Scar management and wound healing remains a significant challenge in plastic and reconstructive surgery. Recent advances in biologic injectables have introduced a regenerative paradigm. Among the most widely used options are exosome-based therapies and polynucleotide solutions such as Rejuran, both of which have shown encouraging results in improving scar texture, quality and pigmentation. Exosomes are nanosised extracellular vesicles that mediate intercellular communication and modulate key processes such as inflammation, angiogenesis, and collagen synthesis. Early studies suggest that exosome therapy enhances wound healing and scar remodeling by promoting cell proliferation and migration while reducing the inflammatory responses. Their efficacy appears particularly notable when combined with microneedling or laser therapy. Polynucleotides, such as Rejuran, are derived from salmon DNA and stimulate dermal regeneration by activating fibroblasts and enhancing extracellular matrix synthesis. Clinical studies from South Korea and Singapore have demonstrated significant improvements in both Patient and Observer Scar Assessment Scale (POSAS) scores and dermal thickness following treatment. Unlike exosomes, which act through paracrine signaling pathways, Rejuran primarily functions as a scaffold, supporting tissue repair, hydration and structural integrity. While direct comparative evidence remains limited, emerging data suggest that exosome-based therapies may offer faster epithelial recovery and reduced post-injection inflammation, whereas Rejuran benefits from established safety profiles and regulatory approval. While larger randomised controlled trials are warranted to compare both treatments and establish clinical protocols, both options represent promising adjuncts in the evolving field of regenerative scar management.