Adipose-derived stem cells (ADSCs) are mesenchymal stem cells with significant potential for self-renewal and differentiation. Exosomes derived from ADSCs (ADSC-exos) can mimic the functions of ADSCs, carrying bioactive molecules that affect specific cellular targets and signaling processes. Recent evidence suggests that ADSC-exos can mediate tissue regeneration by regulating the inflammatory response, enhancing cell proliferation, and inducing angiogenesis. They also promote wound healing and extracellular matrix remodeling. When combined with scaffolds, ADSC-exos present promising cell-free therapies and adjuncts to reconstructive surgery with diverse tissue-specific functions and minimal adverse effects. This review discusses the main characteristics and functional properties of ADSC-exos in tissue regeneration, exploring their clinical applications in wound healing, musculoskeletal regeneration, dermatology, plastic surgery, and tissue engineering. ADSC-exos contain various bioactive cargos, including growth factors, cytokines, and nucleic acids, which contribute to their therapeutic effects. The isolation methods of ADSC-exos and their bioactive cargos are also discussed, highlighting the importance of culturing conditions and priming of MSCs in modulating their content and function. Clinical applications of ADSC-exos in wound healing, musculoskeletal regeneration, dermatology, and plastic surgery are detailed, emphasizing their potential in enhancing tissue repair and regeneration. In tissue engineering, ADSC-exos are used in conjunction with scaffolds to promote tissue regeneration, with studies showing their effectiveness in bone, cartilage, and skin regeneration. Overall, ADSC-exos offer a promising approach to regenerative medicine, providing a safe and effective means to promote tissue healing and regeneration.Adipose-derived stem cells (ADSCs) are mesenchymal stem cells with significant potential for self-renewal and differentiation. Exosomes derived from ADSCs (ADSC-exos) can mimic the functions of ADSCs, carrying bioactive molecules that affect specific cellular targets and signaling processes. Recent evidence suggests that ADSC-exos can mediate tissue regeneration by regulating the inflammatory response, enhancing cell proliferation, and inducing angiogenesis. They also promote wound healing and extracellular matrix remodeling. When combined with scaffolds, ADSC-exos present promising cell-free therapies and adjuncts to reconstructive surgery with diverse tissue-specific functions and minimal adverse effects. This review discusses the main characteristics and functional properties of ADSC-exos in tissue regeneration, exploring their clinical applications in wound healing, musculoskeletal regeneration, dermatology, plastic surgery, and tissue engineering. ADSC-exos contain various bioactive cargos, including growth factors, cytokines, and nucleic acids, which contribute to their therapeutic effects. The isolation methods of ADSC-exos and their bioactive cargos are also discussed, highlighting the importance of culturing conditions and priming of MSCs in modulating their content and function. Clinical applications of ADSC-exos in wound healing, musculoskeletal regeneration, dermatology, and plastic surgery are detailed, emphasizing their potential in enhancing tissue repair and regeneration. In tissue engineering, ADSC-exos are used in conjunction with scaffolds to promote tissue regeneration, with studies showing their effectiveness in bone, cartilage, and skin regeneration. Overall, ADSC-exos offer a promising approach to regenerative medicine, providing a safe and effective means to promote tissue healing and regeneration.