, exosomes cannot yet be widely used as primary or definitive treatment options. Currently, no exosome-based products have received official approval from the U.S. Food and Drug Administration (FDA) as licensed drugs. Most human studies are still in early phases, such as phase I or II clinical trials, mainly focused on evaluating safety and preliminary efficacy. Therefore, the clinical application of exosomes remains largely limited to research settings or private clinics, and broader medical use awaits more extensive studies and regulatory approvals.